Two-dose varicella vaccine effectiveness in China: a meta-analysis and evidence quality assessment

Zhang, Zhujiazi; Suo, Luodan; Pan, Jingbin; Zhao, Dan; Lü, Li

doi:10.1186/s12879-021-06217-1

Cited by 19 publications

(35 citation statements)

References 40 publications

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“…An upward shift in the infection age should be addressed because adult patients with varicella have more severe symptoms and a higher risk of death and complications than children [ 16 , 17 , 18 ]. However, varicella vaccination is still recommended school-aged children to reduce the risk of infection risk [ 19 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological Characteristics of Varicella under Different Immunisation Strategies in Suzhou Prefecture, Jiangsu Province

et al. 2022

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Background: The varicella vaccine is excluded from the Chinese national immunisation programme but is included in the local expanded programme on immunisation (EPI) in the Suzhou Prefecture. This study investigated the epidemiological characteristics of the varicella cases during the implementation of different immunisation strategies in the Suzhou Prefecture, Jiangsu Province. Methods: In this study, we used descriptive statistics. Information on reported instances from 2012 to 2021 was first retrieved. Data on varicella cases were collected from the China Information System for Disease Control and Prevention (CISDCP). Similarly, information on vaccinated children was obtained from the Jiangsu Province Vaccination Integrated Service Management Information System (JPVISMIS). The census data in this study was procured from the Suzhou Bureau of Statistics. Results: From 2012 to 2021, a total of 118,031 cases of varicella were reported in Suzhou, and the average annual reported incidence was 91.35 per 100,000. The average yearly incidence after implementing the two-dose varicella vaccination decreased by 41.57% compared with the implementation of one dose. This study demonstrates two annual incidence peaks, a small peak between April and July and a prominent peak between October and January. It is also possible that this seasonal distribution is related to the geography of Suzhou. The average annual reported incidence between districts with a statistically significant difference (χ2 = 98.077, p < 0.05). The one-dose varicella vaccination coverage gradually increased from 55.34% in 2012 to 89.06% in 2021 and the two-dose varicella vaccination coverage gradually increased from 0.27% in 2012 to 82.17% in 2021. Conclusions: Administering the varicella vaccine in the local EPI has significantly decreased the incidence rate and the total number of cases. A two-dose vaccination schedule is still the best vaccination strategy for varicella vaccine effectiveness.

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Section: Discussionmentioning

confidence: 99%

Epidemiological Characteristics of Varicella under Different Immunisation Strategies in Suzhou Prefecture, Jiangsu Province

et al. 2022

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“…Monovalent or quadrivalent vaccine (vaccine type unclear). A meta‐analysis of studies from China only reported a pooled VE of two‐dose vaccination (vaccine type not reported) against varicella, compared with no vaccination, of 90% (95% CI: 69%–97%, I 2 = 83%; 12 cohort studies, n = 87,196; low quality evidence [GRADE] reported in review) 19 . In sub‐group analysis, the estimate was lower in outbreak settings (VE = 87%, 95% CI: 76%–93%, I 2 = 0%; 10 cohort studies, n = 3636) compared with non‐outbreak settings (VE = 99%, 95% CI: 98%–99%, I 2 = 34%; 2 cohort studies, n = 83,560) 19 .…”

Section: Resultsmentioning

confidence: 99%

“…The most recent specified end search date within these reviews was September 2019. 19 Of the 20 reviews, five reviews included randomised controlled trials (RCTs) and observational studies 20 , 21 , 22 , 23 , 24 (including one 24 that also included four previously published systematic reviews); 13 reviews included observational studies only 7 , 19 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ; one review included four previously published systematic reviews and observational studies 36 ; and the final review included two previously published systematic reviews. 37 Of the eight systematic reviews that were themselves included in eligible systematic reviews for this overview, only three met our pre‐defined eligibility criteria (Table 1 ) for a systematic review and were therefore included in this overview.…”

Section: Resultsmentioning

confidence: 99%

Clinical efficacy and effectiveness of alternative varicella vaccination strategies: An overview of reviews

