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      Antibody induced by one-dose varicella vaccine soon became weak in children: evidence from a cross-sectional seroepidemiological survey in Beijing, PRC

      research-article
      , , ,
      BMC Infectious Diseases
      BioMed Central
      Chickenpox, Varicella, Seroprevalence, Vaccine failure

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          Abstract

          Background

          Numerous post-licensure studies, mostly from field epidemiological evidences such as outbreak surveys, have demonstrated the effectivenesss and insufficiency of one-dose varicella vaccine in outbreak control. Serological evidence of immunization failure is, however, relatively less reported in contrast. A cross-sectional seroepidemiological survey of Beijing residents was performed in 2012 in the People’s Republic of China, after the one-dose varicella vaccine had been widely used for several years.

          Methods

          Multistage stratified random sampling method was designed to recruit 2 144 subjects. The ELISA method was used to test the present blood samples collected and the reserve samples collected in 2008 to assess the trends of anti-VZV seroprevalence in the past 5 years and to determine the risk factors for varicella infection.

          Results

          The age- and sex- adjusted overall anti-VZV seropositivity of Beijing residents in 2012 was 84.5 %. Two groups’ adjusted overall anti-VZV seroprevalence in 2012 showed obvious growth compared with 2008 (<1 yr old: from 6.3 % to 16.9 %; 1-4 yr old: from 27.6 % to 57.2 %). Reported one-dose vaccination history was 71.6 % (149/208), 80.9 % (182/225) and 82.2 % (180/219) in the 1-4 yr, 5-9 yr, 10-14 yr age groups, respectively. Of subjects who had received the one-dose vaccine, 36 % (216/603) showed negative anti-VZV concentrations (<110 mIU/mL); additionally 15.9 % (96/603) of such subjects’ anti-VZV concentrations were in the lowest positive concentration group (110-299 mIU/mL). Seropositivity in permanent residents of 1-9 yr old with verified vaccination was merely 61.8 %. Various age groups (1-3 yr, 4-6 yr, and 7-9 yr) all showed seropositivity that gradually decreased with increasing of the interval between vaccination and blood sampling.

          Conclusion

          Mass varicella vaccination significantly improved the immunity of younger Beijing residents. However, vaccine-induced anti-VZV antibody soon became weak in children with high coverage (approximately 80 %) after vaccination for several years which is significantly higher than reported in pre-licensure studies. A government-funded 2-dose immunization program with mandatory vaccination schedule for Beijing residents may need consideration in the near future.

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          Most cited references18

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          Varicella disease after introduction of varicella vaccine in the United States, 1995-2000.

          Before licensure of varicella vaccine in 1995, varicella was a universal childhood disease in the United States, causing 4 million cases, 11,000 hospitalizations, and 100 deaths every year. To examine population-based disease surveillance data in 3 communities to document the impact of the varicella vaccination program. Active surveillance for varicella conducted among the populations of Antelope Valley, Calif; Travis County, Tex; and West Philadelphia, Pa; from January 1, 1995, to December 31, 2000. Reporting sites included child care centers, schools, universities, physicians, public health clinics, hospitals, emergency departments, and households. Trends in number and rate of varicella cases and hospitalizations; varicella vaccine coverage. From 1995 through 1998, in each surveillance area, the number of verified varicella cases varied from year to year with marked springtime seasonality. In 1999, the number and rates of varicella cases and hospitalizations declined markedly. From 1995 through 2000, in Antelope Valley, Travis County, and West Philadelphia, varicella cases declined 71%, 84%, and 79%, respectively. Cases declined to the greatest extent among children aged 1 to 4 years, but cases declined in all age groups, including infants and adults. In the combined 3 surveillance areas, hospitalizations due to varicella declined from a range of 2.7 to 4.2 per 100,000 population in 1995 through 1998 to 0.6 and 1.5 per 100,000 population in 1999 and 2000, respectively (P =.15). By 2000, vaccine coverage among children aged 19 to 35 months was 82.1%, 73.6%, and 83.8% in Los Angeles County, Texas, and Philadelphia County, respectively. Varicella disease has declined dramatically in surveillance areas with moderate vaccine coverage. Continued implementation of existing vaccine policies should lead to further reductions of varicella disease in these communities and throughout the United States.
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            Ten year follow-up of healthy children who received one or two injections of varicella vaccine.

