Chickenpox in Poland in 2021. / Ospa wietrzna w Polsce w 2021 roku.

INTRODUCTION: Chickenpox is a highly contagious disease, but one that can be effectively prevented by vaccination. In Poland, vaccination against the disease is recommended, paid for, and chickenpox remains very common. In recent years, starting in 2002, the upward trend in the incidence of chickenpox has continued, except in 2020. In 2020, there was a decrease in incidence. OBJECTIVES: The aim of this study was to evaluate epidemiological indicators of chickenpox in Poland in 2021 compared to previous years, taking into account the impact of the COVID-19 pandemic. MATERIAL AND METHODS: The evaluation of the epidemiological situation of chickenpox in Poland in 2021 was carried out based on the results of the analysis of aggregate data published in the annual bulletins: "Infectious Diseases and Poisons in Poland in 2021" and "Immunization in Poland in 2021". In addition, recommendations from the 2021 Immunization Program are described. RESULTS: 57,669 cases of chickenpox were registered in Poland in 2021, 42% less than in the previous year. The incidence of chickenpox in 2021 was 151.1 per 100,000, which was lower than in 2020, as well as in 2019, when it was 470.6/100,000. The lowest incidence was registered in Lower Silesia Province - 99.2/100,000, while the highest in Silesia Province - 215.8/100,000. The highest incidence was in children aged 0-4 years (18,028). The incidence of chickenpox in males was higher than in females (159.5 vs. 143.3/100 thousand), and urban residents were higher than rural residents (152.1 vs. 149.6/100 thousand). Hospitalization due to chickenpox in 2021 included 210 people, which accounted for 0.36% of the total number of registered cases. CONCLUSIONS: In 2021, there was a decrease in the number of chickenpox cases compared to the previous year. The lower incidence may have been the result of a decrease in the transmission of the chickenpox virus, the decrease in the number of cases has to do with, among other things, the restrictions put in place in connection with the COVID-19 pandemic, which result in, among other things, reduced human contact, the wearing of masks and increased social distance.

[Varicella-zoster virus (VZV) acute retinal necrosis and recombinant zoster vaccine]. / Nécrose rétinienne aiguë due au virus de la varicelle et du zona et vaccin recombinant contre le zona.

Varicella zoster virus (VZV) is responsible for chickenpox. Like all herpes viruses, after primary infection it enters into latency and can be reactivated afterwards. Many forms of symptomatic reactivation of VZV exist including acute retinal necrosis (ARN), an ophthalmic emergency which can lead to blindness. ARN is treated starting with high-dose intravenous acyclovir then with oral valaciclovir for a total duration of up to 3 months. Symptomatic reactivations of VZV are public health issues. The new Swiss 2022 vaccination plan includes the recombinant vaccine Shingrix. It effectively prevents VZV symptomatic reactivations even in elderly and immuno suppressed patients.

Le virus de la varicelle et du zona (VZV) est responsable de la varicelle. Comme tous les virus herpétiques, après la primo-infection, il entre en latence et peut se réactiver plus tard. Il existe de nombreuses formes de réactivations symptomatiques du VZV, dont la nécrose rétinienne aiguë (NRA), qui est une urgence ophtalmique pouvant aboutir à la cécité. La NRA est traitée par aciclovir intraveineux à haute dose dans sa prise en charge initiale puis par valaciclovir per os pour une durée totale pouvant aller jusqu'à 3 mois. Les réactivations symptomatiques de VZV sont un enjeu de santé publique. Le nouveau plan de vaccination suisse 2022 intègre le vaccin recombinant Shingrix, qui permet de prévenir efficacement les réactivations symptomatiques de VZV chez les patients même âgés et immunosupprimés.

Acceptance of universal varicella vaccination among Swiss pediatricians and general practitioners who treat pediatric patients.

