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Streng, Andrea; Grote, Veit; Carr, David; Hagemann, Christine; Liese, Johannes G.: Varicella routine vaccination and the effects on varicella epidemiology - results from the Bavarian Varicella Surveillance Project (BaVariPro), 2006-2011. In: BMC Infectious Diseases 2013, 13:303
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Abstract

Background: In 2004, routine varicella vaccination was recommended in Germany for children 11-14 months of age with one dose, and since 2009, with a second dose at 15-23 months of age. The effects on varicella epidemiology were investigated. Methods: Data on varicella vaccinations, cases and complications were collected from annual parent surveys (2006-2011), monthly paediatric practice surveillance (Oct 2006 - Sep 2011; five varicella seasons) and paediatric hospital databases (2005-2009) in the area of Munich (about 238,000 paediatric inhabitants); annual incidences of cases and hospitalisations were estimated. Results: Varicella vaccination coverage (1st dose) in children 18-36 months of age increased in two steps (38\%, 51\%, 53\%, 53\%, 66\% and 68\%); second-dose coverage reached 59\% in the 2011 survey. A monthly mean of 82 (62\%) practices participated; they applied a total of 50,059 first-dose and 40,541 second-dose varicella vaccinations, with preferential use of combined MMR-varicella vaccine after recommendation of two doses, and reported a total of 16,054 varicella cases <17 years of age. The mean number of cases decreased by 67\% in two steps, from 6.6 (95\% CI 6.1-7.0) per 1,000 patient contacts in season 2006/07 to 4.2 (95\% CI 3.9-4.6) in 2007/08 and 4.0 (95\% CI 3.6-4.3) in 2008/09, and further to 2.3 (95\% CI 2.0-2.6) in 2009/10 and 2.2 (95\% CI 1.9-2.5) in 2010/11. The decrease occurred in all paediatric age groups, indicating herd protection effects. Incidence of varicella was estimated as 78/1,000 children <17 years of age in 2006/07, and 19/1,000 in 2010/11. Vaccinated cases increased from 0.3 (95\% 0.2-0.3) per 1,000 patient contacts in 2006/07 to 0.4 (95\% CI 0.3-0.5) until 2008/09 and decreased to 0.2 (95\% CI 0.2-0.3) until 2010/11. The practices treated a total of 134 complicated cases, mainly with skin complications. The paediatric hospitals recorded a total of 178 varicella patients, including 40 (22.5\%) with neurological complications and one (0.6\%) fatality due to varicella pneumonia. Incidence of hospitalisations decreased from 7.6 per 100,000 children <17 years of age in 2005 to 4.3 in 2009, and from 21.0 to 4.7 in children <5 years of age. Conclusions: Overall, the results show increasing acceptance and a strong impact of the varicella vaccination program, even with still suboptimal vaccination coverage.