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Abstract

In Germany, routine childhood varicella vaccination was implemented in 2004 with two doses recommended since 2009. We used an immunisation information system based on countrywide health insurance claims data to analyse vaccine effectiveness (VE) and factors influencing VE. We applied proportional hazard models to estimate VE under various conditions and compared the risk of acquiring varicella among unvaccinated children in regions with high vs low vaccination coverage (VC). Among 1.4 million children we identified 29,404 varicella cases over a maximum follow-up of 8 years post-vaccination. One-dose VE was 81.9% (95% confidence interval (CI): 81.4–82.5), two-dose VE 94.4% (95% CI: 94.2–94.6). With dose one given 1–27 days after measles-containing vaccine (MCV), one-dose VE was 32.2% (95% CI: 10.4–48.6), two-dose VE 92.8% (95% CI: 84.8–96.6). VE was not associated with age at vaccination (11–14 vs ≥ 15 months), time since vaccination, or vaccine type. Unvaccinated children had a twofold higher risk of acquiring varicella in low VC regions. Our system generated valuable data, showing that two-dose varicella vaccination provides good protection for at least 8 years. Unvaccinated children benefit from herd effects. When the first varicella vaccine dose is given shortly after MCV, a second dose is essential.

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/content/10.2807/1560-7917.ES.2017.22.17.30521
2017-04-27
2017-10-17
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2017.22.17.30521
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References

  1. Centers for Disease Control Prevention. About Immunization Information Systems [internet]. 2012 May 15 [cited 2017 Apr 25]. Available from: http://www.cdc.gov/vaccines/programs/iis/about.html
  2. Rieck T, Feig M, Deleré Y, Wichmann O. Utilization of administrative data to assess the association of an adolescent health check-up with human papillomavirus vaccine uptake in Germany. Vaccine. 2014;32(43):5564-9.  https://doi.org/10.1016/j.vaccine.2014.07.105  PMID: 25131739 
  3. Rieck T, Feig M, Eckmanns T, Benzler J, Siedler A, Wichmann O. Vaccination coverage among children in Germany estimated by analysis of health insurance claims data. Hum Vaccin Immunother. 2014;10(2):476-84.  https://doi.org/10.4161/hv.26986  PMID: 24192604 
  4. Siedler A, Rieck T, Reuss A, Walter D, Poggensee G, Poethko-Muller C, et al. Estimating vaccination coverage in the absence of immunisation registers--the German experience. Euro Surveill. 2012;17(17):20152. PMID: 22551497 
  5. Robert Koch Institute (RKI). KV-Impfsurveillance: Ergänzungen zu den Impfdaten aus den Schuleingangsuntersuchungen. [ASHIP vaccination monitoring: Complements to vaccination data from school entrance examinations]. Epid Bull 2016;16:134. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2016/Ausgaben/16_16.pdf?__blob=publicationFile
  6. Takla A, Wichmann O, Klinc C, Hautmann W, Rieck T, Koch J. Mumps epidemiology in Germany 2007-11. Euro Surveill. 2013;18(33):20557.  https://doi.org/10.2807/1560-7917.ES2013.18.33.20557  PMID: 23968877 
  7. Takla A, Wichmann O, Rieck T, Matysiak-Klose D. Measles incidence and reporting trends in Germany, 2007-2011. Bull World Health Organ. 2014;92(10):742-9.  https://doi.org/10.2471/BLT.13.135145  PMID: 25378728 
  8. Ultsch B, Siedler A, Rieck T, Reinhold T, Krause G, Wichmann O. Herpes zoster in Germany: quantifying the burden of disease. BMC Infect Dis. 2011;11(1):173.  https://doi.org/10.1186/1471-2334-11-173  PMID: 21679419 
