Impact assessment of immunization and the COVID-19 pandemic on varicella across Europe using digital epidemiology methods: A descriptive study

Abstract

Background Varicella is usually a mild disease in children but may be life-threatening, especially in adolescents and adults. Infection control measures implemented during the Coronavirus Disease 2019 (COVID-19) pandemic may have suppressed varicella transmission, potentially creating an ‘immunity debt’, particularly in countries without universal varicella vaccination. Objectives To assess trends in Google search engine queries for varicella keywords as a proxy for varicella infection rates and to evaluate the effect of universal varicella vaccination on these trends. A further objective was to assess the impact of the COVID-19 pandemic on varicella keyword search query trends in countries with and without universal varicella vaccination. Methods This study used the keyword research tool, Google Trends, to evaluate trends in time series of the relative search query popularity of language-specific varicella keywords in 28 European countries from January 2015 through December 2021. The Google Ads Keyword Planner tool was used to evaluate absolute search volumes from March 2018 through December 2021. Results The relative search query popularity of varicella keywords displayed marked seasonal variation. In all 28 countries, the relative search query popularity of varicella keywords declined after the start of the COVID-19 pandemic (March 2020), compared with pre-pandemic levels (range, -18% to -70%). From April 2020 to July 2021, a period of intense COVID-19 transmission and infection control, absolute search volumes for varicella keywords were lower than pre-pandemic levels but rebounded after July 2021, when infection control measures were relaxed. Conclusion This evaluation of search query trends demonstrated that search query data could be used as a proxy for trends in varicella infection rates and revealed that transmission of varicella may have been suppressed during the COVID-19 pandemic. Consideration should be given to using search query data to better understand the burden of varicella, particularly in countries where surveillance systems are inadequate.

Chickenpox in Poland in 2021

“…Across all 28 countries, the relative popularity of varicella-related keywords declined after the onset of the COVID-19 pandemic (March 2020) compared to pre-pandemic levels (range -18% to -70%). From April 2020 to July 2021, a period of intense COVID-19 transmission and infection control, the absolute number of searches for varicellarelated keywords was lower than before the pandemic, but increased after July 2021 (7). Vaccination against chickenpox in 2021.…”

“…We wszystkich 28 krajach względna popularność słów kluczowych związanych z ospą wietrzną spadła po rozpoczęciu pandemii COVID-19 (marzec 2020 r.) w porównaniu z poziomem sprzed pandemii (zakres od -18% do -70%). Od kwietnia 2020 r. do lipca 2021 r., czyli w okresie intensywnej transmisji COVID-19 i kontroli zakażeń, bezwzględna liczba wyszukiwań słów kluczowych związanych z ospą wietrzną była niższa niż przed pandemią, ale wzrosła po lipcu 2021 r. (7).…”