1887
  1. Home
  2. Eurosurveillance
  3. Volume 24, Issue 42, 17/Oct/2019
  4. Article
Surveillance Open Access
Like 0
Download

Abstract

Background

Strategies to control varicella vary across Europe. Evidence from established programmes has prompted the United Kingdom to re-evaluate the need for universal vaccination. The burden of complicated varicella is a key parameter in the cost-effectiveness analysis.

Aim

Our objective was to estimate the burden of complicated varicella in England.

Methods

This electronic health record surveillance study used data from all NHS hospitals in England to identify varicella admissions between 2004 and 2017. The incidence of pre-defined complications of varicella was estimated using ICD-10 codes. Inpatient costs were calculated based on the payment rules for providers of NHS services.

Results

There were 61,024 admissions with varicella between 2004 and 2017 and 38.1% had a recognised varicella complication. Incidence of hospitalisation increased by 25% and the proportion with complicated varicella by 24% from 2004/05 to 2016/17. The most common complications were bacterial skin infections (11.25%), pneumonia (4.82%), febrile convulsions (3.39%) and encephalitis (2.44%). Complication rates were higher in older age groups and the type of complications more severe. Length of stay for complicated varicella was 3.1 times longer than for uncomplicated varicella and inpatient costs were 72% greater.

Conclusion

Complicated varicella has a substantial health and economic burden. These data together with data on impact on quality of life are important in informing the cost-effectiveness analysis of universal varicella vaccination.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2019.24.42.1900233
2019-10-17
2024-04-20
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.42.1900233
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/24/42/eurosurv-24-42-5.html?itemId=/content/10.2807/1560-7917.ES.2019.24.42.1900233&mimeType=html&fmt=ahah