  9. Heymann D. Control of communicable disease manual. 19th edition ed.: American Public Health Association, 2008.
  10. European Centre for Disease Prevention and Control (ECDC). Varicella vaccination in the European Union. Stockholm: ECDC, 2015. Available from: http://ecdc.europa.eu/en/publications/Publications/Varicella-Guidance-2015.pdf
  11. Schink T, Holstiege J, Kowalzik F, Zepp F, Garbe E. Risk of febrile convulsions after MMRV vaccination in comparison to MMR or MMR+V vaccination. Vaccine. 2014;32(6):645-50.  https://doi.org/10.1016/j.vaccine.2013.12.011  PMID: 24374498 
  12. Siedler A, Hecht J, Rieck T, Tolksdorf K, Hengel H. [Varicella vaccination in Germany. A provisional appraisal in the context of MMR vaccination]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(9):1313-20.  https://doi.org/10.1007/s00103-013-1789-z  PMID: 23990095 
  13. Cenoz MG, Martínez-Artola V, Guevara M, Ezpeleta C, Barricarte A, Castilla J. Effectiveness of one and two doses of varicella vaccine in preventing laboratory-confirmed cases in children in Navarre, Spain. Hum Vaccin Immunother. 2013;9(5):1172-6.  https://doi.org/10.4161/hv.23451  PMID: 23324571 
  14. Shapiro ED, Vazquez M, Esposito D, Holabird N, Steinberg SP, Dziura J, et al. Effectiveness of 2 doses of varicella vaccine in children. J Infect Dis. 2011;203(3):312-5.  https://doi.org/10.1093/infdis/jiq052  PMID: 21208922 
  15. Siedler A, Rieck T, Tolksdorf K. Strong Additional Effect of a Second Varicella Vaccine Dose in Children in Germany, 2009-2014. J Pediatr. 2016; 173:202-6 e2.
  16. Spackova M, Wiese-Posselt M, Dehnert M, Matysiak-Klose D, Heininger U, Siedler A. Comparative varicella vaccine effectiveness during outbreaks in day-care centres. Vaccine. 2010;28(3):686-91.  https://doi.org/10.1016/j.vaccine.2009.10.086  PMID: 19874924 
  17. Baxter R, Ray P, Tran TN, Black S, Shinefield HR, Coplan PM, et al. Long-term effectiveness of varicella vaccine: a 14-Year, prospective cohort study. Pediatrics. 2013;131(5):e1389-96.  https://doi.org/10.1542/peds.2012-3303  PMID: 23545380 
  18. Bonanni P, Gershon A, Gershon M, Kulcsár A, Papaevangelou V, Rentier B, et al. Primary versus secondary failure after varicella vaccination: implications for interval between 2 doses. Pediatr Infect Dis J. 2013;32(7):e305-13.  https://doi.org/10.1097/INF.0b013e31828b7def  PMID: 23838789 
  19. Chaves SS, Gargiullo P, Zhang JX, Civen R, Guris D, Mascola L, et al. Loss of vaccine-induced immunity to varicella over time. N Engl J Med. 2007;356(11):1121-9.  https://doi.org/10.1056/NEJMoa064040  PMID: 17360990 
  20. Robert Koch Institute (RKI). Evaluation der Varizellen-Impfempfehlung durch die STIKO. [Evaluation of the varicella vaccination recommendation by STIKO]. Epid Bull 2013;1:1-5. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2013/Ausgaben/01_13.pdf?__blob=publicationFile
  21. Höhle M, Siedler A, Bader HM, Ludwig M, Heininger U, Von Kries R. Assessment of varicella vaccine effectiveness in Germany: a time-series approach. Epidemiol Infect. 2011;139(11):1710-9.  https://doi.org/10.1017/S0950268810002815  PMID: 21156098 
  22. Liese JG, Cohen C, Rack A, Pirzer K, Eber S, Blum M, et al. The effectiveness of varicella vaccination in children in Germany: a case-control study. Pediatr Infect Dis J. 2013;32(9):998-1004.  https://doi.org/10.1097/INF.0b013e31829ae263  PMID: 23694831 
  23. Huang WC, Huang LM, Chang IS, Tsai FY, Chang LY. Varicella breakthrough infection and vaccine effectiveness in Taiwan. Vaccine. 2011;29(15):2756-60.  https://doi.org/10.1016/j.vaccine.2011.01.092  PMID: 21315697 
  24. Seward JF, Zhang JX, Maupin TJ, Mascola L, Jumaan AO. Contagiousness of varicella in vaccinated cases: a household contact study. JAMA. 2004;292(6):704-8.  https://doi.org/10.1001/jama.292.6.704  PMID: 15304467 