BACKGROUND: Over the last two decades, several countries have initiated universal varicella vaccination (UVV) programs in infants. In 2019, the Swiss National Immunization Technical Advisory Group (NITAG) decided to start evaluating the introduction of universal varicella vaccination. There is a theoretical concern that suboptimal vaccination coverage could lead to a shift in the varicella incidence to older age groups, thereby potentially increasing complication rates. To achieve a high vaccination coverage rate, it is important that practicing physicians comply with a potential recommendation for UVV. We studied the perception of varicella and the current vaccination behavior among Swiss pediatricians and general practitioners (GPs) who treat children. We also assessed their intention to advise parents to vaccinate their children against varicella in the event the Swiss NITAG will recommend UVV. METHODS: Primary data was collected through a structured, 20-min online survey with Swiss pediatricians and GPs who treat children. RESULTS: 150 physicians participated in the study: 40 GPs in the German-speaking part, 20 GPs in the French-speaking part, 67 pediatricians in the German-speaking part, and 23 pediatricians in the French-speaking part. The majority (64%) of all participants reported that they currently recommend varicella vaccination for risk groups according to the national immunization plan. About one third of physicians (35%) - predominantly pediatricians - currently already recommend it for all infants. In these situations, a measles, mumps, rubella, varicella combination vaccine is currently used by 58% for the first dose and by 59% for the second dose. 86% of participants stated that they would advise parents to have their children vaccinated against varicella in case of a recommendation for UVV by the Swiss NITAG. 68% responded that they expect many questions from parents and 65% agreed that they have good arguments to convey the importance of varicella vaccination. CONCLUSIONS: The survey study results show that most participating pediatricians and GPs indicated a favorable attitude towards childhood vaccination against varicella in the setting of a Swiss NITAG recommendation for UVV. This data shows the importance of NITAG recommendations in influencing vaccine education and supporting achievement of high coverage of varicella vaccination.

Varicella in Adult Foreigners at a Referral Hospital, Central Tokyo, Japan, 2012-2016.

We report a case series of varicella among adult foreigners at a referral hospital in central Tokyo, Japan, during 2012-2016. This series highlights differences in varicella vaccination schedules by country and epidemiology by climate and identifies immigrants and international students as high-risk populations for varicella.

The impact of long-term moderate level of vaccination coverage for epidemiology of varicella in Lu'an, China: should we change immunisation strategy now?

As China implements the voluntary vaccination programme of one-dose of varicella vaccine (VarV) for decades, robust estimates of the impact of voluntary vaccination era on epidemiology of varicella are needed. We estimated the vaccination coverage (VC) of VarV by using surveillance data on immunisation. The descriptive epidemiological method was used to describe the changing epidemiology of varicella from 2007 to 2018. The screening method was used to estimate the vaccine effectiveness (VE) of VarV. The overall VC for VarV was 71.7%, ranged from 47.7% to 79.5% among 2008-2017 birth cohorts. In total, 16 660 varicella cases were reported during 2007-2018, the incidence increased from 10.0 cases per 100 000 population in 2007 to 65.2 cases per 100 000 population in 2018. A shift in age group of varicella was observed since 2012, with the age increased from 5-9 years to 10-14 years. The overall VE was 79.9%, and the VE increased from 60.1% in 2008 birth cohort to 96.2% in 2017 birth cohort. We found that the overall VE for VarV is moderate, but appears highly effective within 5 years after vaccination. In addition, a shift varicella infection to older ages has occurred at the long-term moderate level VC of one-dose VarV. Therefore, to contain the incidence of varicella and prevent any potential shift to older ages, the introduction of VarV into routine immunisation programme is likely needed in Lu'an.

Measuring Infection Transmission in a Stochastic SIV Model with Infection Reintroduction and Imperfect Vaccine.

An additional compartment of vaccinated individuals is considered in a SIS stochastic epidemic model with infection reintroduction. The quantification of the spread of the disease is modeled by a continuous time Markov chain. A well-known measure of the initial transmission potential is the basic reproduction number [Formula: see text], which determines the herd immunity threshold or the critical proportion of immune individuals required to stop the spread of a disease when a vaccine offers a complete protection. Due to repeated contacts between the typical infective and previously infected individuals, [Formula: see text] overestimates the average number of secondary infections and leads to, perhaps unnecessary, high immunization coverage. Assuming that the vaccine is imperfect, alternative measures to [Formula: see text] are defined in order to study the influence of the initial coverage and vaccine efficacy on the transmission of the epidemic.

The impact of childhood varicella vaccination on the incidence of herpes zoster in the general population: modelling the effect of exogenous and endogenous varicella-zoster virus immunity boosting.