References

  1. European Centre for Disease Prevention and Control (ECDC). Vaccine scheduler: Vaccine schedules in all countries of the European Union. Stockholm: ECDC. [Accessed: 11 Jun 2018]. Available from: https://vaccine-schedule.ecdc.europa.eu
  2. Brisson M, Edmunds WJ. Varicella vaccination in England and Wales: cost-utility analysis. Arch Dis Child. 2003;88(10):862-9.  https://doi.org/10.1136/adc.88.10.862  PMID: 14500303 
  3. Brisson M, Gay NJ, Edmunds WJ, Andrews NJ. Exposure to varicella boosts immunity to herpes-zoster: implications for mass vaccination against chickenpox. Vaccine. 2002;20(19-20):2500-7.  https://doi.org/10.1016/S0264-410X(02)00180-9  PMID: 12057605 
  4. Hobbelen PH, Stowe J, Amirthalingam G, Miller L, van Hoek AJ. The burden of hospitalisation for varicella and herpes zoster in England from 2004 to 2013. J Infect. 2016;73(3):241-53.  https://doi.org/10.1016/j.jinf.2016.05.008  PMID: 27283754 
  5. Joint Committee on Vaccination and Immunisation. Minute of the meeting on 01 February 2017 Skipton House, 80 London Rd, London SE1 6LH. Colindale: Public Health England; 2017. Available from: http://www.nitag-resource.org/uploads/media/default/0001/04/3d9769b85796db91fb8ec14df1c0f790ca08fc76.pdf
  6. Liese JG, Grote V, Rosenfeld E, Fischer R, Belohradsky BH, v Kries R, et al. The burden of varicella complications before the introduction of routine varicella vaccination in Germany. Pediatr Infect Dis J. 2008;27(2):119-24.  https://doi.org/10.1097/INF.0b013e3181586665  PMID: 18227713 
  7. Heywood AE, Wang H, Macartney KK, McIntyre P. Varicella and herpes zoster hospitalizations before and after implementation of one-dose varicella vaccination in Australia: an ecological study. Bull World Health Organ. 2014;92(8):593-604.  https://doi.org/10.2471/BLT.13.132142  PMID: 25177074 
  8. Office for National Statistics (ONS). Population estimates. London: ONS. [Accessed: 8 Jul 2019]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates
  9. National Health Service England. Monitor. 2016/17 national tariff payment system. London; NHS England; 2016. Available from: https://www.gov.uk/government/publications/nhs-national-tariff-payment-system-201617
  10. National Health Service England and Wales (NHS). The Health Service (Control of Patient Information) Regulations 2002. London: NHS; 2002. Available from: http://www.legislation.gov.uk/uksi/2002/1438/regulation/3/made
  11. Abdalrahman B, Laverty AA, Beckett G, Majeed A. Trends in hospital admissions for Varicella and Zoster viruses in England, 2001/2002-2010/2011: time trend study. JRSM Open. 2015;6(1):2054270414562984.  https://doi.org/10.1177/2054270414562984  PMID: 25852952 
  12. Cameron JC, Allan G, Johnston F, Finn A, Heath PT, Booy R. Severe complications of chickenpox in hospitalised children in the UK and Ireland. Arch Dis Child. 2007;92(12):1062-6.  https://doi.org/10.1136/adc.2007.123232  PMID: 17991685 
  13. Blumental S, Sabbe M, Lepage PBelgian Group for Varicella. Varicella paediatric hospitalisations in Belgium: a 1-year national survey. Arch Dis Child. 2016;101(1):16-22.  https://doi.org/10.1136/archdischild-2015-308283  PMID: 26130380 
  14. Pierik JG, Gumbs PD, Fortanier SA, Van Steenwijk PC, Postma MJ. Epidemiological characteristics and societal burden of varicella zoster virus in the Netherlands. BMC Infect Dis. 2012;12(1):110.  https://doi.org/10.1186/1471-2334-12-110  PMID: 22574722 
  15. Dubos F, Grandbastien B, Hue V, Martinot AHospital Network for Evaluating Management of Common Childhood Diseases. Epidemiology of hospital admissions for paediatric varicella infections: a one-year prospective survey in the pre-vaccine era. Epidemiol Infect. 2007;135(1):131-8.  https://doi.org/10.1017/S0950268806006467  PMID: 16740185 
  16. Bonhoeffer J, Baer G, Muehleisen B, Aebi C, Nadal D, Schaad UB, et al. Prospective surveillance of hospitalisations associated with varicella-zoster virus infections in children and adolescents. Eur J Pediatr. 2005;164(6):366-70.  https://doi.org/10.1007/s00431-005-1637-8  PMID: 15747132 
  17. Walker JL, Andrews NJ, Mathur R, Smeeth L, Thomas SL. Trends in the burden of varicella in UK general practice. Epidemiol Infect. 2017;145(13):2678-82.  https://doi.org/10.1017/S0950268817001649  PMID: 28853391 
  18. Siedler A, Dettmann M. Hospitalization with varicella and shingles before and after introduction of childhood varicella vaccination in Germany. Hum Vaccin Immunother. 2014;10(12):3594-600.  https://doi.org/10.4161/hv.34426  PMID: 25483695 
  19. National Institute for Health Care Excellence (NICE). Clinical knowledge summaries: chickenpox. London: NICE; 2018.
  20. Samad L, Cortina-Borja M, Sutcliffe AG, Marven S, Cameron JC, El Bashir H, et al. National hospital data for intussusception: Data linkage and retrospective analysis to assess quality and use in vaccine safety surveillance. Vaccine. 2016;34(3):373-9.  https://doi.org/10.1016/j.vaccine.2015.11.041  PMID: 26667612 
  21. Hales CM, Harpaz R, Joesoef MR, Bialek SR. Examination of links between herpes zoster incidence and childhood varicella vaccination. Ann Intern Med. 2013;159(11):739-45.  https://doi.org/10.7326/0003-4819-159-11-201312030-00006  PMID: 24297190 
  22. Leung J, Harpaz R, Molinari N-A, Jumaan A, Zhou F. Herpes zoster incidence among insured persons in the United States, 1993-2006: evaluation of impact of varicella vaccination. Clin Infect Dis. 2011;52(3):332-40.  https://doi.org/10.1093/cid/ciq077  PMID: 21217180 
  23. Sauboin C, Holl K, Bonanni P, Gershon AA, Benninghoff B, Carryn S, et al. 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. BMC Infect Dis. 2019;19(1):126.  https://doi.org/10.1186/s12879-019-3759-z  PMID: 30727971 
  24. Clements DA, Zaref JI, Bland CL, Walter EB, Coplan PM. Partial uptake of varicella vaccine and the epidemiological effect on varicella disease in 11 day-care centers in North Carolina. Arch Pediatr Adolesc Med. 2001;155(4):455-61.  https://doi.org/10.1001/archpedi.155.4.455  PMID: 11296072 
  25. Goldman GS, King PG. Review of the United States universal varicella vaccination program: Herpes zoster incidence rates, cost-effectiveness, and vaccine efficacy based primarily on the Antelope Valley Varicella Active Surveillance Project data. Vaccine. 2013;31(13):1680-94.  https://doi.org/10.1016/j.vaccine.2012.05.050  PMID: 22659447 
Burden of varicella complications in secondary care, England, 2004 to 2017
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=James+Lopez+Bernal&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bernal James Lopez</a>, <a href="/search?value1=Peter+Hobbelen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hobbelen Peter</a>, <a href="/search?value1=Gayatri+Amirthalingam&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Amirthalingam Gayatri</a></span>. Burden of varicella complications in secondary care, England, 2004 to 2017. <a href="/content/ecdc">Euro Surveill.</a> 2019;24(42):pii=1900233. <a href="https://doi.org/10.2807/1560-7917.ES.2019.24.42.1900233" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2019.24.42.1900233</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 09 Apr 2019;&nbsp;&nbsp; <span class="generated">Accepted</span>: 19 Jul 2019 </span> </p>
/content/10.2807/1560-7917.ES.2019.24.42.1900233
/content/10.2807/1560-7917.ES.2019.24.42.1900233
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error