Materiały źródłowe

• #1 Chickenpox | Monitoring Vaccine Impact | Varicella | CDC

  http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/chickenpox/surveillance/monitoring-varicella.html

  Chickenpox used to be very common in the United States. In the early 1990s, an average of 4 million people got varicella, 10,500 to 13,000 were hospitalized (range, 8,000 to 18,000), and 100 to 150 died each year. […] Chickenpox vaccine became available in the United States in 1995. In 2014, 91% of children 19 to 35 months old in the United States had received one dose of varicella vaccine, varying from 83% to 95% by state. Among adolescents 13 to 17 years of age without a prior history of disease, 95% had received 1 dose of varicella vaccine, and 81% had received 2 doses of the vaccine. Eighty-five percent of adolescents had either a history of varicella disease or received 2 doses of varicella vaccine. […] Each year, more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented by varicella vaccination in the United States.

• #2 Epidemiology of varicella-zoster virus infection: Chickenpox – UpToDate

  https://www.uptodate.com/contents/epidemiology-of-varicella-zoster-virus-infection-chickenpox

  Epidemiology of varicella-zoster virus infection: Chickenpox […] The epidemiology of varicella has changed dramatically since the introduction of the varicella vaccine in 1995. In the United States, routine childhood immunization has reduced disease incidence, complications, hospital admissions, and deaths in children and in the general population, indicating strong herd immunity. Similar immunization programs have been adopted by several other countries, including Uruguay, Germany, Taiwan, Canada, and Australia. […] Prior to 1995 the Centers for Disease Control and Prevention (CDC) estimated the yearly incidence of chickenpox in the United States at approximately four million cases, with nearly 11,000 admissions and 100 deaths.

• #3

  https://www.who.int/publications/m/item/vaccine-preventable-diseases-surveillance-standards-varicella

  Varicella-zoster virus (VZV) causes both varicella (chickenpox) by primary infection and herpes zoster (HZ or shingles) by endogenous reactivation from latency. […] Acquisition of infection tends to be at a younger age in temperate countries ( 90% infected by adolescence in absence of vaccination programme), compared to an older distribution in tropical countries. […] VZV is highly contagious with secondary attack rates from varicella cases ranging from 61100%. […] Without vaccination, almost everyone in the population acquires wild-type varicella infection by adulthood.

• #4 Chapter 17: Varicella | Manual for the Surveillance of Vaccine-Preventable Diseases | CDC

  https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-17-varicella.html

  This chapter provides general guidance for vaccine-preventable disease surveillance, describing the disease background/epidemiology, case investigation and reporting/notification, disease case definitions, and activities for enhancing surveillance, case investigation, and outbreak control for varicella. […] Varicella vaccine was licensed and has been recommended in the United States since 1995. A two-dose series is recommended, with routine administration of the first dose at 12-15 months of age and the second dose at 4-6 years of age. […] Attaining and maintaining high vaccine coverage led to substantial declines in varicella morbidity and mortality in the United States. Overall, by 2018-2019, varicella incidence declined 97% based on data from four states that have continuously reported varicella cases to the National Notifiable Diseases Surveillance System (NNDSS) since before the varicella vaccination program.

• #5 Monitoring Varicella Vaccine Impact on Varicella Incidence in the United States: Surveillance Challenges and Changing Epidemiology, 1995-2019 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36265855/

  Surveillance is critical for monitoring vaccine impact. Varicella surveillance challenges predated varicella vaccine US licensure in 1995. […] By the end of the 1-dose program in 2005, incidence had declined 90% in the active surveillance areas, with significant declines occurring in all age groups within 5 years of program implementation. Additional declines occurred during the 2-dose program leading to 97% decline in incidence over the 25 years of program implementation through 2019, based on data from 4 states with continuous passive reporting. […] Surveillance showed that declines were highest among children and adolescents covered by the routine vaccination recommendations but occurred in all age groups. Although surveillance systems changed and were adapted to reflect evolving epidemiology, data consistently demonstrated decreasing varicella incidence following the vaccination program implementation. The vaccination program dramatically decreased virus circulation and increased community protection. Continued and improved varicella surveillance is needed to accurately monitor disease epidemiology and further guide prevention efforts.

