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Pediatr Infect Dis J. 2008 Feb;27(2):119-24. doi: 10.1097/INF.0b013e3181586665.

The burden of varicella complications before the introduction of routine varicella vaccination in Germany.

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  • 1Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany. johannes.liese@med.uni-muenchen.de

Abstract

BACKGROUND:

The true burden of varicella complications in Germany is not known. We investigated the incidence and pattern of varicella complications in children and adolescents using 3 independent surveillance sources.

METHODS:

Prospective nationwide surveillance in all pediatric hospitals through the German Pediatric Surveillance Unit [Erhebungseinheit für Seltene Pädiatrische Erkrankungen in Deutschland (ESPED)] was used to ascertain hospitalized varicella cases in children <or=16 years of age between January 2003 and December 2004. In the federal state, North-Rhine Westphalia (NRW), a practice sentinel network [European Diabetes Study Group (EURODIAB)] and pediatric hospital based International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) surveillance were additionally used to refine incidence estimates via capture-recapture methodology.

RESULTS:

A total of 918 hospitalized varicella patients (male-to-female: 55%/45%) with a median age of 3.3 years (interquartile range, 1.4-5.2) and a median hospital stay of 5 days (interquartile range, 3-8) were reported. Varicella associated complications occurred in 80% of the hospitalizations, most frequently being neurologic (25.4%), skin infectious (23.2%), and gastrointestinal tract complications (15.0%). Most hospitalizations (77%) occurred in previously healthy children. A predisposing condition existed in 207 children (23%): immunosuppression 7%, atopic dermatitis 7%, and other underlying chronic conditions 9%. Severity of varicella complications was related to increasing age and immunosuppression. Permanent or possible sequelae were reported in 15 (1.7%) and 78 (8.7%) of all children, respectively; 10 children died. Capture-recapture analyses yielded an incidence of 14.1 (95% confidence interval, 9.7-18.6) varicella hospitalizations/100,000 children, corresponding to 1996 (95% confidence interval, 1363-2629) varicella-related hospitalizations per year in Germany.

CONCLUSIONS:

These data show that the severity of varicella complications in healthy children has been previously underestimated.

PMID:
18227713
[PubMed - indexed for MEDLINE]
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