BACKGROUND: A controversy exists about the potential effect of childhood varicella vaccination on Herpes Zoster (HZ) incidence. Mathematical models projected temporary HZ incidence increase after vaccine introduction that was not confirmed by real-world evidence. These models assume that absence of contacts with infected children would prevent exogenous boosting of Varicella-Zoster-Virus (VZV) immunity and they do not include an endogenous VZV immunity-boosting mechanism following asymptomatic VZV reactivation. This study aims to explore the effect of various assumptions on exogenous and endogenous VZV immunity-boosting on HZ incidence in the general population after introduction of routine childhood varicella vaccination. METHODS: An age-structured dynamic transmission model was adapted and fitted to the seroprevalence of varicella in France in absence of vaccination using the empirical contact matrix. A two-dose childhood varicella vaccination schedule was introduced at 12 and 18 months. Vaccine efficacy was assumed at 65%/95% (dose 1/dose 2), and coverage at 90%/80% (dose 1/dose 2). Exogenous boosting intensity was based on assumptions regarding HZ-immunity duration, age-dependent boosting effect, and HZ reactivation rates fitted to observed HZ incidence. Endogenous boosting was the same as pre-vaccination exogenous boosting but constant over time, whilst exogenous boosting depended on the force of infection. Five scenarios were tested with different weightings of exogenous (Exo) - endogenous (Endo) boosting: 100%Exo-0%Endo, 75%Exo-25%Endo, 50%Exo-50%Endo, 25%Exo-75%Endo, 0%Exo-100%Endo. RESULTS: HZ incidence before varicella vaccination, all ages combined, was estimated at 3.96 per 1000 person-years; it decreased by 64% by year 80 post vaccine introduction, for all boosting assumptions. The 100%Exo-0%Endo boosting scenario, predicted an increase in HZ incidence for the first 21 years post vaccine introduction with a maximum increase of 3.7% (4.1/1000) at year 9. However, with 0%Exo-100%Endo boosting scenario an immediate HZ decline was projected. The maximum HZ incidence increases at 10, 3, and 2 years post vaccination were 1.8% (75%Exo-25%Endo), 0.8% (50%Exo-50%Endo) and 0.2% (25%Exo-75%Endo), respectively. CONCLUSIONS: Assuming modest levels of endogenous boosting, the increase in HZ incidence following childhood varicella vaccination was smaller and lasted for a shorter period compared with 100%Exo-0%Endo boosting assumption. Endogenous boosting mechanism could partly explain the divergence between previous HZ-incidence projections and real-world evidence.

Seroprevalence and molecular characteristics of varicella-zoster virus infection in Chinese children.

BACKGROUND: Varicella-zoster virus (VZV) infection in children is an important public health problem in China. We performed the current study to explore the seroprevalence of VZV infection in Chinese children in order to provide more information for improvement of varicella vaccination in China. METHODS: Three thousand fourteen children were recruited from Chinese kindergarten students aged from four to six years. Anti-VZV IgG and IgM were assayed using enzyme-linked immunosorbent assay. Both ORF22 and ORF62 of VZV were amplified, sequenced, and analyzed by nested PCR. RESULTS: Among 3014 children, 43.9% of boys and 46.3% of girls were vaccinated with varicella vaccine, respectively. The seroprevalence of anti-VZV IgG was 54.4% in the children with varicella vaccination, which was significantly higher than those in unvaccinated children (49.2%) (χ2 = 8.206, P = 0.004). Among of the vaccinated children, the detection rates of VZV IgG antibody increased with age, with 49.4, 50.9 and 58.9% in 4, 5 and 6-year groups, respectively (Trend χ2 = 17.202, P = 0.002). However, there was no difference in anti-VZV IgG detection rates among those unvaccinated children in different age groups (Trend χ2 = 8.681, P = 0.070). In addition, 13 boys and 13 girls were positive for anti-VZV IgM, respectively. Among of them, eight children (0.6%) have received varicella vaccination, which was similar to those in unvaccinated children (1.1%). However, only one ORF22 sequence was isolated from an unvaccinated 5-year boy. Compared to the reference VZV sequences, the nucleotide homology was estimated to be 99.7% with genotype J. CONCLUSIONS: Our study indicated that about half of Chinese children aged four to six years have a high risk of VZV infection. It should be helpful for the evaluation on the necessity of varicella immunization in China.

Varicella Vaccination Among US Adolescents: Coverage and Missed Opportunities, 2007-2014.