• #6 Chapter 17: Varicella | Manual for the Surveillance of Vaccine-Preventable Diseases | CDC

  https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-17-varicella.html

  The varicella vaccination program has also substantially reduced the number of outbreaks in the U.S. Additionally, outbreak size and duration declined from a median of 15 cases per outbreak and 45 days duration early in the vaccination program to 7 cases and 30 days duration during the mature phase of the vaccination program. […] Varicella surveillance helps to facilitate public health actions at the state and local level and to monitor the impact of the varicella vaccination program. Specifically, surveillance data are needed to document and monitor the impact of the vaccination program on disease incidence, morbidity, and mortality; characterize and understand changes in the burden of disease; characterize populations requiring additional disease control measures; detect and respond to outbreaks; evaluate the effectiveness of prevention strategies; and assess for waning of immunity.

• #7 Chickenpox Now Rare In U.S. Due To Routine Vaccination

  https://www.idsociety.org/news–publications-new/articles/2022/chickenpox-now-rare-in-u.s.-due-to-routine-vaccination

  The United States was the first country to start universally vaccinating children against varicella (chickenpox) in 1995. […] Vaccination decreased cases of the disease in the United States by 97% and hospitalizations and deaths among individuals under 20 by 97% and 99%, respectively. […] Researchers estimate the chickenpox vaccine now prevents more than 3.8 million cases, 10,500 hospitalizations and 100 deaths in the United States each year, indicating the tremendous success of the vaccine campaign. […] As more children were vaccinated, chickenpox transmission decreased significantly in the general population (97%). […] Researchers urge clinicians to remain vigilant and for continued support for the U.S. vaccination program.

• #8 The epidemiology of varicella and effectiveness of varicella vaccine in Ganyu, China: a long-term community surveillance study | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-16304-4

  The insufficient vaccination coverage (37.1%) may have contributed in part to the rising annual incidence of varicella infection, and a shift of varicella cases to older age groups occurred. […] The effectiveness of one dose of varicella vaccine was moderate and waned over time. It is urgent to increase varicella vaccine coverage to 80% to reduce the incidence of varicella and prevent any potential shift in the age at infection in China. […] The effectiveness of the two-dose varicella vaccine can provide higher protection against varicella infections than the one-dose varicella vaccine (92% vs. 81%). […] The two-dose schedule of varicella has been recommended since 2012 in some districts of China to further control the outbreaks of varicella. […] The overall adjusted effectiveness of one dose of varicella vaccine was 56.5%.

• #9 The epidemiology of varicella and effectiveness of varicella vaccine in Ganyu, China: a long-term community surveillance study | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-16304-4

  The effectiveness of the one-dose varicella vaccine decreased steadily with the follow-up time. The adjusted VE of the one-dose group was 72.9% during the initial 4 year and decreased to 41.8% during years 7 to 12. […] The significant increase in incidence since 2017 may due to a further decrease in vaccination coverage and an increased sensitivity of varicella surveillance since varicella designation as a Class C infectious disease in Jiangsu Province. […] Therefore, it is urgent to increase the varicella vaccine coverage to 80% to reduce the incidence of varicella and prevent any potential shift in the age at infection in China.

• #10 Chickenpox Reporting and Surveillance | Chickenpox (Varicella) | CDC

  https://www.cdc.gov/chickenpox/php/conducting-surveillance/index.html

  Learn why varicella (chickenpox) surveillance data are needed, the definitions for varicella clinical cases, how to classify cases as probable or confirmed, and how to report varicella deaths. […] Document and monitor the impact of the varicella vaccination program on varicella morbidity and mortality. […] Describe clinical and epidemiological characteristics of varicella cases during the varicella vaccination program. […] Evaluate the effectiveness of chickenpox prevention strategies. […] Evaluate chickenpox vaccine effectiveness under conditions of routine use. […] In 2002, the Council of State and Territorial Epidemiologists (CSTE) recommended that states establish case-based surveillance for varicella by 2005. […] As of 2020, 39 states have been conducting case-based varicella surveillance. […] In 1998, CSTE recommended that varicella-related deaths be placed under national surveillance. […] As of January 1, 1999, varicella-related deaths became nationally notifiable to CDC. […] Since varicella is vaccine preventable, all deaths due to varicella should be investigated.

