Seroepidemiology of Varicella and the Reliability of a Self-reported History of Varicella Infection in Singapore Military Recruits

Abstract

Introduction: Varicella is an acute disease with significant morbidity. However, there is little knowledge on the seroepidemiology of the disease in Singapore. The objective of this study was to assess the seroprevalence of varicella zoster virus (VZV) antibodies in military recruits in Singapore and to ascertain the predictive value of a self-reported history of varicella. The latter is a possible proxy for seroprevalence, and may be used to provide efficient identification of candidates for vaccination. Materials and Methods: From September 2000 to October 2005, 2189 servicemen were selected during their pre-enlistment medical check-up. Blood samples were obtained to determine the varicella IgG levels via enzyme-linked immunosorbent assay (ELISA). Information about the participant’s race, history of varicella and vaccination, and other clinical variables were obtained through a questionnaire. Results: The overall prevalence of VZV seropositivity in military recruits was 76.0% (75.8% in the 16 years to 20 years age group). For the reported history, 73.7% of Chinese participants, 73.0% of Malays, and 63.6% of Indians reported having had varicella infection and/or vaccination. Overall, the sensitivity, specificity, positive and negative predictive values of a self-reported history of varicella for serologically confirmed immunity were 87.2%, 83.2%, 94.3% and 67.1% respectively. Conclusions: The prevalence of VZV antibodies in pre-enlistees to the Singapore Armed Forces (SAF) is high. Incidence of varicella in the SAF is on the wane, indicating an increase in herd immunity against VZV. A recalled history of varicella infection was also a good predictor of serological immunity and may be used for selection for vaccination. Key words: Antibody, Chickenpox, Cost-effective, Military, Seroprevalence, Varicella zoster virus