CONTEXT: Since 2007, 2 doses of varicella vaccine have been routinely recommended, with a catch-up second dose recommended for those who received only 1 prior dose. OBJECTIVE: To examine varicella vaccination coverage with 2 or more doses and the proportions of adolescents with evidence of immunity to varicella (≥2 doses of vaccine or varicella history) during 2007-2014. To assess timing of second-dose receipt, factors associated with 2 or more vaccine doses, and missed second-dose opportunities during 2014. DESIGN, SETTING, AND PARTICIPANTS: We used data from the 2007-2014 National Immunization Survey-Teen (NIS-Teen), which collects information on adolescents aged 13 to 17 years in the United States. RESULTS: From 2007 to 2014, varicella vaccination coverage with 2 or more doses increased from 8.3% to 66.9% in 13- to 15-year-olds and from 3.6% to 56.7% in 16- to 17-year-olds. The proportions with evidence of immunity also increased from 68.0% to 84.1% (13- to 15-year-olds) and 78.6% to 83.4% (16- to 17-year-olds). In 2014, 13.4% of 13- to 15-year-olds and 3.2% of 16- to 17-year-olds had received their second dose at 4 to 6 years of age. Factors most significantly associated with lower coverage with 2 or more doses were not having an 11- to 12-year well-child visit, not receiving an adolescent vaccine, and residence in a state with no 2-dose immunization school entry requirement. Seventy-seven percent of 1-dose vaccinated adolescents had 1 or more missed opportunities to receive their second dose; if were they not missed, 2-dose coverage would have increased from 79.5% to 94.8%. CONCLUSIONS: Levels of varicella vaccination coverage with 2 or more doses and the proportion of adolescents with evidence of immunity increased from 2007 to 2014, though 16% lacked evidence of immunity in 2014. Although catch-up campaigns have succeeded, missed vaccination opportunities persist.

Chickenpox in Poland in 2017

BACKGROUND: Chickenpox is a common disease in Poland, which is usually mild, but can lead to serious complications. Vaccination is an effective form of prevention. Before the introduction of universal vaccination against chickenpox, high incidence was recorded in many countries. In Poland, since 2003, vaccinations are recommended for people who did not get sick, and since 2009, compulsory for children up to 12 years of age particularly exposed to infection and children from their surroundings. AIM: To assess epidemiological situation of chickenpox in Poland in 2017, including vaccination coverage in Polish population, in comparison to previous years. METHODS: Assessment of the epidemiological situation of chickenpox in Poland in 2017. was based on the results of the analysis of aggregate data published in the annual bulletins: "Infectious diseases and poisoning in Poland in 2017" and "Protective Vaccination in Poland in 2017. In addition, the recommendations from the Protective Vaccine Program for 2017 were used. RESULTS: In 2017, 173 196 cases of chickenpox were registered in Poland, 7.21% more than in the previous year. The incidence of varicella in 2017 was 450.8 per 100,000. and was higher than in 2016 . The lowest incidence was registered in the Dolnoslaskie voivodeship ­ 324.6/ 100,000, the highest in the Opolskie voivodeship ­ 601.0 / 100,000. The most incidence was observed among children aged 0-4 years (88 711). Incidence in men was higher than in women, and the rural population higher than for urban residents. In 2017, 1200 people were hospitalized due to chickenpox. 75 040 people were vaccinated against varicella.SUMMARY. In 2017, there was a slight increase in the number of smallpox cases compared to the previous year, however, the incidence remains lower than in 2012-2014. An effective method of preventing it is chickenpox vaccination, which despite the lack of universal funding is being carried out in ever greater population. Further improvement of the epidemiological situation requires public health education in the field of primary prevention based on vaccination. As recommended, the smallpox vaccination course includes two doses of the vaccine at least 6 weeks apart from the previous dose.

The impact of demographic changes, exogenous boosting and new vaccination policies on varicella and herpes zoster in Italy: a modelling and cost-effectiveness study.