• #11 Chapter 17: Varicella | Manual for the Surveillance of Vaccine-Preventable Diseases | CDC

  https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-17-varicella.html

  Each state and territory has regulations or laws governing the reporting of diseases and conditions of public health importance. These regulations and laws list the diseases to be reported and describe the persons or institutions responsible for reporting, including healthcare providers, hospitals, laboratories, schools, childcare facilities, and other institutions. […] Notifications for confirmed or probable cases of varicella should be sent to CDC using event code 10030 through National Notifiable Diseases Surveillance System (NNDSS). Case notifications should not be delayed because of incomplete information or lack of confirmation. Data can be updated electronically as more information becomes available.

• #12 Safety Surveillance of Varicella Vaccines in the Vaccine Adverse Event Reporting System, United States, 2006-2020 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36265846/

  The Vaccine Adverse Event Reporting System (VAERS) is the United States national passive vaccine safety surveillance system. […] We updated the data on the safety of single-antigen varicella vaccine (VAR) and assessed the safety of combination measles, mumps, rubella, and varicella vaccine (MMRV) licensed in the United States using VAERS data. […] During 2006-2020, approximately 132.8 million VAR doses were distributed; 40 684 reports were received in VAERS (30.6/100 000 doses distributed), with 4.1% classified as serious (1.3/100 000 doses distributed). […] Approximately 35.5 million MMRV doses were distributed; 13 325 reports were received (37.6/100 000 doses distributed) with 3.3% classified as serious (1.3/100 000 doses distributed). […] No new or unexpected safety findings were detected for VAR and MMRV given as recommended, reinforcing the favorable safety profiles of these vaccines. […] Keywords: epidemiology; postmarketing; surveillance; vaccine safety; varicella vaccine.

• #13 Surveillance of Adverse Events Following Varicella Vaccine Immunization in Zhejiang Province, China, from 2020 to 2022

  https://www.mdpi.com/2076-393X/13/1/57

  Surveillance of Adverse Events Following Varicella Vaccine Immunization in Zhejiang Province, China, from 2020 to 2022 […] This study aimed to describe VarV-related adverse events following immunization (AEFIs) and analyze their characteristics in Zhejiang, China, 2020–2022. […] VarV-related AEFIs in Zhejiang Province from 1 January 2020 to 31 December 2022 were collected through the Chinese National AEFI Information System (CNAEFIS) for a descriptive epidemiological analysis. […] The reported incidence rate of VarV-related AEFIs in Zhejiang Province from 2020 to 2022 was 34.79/100,000 doses, with no statistical significance by year. […] The distribution of VarV-related AEFIs varied significantly by age, dose, severity, and season. […] VarV-related AEFIs were more likely to be non-severe adverse events that occurred in the summer and winter seasons following the first dose of vaccine and among those under 3 years old.

• #14 Varicella (Chickenpox) – Canada.ca

  https://www.canada.ca/en/public-health/services/immunization/vaccine-preventable-diseases/varicella-chickenpox.html

  Varicella can be prevented by immunization. The National Advisory Committee on Immunization (NACI) recommends that healthy children 12 months to 12 years of age should receive two doses of varicella-containing vaccine (univalent varicella or MMRV) for primary immunization. […] In the pre-vaccine era, approximately 350,000 varicella cases were estimated to occur each year in Canada. However, assessing the effect of varicella immunization programs on the incidence of varicella is difficult because varicella infections are significantly under-reported, less than 10% of the expected cases being reported through the Canadian Notifiable Disease Surveillance System (CNDSS) annually. […] In Canada, limited surveillance information on varicella is available through Canadian Notifiable Disease Surveillance System (CNDSS) and Immunization Monitoring Program, ACTive (IMPACT).

