Varicella infection in the Middle East: Prevalence, complications, and vaccination

Abstract

Varicella (chickenpox) is the primary infection of varicella-zoster virus (VZV), it is a mild self-limiting infection, but it is also highly contagious and can cause severe complications among high-risk group of individuals. It is usually a childhood infection providing lifelong immunity, but adults without varicella history are also susceptible to infection. High-risk group of individuals is more likely to develop serious complications. Varicella vaccine was introduced to protect this group of individuals and to prevent epidemic spread of VZV infection in a community. Thus, it was added to the recommended vaccination schedules for children in most developed countries. This review aimed to outline varicella status, seroprevalence, complications, and vaccination in the Middle East region. Based on our findings, children were the most affected age group, but there are also adult cases due to high number of expatriates, especially in Gulf Cooperation Council countries. Central nervous system involvements and skin diseases followed by varicella pneumonia were the most varicella-associated complications. Varicella vaccine was introduced in most Middle East countries, either mandatory by the Ministries of Health or optional in the private clinics. Few numbers of studies have reported an obvious reduction in varicella prevalence, hospitalizations, and deaths in the Middle East following varicella vaccination. A basic database about varicella infection before the initiation and implementation of a vaccination policy is essential to determine the target group of individuals. As far as our knowledge, this is the first review about varicella infection in the Middle East.

Global impact of varicella vaccination programs

“…The impact data on its effect are available from Saudi Arabia, which introduced universal VV in 2008 with a two dose schedule, and a study using health insurance data found an overall 60% reduction in the proportion of disease in children aged between 1-4 years after introduction. 31,75 Herd immunity and shift to older age groups An indirect effect of VV in non-vaccinated age groups has been described in many studies. As herd immunity is more pronounced in age groups closer to the vaccinated group, there are concerns about a shift of the disease to older age groups, which have a higher rate of complications.It is more likely in scenarios with low vaccine coverage (< 80%).…”

Bullous varicella in a preschool-aged patient

“…Complications such as bacterial skin superinfections, pneumonia, bronchitis, laryngotracheitis, and gastrointestinal tract disorders are the most characteristic in children under two years of age. Cerebellar ataxia, encephalitis, aseptic meningitis, transverse myelitis, and Guillain-Barre syndrome are the main viral CNS complications, they are more frequent in children 3-6 years of age [8,9]. Peripheral facial palsy, described by Hanalioğlu et al [10], is an extremely rare neurologic complication of varicella.…”

The burden of herpes zoster disease in Norway

“…The seroprevalence of VZV differs across the world with a lower seroprevalence in adults found in tropical and subtropical climates and higher rates found in temperate climates, e.g. from 58% in Puerto Rico to 86%-99% in Mexico [43,45,46]. In Europe, the majority of children acquire VZV infection before adulthood in age groups <5 and 5-9 years with a variability seen in different countries [43].…”