BACKGROUND: The present study aims to evaluate the cost-effectiveness of the newly introduced varicella and herpes zoster (HZ) vaccination programmes in Italy. The appropriateness of the introduction of the varicella vaccine is highly debated because of concerns about the consequences on HZ epidemiology and the expected increase in the number of severe cases in case of suboptimal coverage levels. METHODS: We performed a cost-utility analysis based on a stochastic individual-based model that considers realistic demographic processes and two different underlying mechanisms of exogenous boosting (temporary and progressive immunity). Routine varicella vaccination is given with a two-dose schedule (15 months, 5-6 years). The HZ vaccine is offered to the elderly (65 years), either alone or in combination with an initial catch-up campaign (66-75 years). The main outcome measures are averted cases and deaths, costs per quality-adjusted life years gained, incremental cost-effectiveness ratios, and net monetary benefits associated with the different vaccination policies. RESULTS: Demographic processes have contributed to shaping varicella and HZ epidemiology over the years, decreasing varicella circulation and increasing the incidence of HZ. The recent introduction of varicella vaccination in Italy is expected to produce an enduring reduction in varicella incidence and, indirectly, a further increase of HZ incidence in the first decades, followed by a significant reduction in the long term. However, the concurrent introduction of routine HZ vaccination at 65 years of age is expected to mitigate this increase and, in the longer run, to reduce HZ burden to its minimum. From an economic perspective, all the considered policies are cost-effective, with the exception of varicella vaccination alone when considering a time horizon of 50 years. These results are robust to parameter uncertainties, to the two different hypotheses on the mechanism driving exogenous boosting, and to different demographic projection scenarios. CONCLUSIONS: The recent introduction of a combined varicella and HZ vaccination programme in Italy will produce significant reductions in the burden of both diseases and is found to be a cost-effective policy. This programme will counterbalance the increasing trend of zoster incidence purely due to demographic processes.

Influence of demographic changes on the impact of vaccination against varicella and herpes zoster in Germany - a mathematical modelling study.

BACKGROUND: Epidemiological studies suggest that reduced exposure to varicella might lead to an increased risk for herpes zoster (HZ). Reduction of exposure to varicella is a consequence of varicella vaccination but also of demographic changes. We analyzed how the combination of vaccination programs and demographic dynamics will affect the epidemiology of varicella and HZ in Germany over the next 50 years. METHODS: We used a deterministic dynamic compartmental model to assess the impact of different varicella and HZ vaccination strategies on varicella and HZ epidemiology in three demographic scenarios, namely the projected population for Germany, the projected population additionally accounting for increased immigration as observed in 2015/2016, and a stationary population. RESULTS: Projected demographic changes alone result in an increase of annual HZ cases by 18.3% and a decrease of varicella cases by 45.7% between 1990 and 2060. Independently of the demographic scenario, varicella vaccination reduces the cumulative number of varicella cases until 2060 by approximately 70%, but also increases HZ cases by 10%. Unlike the currently licensed live attenuated HZ vaccine, the new subunit vaccine candidate might completely counteract this effect. Relative vaccine effects were consistent across all demographic scenarios. CONCLUSION: Demographic dynamics will be a major determinant of HZ epidemiology in the next 50 years. While stationary population models are appropriate for assessing vaccination impact, models incorporating realistic population structures allow a direct comparison to surveillance data and can thus provide additional input for immunization decision-making and resource planning.

Analysis of sero-epidemiological characteristics of varicella in healthy children in Jiangsu Province, China.

BACKGROUND: In recent years, outbreaks of varicella have continued to occur, and the coverage rate of varicella vaccine in Jiangsu Province, China, remains unclear. This study aims to analyse the levels of immune antibody against varicella and obtain a comprehensive understanding of the varicella attenuated live vaccine (VarV) coverage rate in children aged 1-9 years in Jiangsu Province. METHODS: From June to October 2016, a cross-sectional survey was conducted to collect 3631 serum samples from healthy children aged 1-9 years in Jiangsu Province. The immunoglobulin G (IgG) antibody levels of varicella were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS: The VarV coverage rate of healthy children was only 43.1% (95% CI: 41.1-44.7%). The seroprevalence after vaccination with a single dose of VarV was only 57.1%, and the overall seropositivity and geometric antibody titre (GMC) were 43.5% and 225.4 mU/ml, respectively. The seropositivity was significantly higher in girls than in boys (χ2 = 18.82, P < 0.001). The difference in seropositivity between the 5-9 age group and 1-4 age group was statistically significant (χ2 = 84.31, P < 0.001). The difference in seropositivity between different regions was statistically significant, with the highest seropositivity in the northern area, 53.7% (χ2 = 35.64, P < 0.001). The seropositivity in the group receiving one dose of VarV was significantly higher than that of the unvaccinated group (χ2 = 205.16, P < 0.001). Linear regression analysis suggested that the GMC of varicella antibodies wanes with the time since vaccination (F = 65.01, P = 0.002). CONCLUSION: The VarV coverage rate of healthy children in Jiangsu Province was low. Sero-conversion rates were also low after one dose of VarV, and the immune effectiveness of a single dose of VarV was limited. To control the spread of varicella, VarV should be included in the routine immunization program, and strengthened immunization measures for the varicella-susceptible population warrant additional consideration.