• #15 Varicella vaccine – Wikipedia

  https://en.wikipedia.org/wiki/Varicella_vaccine

  Varicella vaccine, also known as chickenpox vaccine, is a vaccine that protects against chickenpox. One dose of vaccine prevents 95% of moderate disease and 100% of severe disease. Two doses of vaccine are more effective than one. If given to those who are not immune within five days of exposure to chickenpox it prevents most cases of the disease. Vaccinating a large portion of the population also protects those who are not vaccinated. The World Health Organization (WHO) recommends routine vaccination only if a country can keep more than 80% of people vaccinated. If only 20% to 80% of people are vaccinated it is possible that more people will get the disease at an older age and outcomes overall may worsen. In the United States two doses are recommended starting at twelve to fifteen months of age. As of 2017, twenty-three countries recommend all non-medically exempt children receive the vaccine, nine recommend it only for high-risk groups, three additional countries recommend use in only parts of the country, while other countries make no recommendation. Vaccines are less effective among high-risk patients, as well as being more dangerous because they contain attenuated live viruses. The risk of developing shingles is reduced for children who receive the varicella vaccine, but not eliminated. The risk of shingles is significantly lower among children who have received varicella vaccination, including those who are immunocompromised. A population with high varicella vaccination also has lower incidence of shingles in unvaccinated children, due to herd immunity. The WHO recommends one or two doses with the initial dose given at 12 to 18 months of age. The varicella vaccine is not recommended for seriously ill people, pregnant women, people who have tuberculosis, people who have experienced a serious allergic reaction to the varicella vaccine in the past, people who are allergic to gelatin, people allergic to neomycin, people receiving high doses of steroids, people receiving treatment for cancer with x-rays or chemotherapy, as well as people who have received blood products or transfusions during the past five months.

• #16 Chickenpox | Monitoring Vaccine Impact | Varicella | CDC

  http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/chickenpox/surveillance/monitoring-varicella.html

  Varicella incidence, based on national passive surveillance data published in 2012, declined 79% during 2000-2010 in 31 states that met CDCs criteria for adequate and consistent reporting. From this same data source, incidence declined 72% during 2006-2010, after a routine second dose of varicella vaccine was recommended. Varicella incidence from 2 active surveillance sites declined 98% during 1995-2010. […] Varicella outbreaks declined 78%, from 147 in 2005 to 33 outbreaks in 2012 based on passive surveillance data from 6 states. Varicella outbreaks from one active surveillance site declined 95%, from 236 outbreaks during 1995 to 1998 to 12 outbreaks during 2007 to 2010. Outbreaks also decreased in size (as measured by number of varicella cases per outbreak), and duration. […] Varicella hospitalizations declined 93% in 2012 versus the pre-vaccine period; during the 2-dose varicella vaccination period (2006-2012), hospitalizations declined 38%.

• #17 Chickenpox | Monitoring Vaccine Impact | Varicella | CDC

  http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/chickenpox/surveillance/monitoring-varicella.html

  Varicella deaths declined by 87% during 2008 to 2011 as compared to 1990 to 1994 based on data from the National Center for Health Statistics (NCHS). In children and adolescents less than 20 years of age, varicella deaths declined by 99% during 2008 to 2011 as compared with 1990 to 1994. […] Varicella vaccination provides indirect benefits to people who are not eligible for vaccination. Varicella incidence among infants, a group not eligible for varicella vaccination, declined by 90% from 1995 to 2008. […] CDC is monitoring the effects of varicella vaccination on the epidemiology of herpes zoster in the United States. Studies indicate that overall rates of herpes zoster appear to be increasing, however, introduction of the varicella vaccine does not seem to be affecting this increase.