  25. Vázquez M, LaRussa PS, Gershon AA, Niccolai LM, Muehlenbein CE, Steinberg SP, et al. Effectiveness over time of varicella vaccine. JAMA. 2004;291(7):851-5.  https://doi.org/10.1001/jama.291.7.851  PMID: 14970064 
  26. Vázquez M, LaRussa PS, Gershon AA, Steinberg SP, Freudigman K, Shapiro ED. The effectiveness of the varicella vaccine in clinical practice. N Engl J Med. 2001;344(13):955-60.  https://doi.org/10.1056/NEJM200103293441302  PMID: 11274621 
  27. Marin M, Marti M, Kambhampati A, Jeram SM, Seward JF. Global Varicella Vaccine Effectiveness: A Meta-analysis. Pediatrics. 2016;137(3):e20153741.  https://doi.org/10.1542/peds.2015-3741  PMID: 26908671 
  28. Black S, Ray P, Shinefield H, Saddier P, Nikas A. Lack of association between age at varicella vaccination and risk of breakthrough varicella, within the Northern California Kaiser Permanente Medical Care Program. J Infect Dis. 2008;197(s2) Suppl 2;S139-42.  https://doi.org/10.1086/522124  PMID: 18419387 
  29. Verstraeten T, Jumaan AO, Mullooly JP, Seward JF, Izurieta HS, DeStefano F, et al. Vaccine Safety Datalink Research Group. A retrospective cohort study of the association of varicella vaccine failure with asthma, steroid use, age at vaccination, and measles-mumps-rubella vaccination. Pediatrics. 2003;112(2):e98-103.  https://doi.org/10.1542/peds.112.2.e98  PMID: 12897314 
  30. World Health Organization (WHO). Immunization Schedule for 2015. Geneva: WHO. [Accessed 9 Nov 2016]. Available from: http://www.who.int/entity/immunization/monitoring_surveillance/data/schedule_data.xls?ua=1
  31. Fireman P, Friday G, Kumate J. Effect of measles vaccine on immunologic responsiveness. Pediatrics. 1969;43(2):264-72. PMID: 4179145 
  32. Petralli JK, Merigan TC, Wilbur JR. Action of Endogenous Interferon against Vaccinia Infection in Children. Lancet. 1965;2(7409):401-5.  https://doi.org/10.1016/S0140-6736(65)90755-5  PMID: 14346758 
  33. Robert Koch Institute (RKI). Impfquoten bei der Schuleingangsuntersuchung in Deutschland 2014. [Vaccination coverage from school entrance examinations in Germany, 2014]. Epid Bull 2016;16:129-33. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2016/Ausgaben/16_16.pdf?__blob=publicationFile
  34. The State Chamber of Physicians of Saxony. Synopsis-Impfkalender für Kinder, Jugendliche und Erwachsene im Freistaat Sachsen, Stand: 1. Januar 2017. [Synopsis-Immunization schedule for children, adolescents and adults in the federal state of Saxony, 1 Jan 2017]. Dresden: The State Chamber of Physicians of Saxony. German. Available from: https://www.slaek.de/media/dokumente/02medien/Patienten/gesundheitsinformationen/impfen/Synopsis_2017_.pdf
  35. Leung J, Harpaz R. Impact of the Maturing Varicella Vaccination Program on Varicella and Related Outcomes in the United States: 1994-2012. J Pediatric Infect Dis Soc. 2016;5(4):395-402. PMID: 26407276 
  36. Huber J, Lampert T, Mielck A. [Inequalities in health risks, morbidity and health care of children by health insurance of their parents (statutory vs. private health insurance): results of the German KiGGS study]. Gesundheitswesen. 2012;74(10):627-38. PMID: 22275061 
  37. Bonanni P, Breuer J, Gershon A, Gershon M, Hryniewicz W, Papaevangelou V, et al. Varicella vaccination in Europe - taking the practical approach. BMC Med. 2009;7(1):26.  https://doi.org/10.1186/1741-7015-7-26  PMID: 19476611 
  38. World Health Organization (WHO). International statistical classification of diseases and related health problems. 10th Revision. Volume 2. Instruction manual. 2010 ed. Geneva: WHO; 2011. Available from: http://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf
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