No. 274-Management of Varicella Infection (Chickenpox) in Pregnancy.

OBJECTIVE: To review the existing data regarding varicella zoster virus infection (chickenpox) in pregnancy, interventions to reduce maternal complications and fetal infection, and antepartum and peripartum management . METHODS: The maternal and fetal outcomes in varicella zoster infection were reviewed, as well as the benefit of the different treatment modalities in altering maternal and fetal sequelae. EVIDENCE: Medline was searched for articles and clinical guidelines published in English between January 1970 and November 2010. VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table).

Lack of evidence for post-vaccine onset of autoimmune/lymphoproliferative disorders, during a nine-month follow-up in multiply vaccinated Italian military personnel.

Anecdotal case reports, amplified by mass media and internet-based opinion groups, have recently indicated vaccinations as possibly responsible for autoimmunity/lymphoproliferation development. Multiply vaccinated Italian military personnel (group 1, operating in Italy, group 2, operating in Lebanon) were followed-up for nine months to monitor possible post-vaccine autoimmunity/lymphoproliferation onset. No serious adverse event was noticed in both groups. Multivariate analysis of intergroup differences only showed a significant association between lymphocyte increase and tetanus/diphtheria vaccine administration. A significant post-vaccine decrease in autoantibody positivity was observed. Autoantibodies were also studied by microarray analysis of self-proteins in subjects exposed to ≥4 concurrent vaccinations, without observing significant difference among baseline and one and nine months post-vaccine. Moreover, HLA-A2 subjects have been analyzed for the possible CD8T-cell response to apoptotic self-epitopes, without observing significant difference between baseline and one month post-vaccine. Multiple vaccinations in young adults are safe and not associated to autoimmunity/lymphoproliferation onset during a nine-month-long follow-up.

Varicella-zoster virus seroprevalence in children and adolescents in the pre-varicella vaccine era, Germany.

BACKGROUND: In 2004, universal childhood varicella vaccination was introduced in Germany. We aimed to determine the age-specific prevalence of anti-varicella zoster virus (VZV) IgG-antibodies among children in the pre-varicella vaccine era in Germany, to identify factors associated with VZV seropositivity, and to assess the suitability of a commercially available ELISA for VZV seroepidemiological studies by comparing it with an in-house fluorescent antibody to membrane antigen test (FAMA) as the gold standard. METHODS: Serum samples of 13,433 children and adolescents aged 1-17 years included in the population-based German Health Interview and Examination Survey for Children and Adolescents (KiGGS; conducted 2003-2006) were tested for anti-VZV IgG by ELISA. All samples with equivocal ELISA results and a random selection of ELISA-negative and -positive samples were tested by FAMA. Statistical analyses were conducted using a weighting factor adjusting the study population to the total population in Germany. Seroprevalences were calculated as percentages (%) with a 95% confidence interval (CI). Odds ratios (OR) were computed by multivariate logistic regression to determine the association between socio-demographic factors and VZV seropositivity. RESULTS: The VZV seropositivity rate was 80.3% (95% CI: 79.3-81.3) in varicella-unvaccinated children and adolescents. VZV seropositivity rates differed significantly between age groups up to age 6 years, but not by gender. Of 118 retested serum samples with an equivocal ELISA result, 45.8% were FAMA-positive. The proportion of samples tested as false-negative in by ELISA varied by age group: 2.6% in children aged 1-6 and 9% in children aged 7-17 years. Multivariate analyses showed that age, having older siblings, and early daycare start were associated with seropositivity in preschoolers; migration background reduced the chance of VZV seropositivity in schoolchildren (OR: 0.65; 0.43-0.99) and adolescents (OR: 0.62; 0.4-0.97). CONCLUSION: In the pre-varicella vaccine era, most children in Germany contracted varicella by age six. Schoolchildren with a migration background and children without siblings have an increased risk of being VZV seronegative and should be targeted for catch-up vaccination, if they have no history of chickenpox. ELISAs are suitable for use in population-level serosurveys on VZV, but samples with equivocal ELISA results should be retested by FAMA.

