The Effectiveness of Varicella Vaccination in Children in Germany: A Case-control Study

Background: Effectiveness of 1 dose of varicella vaccination was estimated to be 85–88% against clinical varicella of any severity in case-control studies in non-European countries, but lower effectiveness has been demonstrated in outbreaks. Methods: A prospective, age- and practice-matched case-control study was conducted in Germany to assess the effectiveness of 1 dose of OKA/GSK varicella vaccine (derived from the OKA strain, a Japanese clinical isolate) and of any varicella vaccine (including OKA/GSK, OKA/Merck and MMR-OKA/GSK) against polymerase chain reaction (PCR)-confirmed varicella under conditions of routine use. Results: The cohort included 432 PCR-confirmed cases and 432 matched controls (1–7 years old). Varicella vaccination was reported for 13.2% (57/432) of cases and 45.1% (195/432) of controls. Median time since vaccination was 28 and 25 months, respectively. Vaccinated cases experienced milder disease (P < 0.0001) and shorter duration of disease (P = 0.004) compared with unvaccinated cases. After adjusting for gender and school/day-care attendance, vaccine effectiveness of 1 dose of OKA/GSK against PCR-confirmed varicella of any severity was 71.5% (95% confidence interval [CI]: 49.1–84.0) and 94.7% (95% CI: 77.8–98.7) against PCR-confirmed moderate or severe varicella. Adjusted effectiveness for any varicella vaccine was 86.4% (95% CI: 77.3–91.8) against any severity and 97.7% (95% CI: 90.5–99.4) against moderate or severe varicella. Conclusions: One dose of varicella vaccine provided high protection against moderate and severe varicella disease for a period of up to 5 years after vaccination. However, further effectiveness data are needed to assess long-term protection.

[1]  Robert Koch-Institut.  Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut , 2015 .

[2]  E. Ledent,et al.  Sampling of herpes zoster skin lesion types and the impact on viral DNA detection. , 2013, Journal of virological methods.

[3]  R. Balicer,et al.  Birth order and private voluntary immunization--a study of 110,902 children. , 2012, Vaccine.

[4]  L. Mascola,et al.  Varicella in Infants After Implementation of the US Varicella Vaccination Program , 2011, Pediatrics.

[5]  F. D’Ancona,et al.  Current immunization policies for pneumococcal, meningococcal C, varicella and rotavirus vaccinations in Italy. , 2011, Health policy.

[6]  J. Seward,et al.  Near Elimination of Varicella Deaths in the US After Implementation of the Vaccination Program , 2011, Pediatrics.

[7]  E. Shapiro,et al.  Effectiveness of 2 doses of varicella vaccine in children. , 2009, The Journal of infectious diseases.

[8]  M. Höhle,et al.  Assessment of varicella vaccine effectiveness in Germany: a time-series approach , 2010, Epidemiology and Infection.

[9]  G. Poggensee,et al.  Varicella vaccination coverage of children under two years of age in Germany , 2010, BMC public health.

[10]  V. Grote,et al.  Varicella vaccination coverage in Bavaria (Germany) after general vaccine recommendation in 2004. , 2010, Vaccine.

[11]  S. Bialek,et al.  The Effectiveness of Varicella Vaccine in China , 2010, The Pediatric infectious disease journal.

[12]  M. Cuccia,et al.  The effectiveness of Varivax and Varilrix vaccines. , 2010, Vaccine.

[13]  A. Siedler,et al.  Impact of the routine varicella vaccination programme on varicella epidemiology in Germany. , 2010, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[14]  Samir S. Shah,et al.  Decline in Varicella-Related Ambulatory Visits and Hospitalizations in the United States Since Routine Immunization Against Varicella , 2010, The Pediatric infectious disease journal.

[15]  R. JorgeQuian,et al.  Estudio de un brote de varicela en un pueblo del Uruguay , 2010 .

[16]  M. Dehnert,et al.  Comparative varicella vaccine effectiveness during outbreaks in day-care centres. , 2010, Vaccine.

[17]  F. Heinen,et al.  Neurologic varicella complications before routine immunization in Germany. , 2010, Pediatric neurology.

[18]  Jorge Quian R,et al.  [Varicella outbreak in a village in Uruguay]. , 2010, Revista chilena de infectologia : organo oficial de la Sociedad Chilena de Infectologia.