            The rate of varicella and persistence of varicella antibody after a one dose vs. a two dose regimen of varicella virus vaccine live Oka/Merck (VARIVAX; Merck & Co., Inc., West Point, PA) in approximately 2000 children were compared during a 9- to 10-year follow-up period. Children 12 months to 12 years of age with a negative history of varicella were randomized in late 1991 to early 1993 to receive either one or two injections of varicella vaccine given 3 months apart. Subjects were actively followed for varicella, any varicella-like illness or zoster and any exposures to varicella or zoster on a yearly basis for 10 years after vaccination. Persistence of varicella antibody was measured yearly for 9 years. Most cases of varicella reported in recipients of one or two injections of vaccine were mild. The risk of developing varicella >42 days postvaccination during the 10-year observation period was 3.3-fold lower (P < 0.001) in children who received two injections than in those who received one injection (2.2% vs. 7.3%, respectively). The estimated vaccine efficacy for the 10-year observation period was 94.4% for one injection and 98.3% for two injections (P < 0.001). Measurable serum antibody persisted for 9 years in all subjects. Administration of either one or two injections of varicella vaccine to healthy children results in long term protection against most varicella disease. The two dose regimen was significantly more effective than a single injection.
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              Decline in mortality due to varicella after implementation of varicella vaccination in the United States.

              Varicella disease has been preventable in the United States since 1995. Starting in 1999, active and passive surveillance data showed sharp decreases in varicella disease. We reviewed national death records to assess the effect of the vaccination program on mortality associated with varicella. Data on deaths for which varicella was listed as an underlying or contributing cause were obtained from National Center for Health Statistics Multiple Cause-of-Death Mortality Data for 1990 through 2001. We calculated the numbers and rates of death due to varicella according to age, sex, race, ethnic background, and birthplace. The rate of death due to varicella fluctuated from 1990 through 1998 and then declined sharply. For the interval from 1990 through 1994, the average number of varicella-related deaths was 145 per year (varicella was listed as the underlying cause in 105 deaths and as a contributing cause in 40); it then declined to 66 per year during 1999 through 2001. For deaths for which varicella was listed as the underlying cause, age-adjusted mortality rates dropped by 66 percent, from an average of 0.41 death per 1 million population during 1990 through 1994 to 0.14 during 1999 through 2001 (P<0.001). This decline was observed in all age groups under 50 years, with the greatest reduction (92 percent) among children 1 to 4 years of age. In addition, by the period from 1999 through 2001, the average rates of mortality due to varicella among all racial and ethnic groups were below 0.15 per 1 million population, as compared with rates ranging from 0.37 per 1 million for whites to 0.66 per 1 million for other races in the period from 1990 through 1994. The program of universal childhood vaccination against varicella in the United States has resulted in a sharp decline in the rate of death due to varicella. Copyright 2005 Massachusetts Medical Society.
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                Author and article information

                Contributors
                suoluodan2004@163.com
                86-10-64407097 , Lulibj@sina.com
                Chenmengx@hotmail.com
                pxh17@sina.com
                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                10 November 2015
                10 November 2015
                2015
                : 15
                : 509
                Affiliations
                Beijing Center for Disease Control and Prevention (CDC), Capital Medical Unversity School of Public Health and Family Medicine, 16 Hepingli Zhongjie, Dongcheng Dist, Beijing 100013 P. R. China
                Article
                1236
                10.1186/s12879-015-1236-x
                4641405
                26554449
                a7fc7a7e-0562-4f2a-9a7c-8a18ab71e10e
                © Suo et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 20 May 2015
                : 19 October 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Infectious disease & Microbiology
                chickenpox,varicella,seroprevalence,vaccine failure
                Infectious disease & Microbiology
                chickenpox, varicella, seroprevalence, vaccine failure

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