• #18 Varicella Zoster | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/information-other-diseases-and-conditions-fact-sheets/varicella-zoster

  Varicella is highly infectious, with secondary infection rates in susceptible household contacts approaching 90%. […] In the prevaccine era (prior to 1995), most cases of varicella in the United States occurred in children younger than 10. With the implementation of universal immunization, a higher proportion of cases are expected to occur among adolescents and adults. […] In sites conducting active surveillance, cases of breakthrough disease have increased as a percentage of all cases from 4% in 1995 to 25% in 2000. This should not be confused as an increasing rate of breakthrough disease or as evidence of increasing vaccine failure. […] The Council of State and Territorial Epidemiologists (CSTE) surveillance case definitions for Varicella can be found at: www.cdc.gov/osels/ph_surveillance/nndss/phs/infdis.htm#top. […] Varicella is not currently a nationally notifiable disease, and surveillance data are limited.

• #19 JMIR Public Health and Surveillance – Epidemiological Characteristics of Varicella in Anhui Province, China, 2012-2021: Surveillance Study

  https://publichealth.jmir.org/2024/1/e50673

  From 2012 to 2021, there were 276,115 cases of varicella and 4 deaths in Anhui, and the average annual incidence was 44.8 per 100,000. […] The reported incidence of varicella in Anhui increased by approximately 20% annually from 2012 to 2019, with a 10-year average incidence of 44.8 per 100,000, which is largely consistent with the rising trend in other regions of China. […] The higher incidence of varicella in Anhui may be related to the increased sensitivity of infectious disease surveillance in recent years but also may be related to the insufficient coverage of vaccination. […] The varicella vaccine is not currently included in the routine immunization program in China and there is no universal two-dose varicella vaccination, which may explain the high disease burden of varicella in Anhui.

• #20 JMIR Public Health and Surveillance – Epidemiological Characteristics of Varicella in Anhui Province, China, 2012-2021: Surveillance Study

  https://publichealth.jmir.org/2024/1/e50673

  The spatial and temporal distributions of varicella were not random in Anhui. […] The most likely clusters of varicella in Anhui were located in the more economically developed areas of Hefei and in the southeast region of the province. […] Therefore, the true reasons for the overall difference in incidence between northern and southern Anhui need to be thoroughly explored. […] Measures should be taken in the future to strengthen varicella prevention and control in the key populations and regions identified in this study.

• #21 Journal of Medical Internet Research – Using Baidu Index Data to Improve Chickenpox Surveillance in Yunnan, China: Infodemiology Study

  https://www.jmir.org/2023/1/e44186/

  Chickenpox is an old but easily neglected infectious disease. Although chickenpox is preventable by vaccines, vaccine breakthroughs often occur, and the chickenpox epidemic is on the rise. […] The Baidu index (BDI) can supplement the traditional surveillance system for infectious diseases, such as brucellosis and dengue, in China. […] The analysis showed that there was a close correlation between the weekly number of newly diagnosed cases and the BDI. […] These findings indicated that the BDI in Yunnan Province can predict the incidence of chickenpox in the same period. Thus, the BDI is a useful tool for monitoring the chickenpox epidemic and for complementing traditional monitoring systems. […] Currently, problems such as low chickenpox vaccine coverage, the breakthrough of the chickenpox vaccine, the lack of attention to chickenpox disease, imperfect chickenpox surveillance reports, and the lack of public information on chickenpox epidemics are still present in China.

• #22 Journal of Medical Internet Research – Using Baidu Index Data to Improve Chickenpox Surveillance in Yunnan, China: Infodemiology Study

  https://www.jmir.org/2023/1/e44186/

  The current chickenpox surveillance system in China is flawed and incomplete. The flawed surveillance system and the lack of public information on chickenpox outbreaks have led to a weak response to chickenpox outbreaks in China. […] Therefore, the use of internet data for disease surveillance has the potential to revolutionize disease prevention and control efforts. […] This study explores the potential of using internet data for disease surveillance, with a focus on chickenpox. […] The BDI reflects changes in public interest in various events over a period of time. […] Therefore, in future studies, we should also consider additional influencing factors related to chickenpox outbreaks, such as climate, economy, and vaccination status, for a comprehensive analysis to achieve accurate prediction of chickenpox incidence.