[19]  B. Rentier,et al.  Varicella vaccination in Europe – taking the practical approach , 2009, BMC medicine.

[20]  J. Seward,et al.  Varicella Prevention in the United States: A Review of Successes and Challenges , 2008, Pediatrics.

[21]  T. Breuer,et al.  Impact of universal varicella vaccination on 1-year-olds in Uruguay: 1997–2005 , 2008, Archives of Disease in Childhood.

[22]  K. Edwards,et al.  Primary vaccine failure after 1 dose of varicella vaccine in healthy children. , 2008, The Journal of infectious diseases.

[23]  J. Seward,et al.  Varicella disease among vaccinated persons: clinical and epidemiological characteristics, 1997-2005. , 2008, The Journal of infectious diseases.

[24]  J. Seward,et al.  Varicella vaccine effectiveness in the US vaccination program: a review. , 2008, The Journal of infectious diseases.

[25]  L. Mascola,et al.  Changing varicella epidemiology in active surveillance sites--United States, 1995-2005. , 2008, The Journal of infectious diseases.

[26]  V. Grote,et al.  The Burden of Varicella Complications Before the Introduction of Routine Varicella Vaccination in Germany , 2008, The Pediatric infectious disease journal.

[27]  R. von Kries,et al.  Varicella‐related deaths in children and adolescents – Germany 2003–2004 , 2008, Acta paediatrica.

[28]  J. Weinberg.  Herpes zoster: epidemiology, natural history, and common complications. , 2007, Journal of the American Academy of Dermatology.

[29]  E. Shapiro,et al.  Methodological issues in design and analysis of a matched case-control study of a vaccine's effectiveness. , 2007, Journal of clinical epidemiology.

[30]  R. von Kries,et al.  Metaanalysis of vaccine effectiveness in varicella outbreaks. , 2007, Vaccine.

[31]  J. Seward,et al.  Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). , 2007, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[32]  H. Lawson,et al.  Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). , 2007, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[33]  L. Mascola,et al.  Loss of vaccine-induced immunity to varicella over time. , 2007, The New England journal of medicine.

[34]  A. Arnedo-Pena,et al.  Varicella Vaccine Effectiveness During an Outbreak in a Partially Vaccinated Population in Spain , 2006, The Pediatric infectious disease journal.

[35]  R. Sheffer,et al.  Effectiveness of the Oka/GSK Attenuated Varicella Vaccine for the Prevention of Chickenpox in Clinical Practice in Israel , 2005, The Pediatric infectious disease journal.

[36]  I. Lavi,et al.  Vaccine Effectiveness and Severity of Varicella Among Previously Vaccinated Children During Outbreaks in Day-Care Centers With Low Vaccination Coverage , 2005, The Pediatric infectious disease journal.

[37]  D. Krysan.  Effectiveness over time of varicella vaccine. , 2004, The Journal of pediatrics.

[38]  L. Lerner-Geva,et al.  Use of a computerized database to study the effectiveness of an attenuated varicella vaccine , 2004, The Pediatric infectious disease journal.

[39]  E. Shapiro.  Case-control studies of the effectiveness of vaccines: validity and assessment of potential bias , 2004, The Pediatric infectious disease journal.

[40]  Robert T. Chen,et al.  A retrospective cohort study of the association of varicella vaccine failure with asthma, steroid use, age at vaccination, and measles-mumps-rubella vaccination. , 2003, Pediatrics.

[41]  R. R. Fernández,et al.  Boletín epidemiológico de la Comunidad de Madrid: encuesta sobre su difusión y percepción entre los médicos de atención primaria en el año 2000 , 2002 .

[42]  S. Wagenpfeil,et al.  Seroprevalence of varicella-zoster virus in the German population. , 2001, Vaccine.

[43]  E. Wang,et al.  Varicella vaccination—a critical review of the evidence , 2001, Archives of disease in childhood.

[44]  E. Shapiro,et al.  The effectiveness of the varicella vaccine in clinical practice. , 2001, The New England journal of medicine.

[45]  M. Wharton,et al.  The epidemiology of varicella-zoster virus infections. , 1996, Infectious disease clinics of North America.