Mona Marin1, H Cody Meissner, Jane F Seward. 1. Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS A-47, Atlanta, GA 30333, USA. mmarin@cdc.gov
Abstract
OBJECTIVE: In 1995, the United States was the first country to introduce a universal 1-dose childhood varicella vaccination program. In 2006, the US varicella vaccine policy was changed to a routine 2-dose childhood program, with catchup vaccination for older children. The objective of this review was to summarize the US experience with the 1-dose varicella vaccination program, present the evidence considered for the policy change, and outline future challenges of the program. METHODS: We conducted a review of publications identified by searching PubMed for the terms "varicella," "varicella vaccine," and "herpes zoster." The search was limited to US publications except for herpes zoster; we reviewed all published literature on herpes zoster incidence. RESULTS: A single dose of varicella vaccine was 80% to 85% effective in preventing disease of any severity and >95% effective in preventing severe varicella and had an excellent safety profile. The vaccination program reduced disease incidence by 57% to 90%, hospitalizations by 75% to 88%, deaths by >74%, and direct inpatient and outpatient medical expenditures by 74%. The decline of cases plateaued between 2003 and 2006, and outbreaks continued to occur, even among highly vaccinated school populations. Compared with children who received 1 dose, in 1 clinical trial, 2-dose vaccine recipients developed in a larger proportion antibody titers that were more likely to protect against breakthrough disease and had a 3.3-fold lower risk for breakthrough disease and higher vaccine efficacy. Two studies showed no increase in overall herpes zoster incidence, whereas 2 others showed an increase. CONCLUSIONS: A decade of varicella prevention in the United States has resulted in a dramatic decline in disease; however, even with high vaccination coverage, the effectiveness of 1 dose of vaccine did not generate sufficient population immunity to prevent community transmission. A 2-dose varicella vaccine schedule, therefore, was recommended for children in 2006. Data are inconclusive regarding an effect of the varicella vaccination program on herpes zoster epidemiology.
OBJECTIVE: In 1995, the United States was the first country to introduce a universal 1-dose childhood varicella vaccination program. In 2006, the US varicella vaccine policy was changed to a routine 2-dose childhood program, with catchup vaccination for older children. The objective of this review was to summarize the US experience with the 1-dose varicella vaccination program, present the evidence considered for the policy change, and outline future challenges of the program. METHODS: We conducted a review of publications identified by searching PubMed for the terms "varicella," "varicella vaccine," and "herpes zoster." The search was limited to US publications except for herpes zoster; we reviewed all published literature on herpes zoster incidence. RESULTS: A single dose of varicella vaccine was 80% to 85% effective in preventing disease of any severity and >95% effective in preventing severe varicella and had an excellent safety profile. The vaccination program reduced disease incidence by 57% to 90%, hospitalizations by 75% to 88%, deaths by >74%, and direct inpatient and outpatient medical expenditures by 74%. The decline of cases plateaued between 2003 and 2006, and outbreaks continued to occur, even among highly vaccinated school populations. Compared with children who received 1 dose, in 1 clinical trial, 2-dose vaccine recipients developed in a larger proportion antibody titers that were more likely to protect against breakthrough disease and had a 3.3-fold lower risk for breakthrough disease and higher vaccine efficacy. Two studies showed no increase in overall herpes zoster incidence, whereas 2 others showed an increase. CONCLUSIONS: A decade of varicella prevention in the United States has resulted in a dramatic decline in disease; however, even with high vaccination coverage, the effectiveness of 1 dose of vaccine did not generate sufficient population immunity to prevent community transmission. A 2-dose varicella vaccine schedule, therefore, was recommended for children in 2006. Data are inconclusive regarding an effect of the varicella vaccination program on herpes zoster epidemiology.
Authors: Donald R Latner; Marcia McGrew; Nobia Williams; Luis Lowe; Roniel Werman; Eli Warnock; Kathleen Gallagher; Peter Doyle; Sandra Smole; Susan Lett; Noelle Cocoros; Alfred DeMaria; Raimond Konomi; Cedric J Brown; Paul A Rota; William J Bellini; Carole J Hickman Journal: Clin Vaccine Immunol Date: 2010-11-03
Authors: Murli U Purswani; Brad Karalius; Tzy-Jyun Yao; D Scott Schmid; Sandra K Burchett; George K Siberry; Kunjal Patel; Russell B Van Dyke; Ram Yogev; Robert H Lurie; Ram Yogev; Margaret Ann Sanders; Kathleen Malee; Scott Hunter; William Shearer; Mary Paul; Norma Cooper; Lynnette Harris; Murli Purswani; Mahboobullah Baig; Anna Cintron; Ana Puga; Sandra Navarro; Patricia Garvie; James Blood; Sandra Burchett; Nancy Karthas; Betsy Kammerer; Andrew Wiznia; Marlene Burey; Molly Nozyce; Arry Dieudonne; Linda Bettica; Susan Adubato; Janet Chen; Maria Garcia Bulkley; Latreaca Ivey; Mitzie Grant; Katherine Knapp; Kim Allison; Megan Wilkins; Midnela Acevedo-Flores; Heida Rios; Vivian Olivera; Margarita Silio; Medea Jones; Patricia Sirois; Stephen Spector; Kim Norris; Sharon Nichols; Elizabeth McFarland; Alisa Katai; Jennifer Dunn; Suzanne Paul; Gwendolyn Scott; Patricia Bryan; Elizabeth Willen Journal: Clin Infect Dis Date: 2015-09-18 Impact factor: 9.079