• #23 Impact of Varicella Immunization and Public Health and Social Measures on Varicella Incidence: Insights from Surveillance Data in Shanghai, 2013–2022

  https://www.mdpi.com/2076-393X/11/11/1674

  To evaluate the impact of a two-dose VarV program on varicella incidence among the whole population, considering the influence of public health and social measures (PHSMs), we extracted surveillance data on varicella cases during 2013–2022 in Minhang, Shanghai. […] The implementation of the two-dose VarV strategy was followed by a significant decrease in varicella incidence (−1.84% per month). […] The WHO recommends universal vaccination in places where varicella remains a public health problem. […] In this study, the main objective was to evaluate the impact of a two-dose VarV immunization program on varicella incidence using surveillance data from 2013 to 2022 in Minhang, Shanghai. […] The two-dose VarV program was implemented in Shanghai in 2017 and has been included in local immunization program since August 2018.

• #24

  https://link.springer.com/article/10.1007/s40121-023-00899-7

  Varicella (chickenpox) is an infectious disease caused by the varicella zoster virus affecting children, adolescents, and adults. Varicella is prevalent globally and has a significant burden. The World Health Organization estimates the annual global burden of varicella to be approximately 140 million cases with 4.2 million severe complications requiring hospitalisation, and 4200 deaths. Varicella is highly contagious, with an incubation period of 14-16 days after exposure, and is transmitted through airborne droplets, as well as through direct contact with skin lesions. In the absence of a universal varicella vaccination (UVV) programme, most infections occur during childhood. However, some geographic variation in the age at which varicella occurs can be observed. Across Europe, varicella incidence is the highest among children less than 5 years of age and ranges from 70-52 to 17,974 per 100,000 population. In tropical regions, adults are observed to acquire the infection more frequently.

• #25

  https://link.springer.com/article/10.1007/s40121-023-00899-7

  Results suggest that different types of varicella-associated complications could be frequent, impacting quality of life, and healthcare resource utilisation and budgets. These findings are crucial to raise awareness of the health and economic burden of varicella disease. […] Many complications have been reported in the literature; however, a comprehensive global synthesis of all complications has not yet been conducted. Therefore, we aimed to quantify the global prevalence of varicella-associated complications using a systematic literature review (SLR) and meta-analysis approach following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards for medical and epidemiological evidence syntheses. […] The highest pooled prevalence was seen for the complication categories severe varicella (22.42%; 95% CI 10.1337.77), skin-related complications (20.12%; 95% CI 15.4825.20), and infection-related complications (10.03%; 95% CI 7.4712.90). The lowest pooled prevalence was seen for the complication categories cardiovascular (0.55%; 95% CI 0.081.33), genitourinary (1.17%; 95% CI 0.551.99), and musculoskeletal (1.54%; 95% CI 1.062.11).

• #26

  https://link.springer.com/article/10.1007/s40121-023-00899-7

  Severe varicella had the highest pooled prevalence (22.42%) but with wide confidence intervals. This may be due to complications included within this category being non-specific (i.e. extreme varicella) or that such a broad category could cover combinations of complications across several organs. In addition, all patients within this category were hospitalised, thereby leading to a higher prevalence compared with other groups. […] Since the introduction of a UVV strategy in Germany, Greece, Italy, and Spain, a decrease in incidence, hospitalisations, and complications has been observed in Europe, while breakthrough varicella cases are usually mild. It was expected that a lower proportion of vaccinated patients would experience complications when compared with unvaccinated patients, and this was confirmed for the complication groups that showed a significant difference: haematological (0.46% vs 3.76%), neurological (0.74% vs 6.85%), and skin-related (0.83% vs 15.93%). […] This study provides valuable insights into the burden of varicella-related complications and its global prevalence. The findings of this study could be used for clinical decision-making and in future economic analyses to capture the costs and health impacts of varicella disease.

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