Economic burden of varicella in children 1-12 Years of age in Hungary, 2011-2015.

BACKGROUND: Although live-attenuated varicella-zoster virus (VZV) vaccines have been proven to be safe and effective in preventing varicella and real-word evidence shows routine childhood immunization programs are effective in dramatically reducing varicella associated morbidity and mortality, varicella vaccine is not included in the National Immunization Program (NIP) in Hungary. The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Hungary. METHODS: This was a multicenter, retrospective, chart review study of patients aged 1-12 years with a primary varicella diagnosis between 2011 and 2015. Healthcare resource utilization (HCRU) associated with varicella, unit costs, and work loss were used to estimate direct and indirect costs. All costs are presented in 2015 HUF / Euros (€). RESULTS: 156 children with varicella were included (75 outpatients, 81 inpatients), with a mean age of 4.4 (SD: 2.0) and 3.7 (SD: 2.1) years, respectively. One or more complications were reported by 12.0% of outpatients and 92.6% of inpatients, the most common being dehydration, skin and soft tissue infections, pneumonia, keratoconjunctivitis, and cerebellitis. HCRU estimates included use of over-the-counter (OTC) medications (96.0% outpatients, 53.1% inpatients), prescription medications (9.3% outpatients, 70.4% inpatients), tests/procedures (4.0% outpatients, 97.5% inpatients), and consultation with allied health professionals (2.7% outpatients, 30.9% inpatients). The average duration of hospital stay (inpatients) was 3.6 (95% CI: 3.2, 4.1) days. The total combined direct and indirect cost per varicella case was 228,146.7 Hungarian Forint (HUF)/€ 736.0 for inpatients and 49,790.6 HUF/€ 106.6 for outpatients. The overall annual cost of varicella in Hungary for children aged <15 years in 2015 was estimated at 1,903,332,524.3 HUF/ € 6,139,980.4. CONCLUSION: Varicella is associated with substantial clinical burden in Hungary, resulting in the utilization of a significant amount of healthcare resources. These results support the need for routine vaccination of all healthy children to reduce the varicella-associated disease burden.

Estimation of the burden of varicella in Europe before the introduction of universal childhood immunization.

BACKGROUND: Varicella is generally considered a mild disease. Disease burden is not well known and country-level estimation is challenging. As varicella disease is not notifiable, notification criteria and rates vary between countries. In general, existing surveillance systems do not capture cases that do not seek medical care, and most are affected by underreporting and underascertainment. We aimed to estimate the overall varicella disease burden in Europe to provide critical information to support decision-making regarding varicella vaccination. METHODS: We conducted a systematic literature review to identify all available epidemiological data on varicella IgG antibody seroprevalence, primary care and hospitalisation incidence, and mortality. We then developed methods to estimate age-specific varicella incidence and annual number of cases by different levels of severity (cases in the community, health care seekers in primary care and hospitals, and deaths) for all countries belonging to the European Medicines Agency (EMA) region and Switzerland. RESULTS: In the absence of universal varicella immunization, the burden of varicella would be substantial with a total of 5.5 million (95% CI: 4.7-6.4) varicella cases occurring annually across Europe. Variation exists between countries but overall the majority of cases (3 million; 95% CI: 2.7-3.3) would occur in children <5 years. Annually, 3-3.9 million patients would consult a primary care physician, 18,200-23,500 patients would be hospitalised, and 80 varicella-related deaths would occur (95% CI: 19-822). CONCLUSIONS: Varicella disease burden is substantial. Most cases occur in children <5 years old but adults require hospitalisation more often and are at higher risk of death. This information should be considered when planning and evaluating varicella control strategies. A better understanding of the driving factors of country-specific differences in varicella transmission and health care utilization is needed. Improving and standardizing varicella surveillance in Europe, as initiated by the European Centre for Disease Prevention and Control (ECDC), is important to improve data quality to facilitate inter-country comparison.

