Trends in varicella and herpes zoster epidemiology before and after the implementation of universal one-dose varicella vaccination over one decade in South Korea, 2003-2015.

Authors:
Sun Hee Park
Sun Hee Park
College of Medicine
South Korea
Sanghyun Park
Sanghyun Park
Stanford University
United States
Si-Hyun Kim
Si-Hyun Kim
College of Medicine
South Korea
Dong-Gun Lee
Dong-Gun Lee
The Rheumatism Research Center
Wichita | United States
Jung-Hyun Choi
Jung-Hyun Choi
Namseoul University
Cheonan | South Korea

Hum Vaccin Immunother 2019 Apr 22:1-7. Epub 2019 Apr 22.

b Vaccine Bio Research Institute, College of Medicine , The Catholic University of Korea , Seoul , Republic of Korea.

Background: In South Korea, the one-dose varicella vaccine was included in the National Immunization Program for children aged 12-15 months in 2005, and the vaccine coverage reached >95%. The impact of varicella vaccination on varicella and herpes zoster (HZ) was investigated, accounting for demographic changes over time.

Methods: We calculated the crude and age-sex standardized incidence rates (IRs) and age-specific IRs of varicella and HZ from 2003 to 2015, using the National Health Information Database including approximately 50 million Koreans. The annual incidence rate ratios (IRRs) were calculated using a negative binomial regression analysis, adjusting for age and sex.

Results: The crude varicella IR steadily declined by 67%, from 5.70/1000 to 1.87/1000 person years (IRR per year: 0.91; 95% CI 0.89-0.93), but the adjusted IRs showed a significant decline only during 2010-2015 (adjusted IRR per year: 0.90; 95% CI 0.88-0.93). The greatest decline was found in children ≤4 years of age, whereas the IR increased until 2011 and then declined afterward in children aged 5-9 years, who represented the highest incidence age group in 2013-2015. The crude HZ IR increased from 2.67/1000 to 9.80/1000 person years (IRR per year: 1.12; 95% CI 1.10-1.15), and the adjusted IR also followed the same trend. A similar increasing trend was observed before and after universal vaccination.

Conclusions: One-dose varicella vaccination was moderately effective in preventing varicella, but this strategy was insufficient to interrupt varicella transmission in children. Furthermore, the HZ incidence dramatically increased over this decade. The current vaccination strategy against varicella-zoster disease should be reconsidered.

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http://dx.doi.org/10.1080/21645515.2019.1603985DOI Listing
April 2019
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References

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Article in Proc R Soc Med
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Proc R Soc Med 1965

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