Ahern

Walsh

Paone

et al. 2022

Reviews in Medical Virology

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A number of countries have implemented universal childhood varicella vaccination programmes over the past 30 years. However, strategies differ in terms of dosing schedule (one‐ or two‐dose), type of vaccine(s) recommended (monovalent, quadrivalent measles‐mumps‐rubella‐varicella, or both), age at vaccination, and dosing interval for a two‐dose schedule. An overview of reviews was undertaken to assess the existing systematic review evidence of the clinical efficacy/effectiveness of alternative varicella vaccination strategies. A comprehensive search of databases, registries and grey literature was conducted up to 2 February 2022. Two reviewers independently screened, extracted data and assessed the methodological quality of included reviews. A total of 20 reviews were included in the overview; 17 assessed the efficacy/effectiveness of one‐dose strategies and 10 assessed the efficacy/effectiveness of two‐dose strategies. Although the quality of most reviews was deemed ‘critically low’, there was clear and consistent evidence that vaccination is very effective at reducing varicella. While the analysis was restricted due to lack of detail in reporting of the reviews, the evidence suggests that two‐dose strategies are more efficacious/effective than one‐dose strategies in preventing varicella of any severity, but that both strategies have similar high efficacy/effectiveness in preventing moderate or severe varicella. Based on this evidence in this overview of reviews, a key consideration for policymakers on the possible introduction of a childhood varicella vaccination programme and the choice between a one‐ or two‐dose strategy, will be whether the objective of a programme is to prevent varicella of any severity or to prevent moderate to severe varicella.

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“…For example, the estimate of the VE in varicella outbreaks is usually lower than that of other studies because when the infection pressure is high, the vaccine performance tends to be underestimated (34). A new meta-analysis (35) with 12 studies and 87,196 individuals also proved that the VE of outbreak studies was lower than in non-outbreak studies. It showed that the pooled two-dose VE was 90% (95% CI: 69-97%), similar to the efficacy of the vaccine of 90.31 with a population of 837,144 in this study.…”

Section: Discussionmentioning

confidence: 99%

Long-term vaccine efficacy of a 2-dose varicella vaccine in China from 2011 to 2021: A retrospective observational study

Shu¹,

Zhang

et al. 2022

Front. Public Health

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ObjectiveA 2-dose varicella vaccine immunization strategy has been implemented in many cities in China, but there is few evidence on a long-term evaluation of the efficacy of the 2-dose varicella vaccine from China. This study aims to assess the long-term vaccine efficacy of the two doses varicella vaccine and analysis of its influencing factors.MethodsA retrospective study was carried out in 837,144 children born between 2011 and 2017 in Ningbo, Easten China. The logistic regression was performed to estimate varicella vaccine effectiveness (VE).ResultsThe overall VE of 2 doses of varicella vaccine compared without the vaccine was 90.31% (89.24–91.26%), and the overall incremental VE of 2 doses of varicella vaccine compared to the 1-dose was 64.71% (59.92–68.93%). Moreover, the varicella vaccination age of the second dose and the interval between 2 doses were both associated with VE. The VE compared to that without the vaccine in children vaccinated at <4 years old was 91.22% (95%CI: 90.16–92.17%) which was higher than in children vaccinated at ≥4 years old (VE: 86.79%; 95%CI: 84.52–88.73). And the effectiveness of the vaccine was 93.60% (95%CI: 92.19–94.75%) in children with the interval of the 2 doses ≤ 24 months significantly higher than in children with the interval of ≥36 months (VE: 85.62%, 95%CI: 82.89–87.91%).ConclusionsThis study provides evidence for long-term VE of the 2-dose varicella vaccine and the better age for 2-dose vaccination and the interval between 2 doses of the vaccine in China.

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Two-dose varicella vaccine effectiveness in China: a meta-analysis and evidence quality assessment

Cited by 19 publications

References 40 publications

Epidemiological Characteristics of Varicella under Different Immunisation Strategies in Suzhou Prefecture, Jiangsu Province

Epidemiological Characteristics of Varicella under Different Immunisation Strategies in Suzhou Prefecture, Jiangsu Province

Clinical efficacy and effectiveness of alternative varicella vaccination strategies: An overview of reviews

Long-term vaccine efficacy of a 2-dose varicella vaccine in China from 2011 to 2021: A retrospective observational study

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