[Varicella Vaccination Coverage and Possible Factors Influencing Parental Vaccination Decisions in Munich Area 2009-2011 after Introduction of Routine Varicella Vaccination]. / Entwicklung der Varizellen-Impfraten und mögliche Einflussfaktoren auf die Impfentscheidung der Eltern im Raum München in den Jahren 2009­2011 nach Einführung der allgemeinen Varizellenimpfung.

Background and Objective: Germany introduced routine varicella vaccination for all infants aged 11-14 months in 2004; since 2009, a second dose was recommended for toddlers aged 15-23 months. In Bavaria, vaccination with combined MMRV vaccine has been routinely reimbursed since the introduction of the 2-dose vaccination schedule. We investigated varicella vaccination coverage and factors associated with parental acceptance of varicella vaccination in the area of Munich from 2009 to 2011, within the frame of the 'Bavarian Varicella Surveillance Project' (2006-2011). Method: Annual cross-sectional parent survey of random samples of 600 children aged 18-36 months in Munich on the child's vaccination status for varicella and measles, socio-demographic data and parental attitude towards varicella vaccination. Results: During 2009-2011, the first dose varicella vaccination (VV) coverage increased from 53% (2009) to 68% (2011) while the second dose VV increased from 29% (2009) to 59% (2011). First-dose measles vaccination coverage was 88-91% (2009-2011). In 2009, 51% of all vaccinated children received the combined MMRV vaccine as first dose; in 2011, 94% (p<0.001). In 2009, 27% of all parents considered varicella vaccination as superfluous. This percentage had decreased to 15% by 2011. Recommendation of varicella vaccination by the physician was the most important explanatory factor and was significantly associated with parental acceptance of varicella vaccination in 2009 to 2011 (adjusted OR 11.5; 95%CI 3.6-36.3 (2009), 26.7; 95%CI 5.4-132.2 (2010) and 12.7; 95%CI 3.9-41.4 (2011)). Conclusions: From 2009 to 2011, first dose VV coverage further increased by approximately 15% up to 68%, corresponding with the increased use of MMRV. Although parental acceptance had increased, first dose coverage for varicella was still considerably lower than coverage for measles in 2011. Physician's recommendation of VV was the only independent factor significantly associated with parental acceptance in all study years. A further increase in varicella vaccination coverage is necessary in order to avoid potential negative effects such as an increase in the mean age of children getting infected with varicella. Therefore, information campaigns for both parents and physicians are urgently needed.

[The epidemiology of varicella disease in Germany after introduction of a vaccination recommendation : Analysis of mandatory and sentinel data between 2002 and 2014]. / Die Epidemiologie der Varizellen in Deutschland unter Einfluss der Varizellen-Impfempfehlung : Auswertung der Sentinel- und Meldepflichtdaten 2002­2014.

BACKGROUND: Since 2004 a single varicella vaccination for all infants aged 11-14 months has been recommended in Germany and since 2009 a second dose at the age of 15-23 months is recommended. Vaccination coverage after 24 months rose from 43% in 2006 to 87.5% in 2012. A mandatory notification system was introduced in the New Federal States (NFS) between 2002 and 2009 and nationwide in 2013. A national sentinel system has been in place since 2005. OBJECTIVE AND METHOD: We analyzed both data sources to describe the varicella epidemiology related to vaccination coverage after initiation of routine childhood varicella vaccination and to evaluate both notification systems regarding informative value and data quality. We looked at trends, age distribution and incidences using Microsoft Excel and Stata12. Vaccination coverage data were available from health insurance claims data. RESULTS: By 2013 a decrease of cases/medical practice/month from 3.47 to 0.43 was observed. The incidence in the NFS declined from 32 to 12 out of 100,000. Sentinel and mandatory notification data showed the largest decrease among the 1-4 year-olds (-94 and -90% resp.). In 2014, varicella incidences increased in all age groups, but not the cases/medical-practice/month by age in the sentinel. DISCUSSION: Increasing vaccination coverage and decreasing varicella cases demonstrate the success of routine childhood varicella vaccination. Mandatory notification data allow incidence calculation; The sentinel system has been providing more detailed information about vaccination status, better data quality and continuous national data since 2005, irrespective of the Infectious disease protection act. Trends and age distribution can be continuously calculated, whereas the nationwide mandatory data collected in the short period since April 2013 can only be evaluated to a limited extent.