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J Infect Dis. 2019 Jan 9;219(3):391-399. doi: 10.1093/infdis/jiy518.

Severe and Complicated Varicella and Associated Genotypes 10 Years After Introduction of a One-Dose Varicella Vaccine Program.

Author information

1
Women's and Children's Health Network, Adelaide, Australia.
2
Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Australia.
3
National Centre for Immunization Research and Surveillance, Westmead, Sydney, Australia.
4
School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
5
Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.
6
Division of Paediatrics, University of Western Australia, Perth, Australia.
7
Princess Margaret Hospital, Perth, Australia.
8
Murdoch Children's Research Institute, Parkville, Australia.
9
Royal Children's Hospital, Melbourne, Australia.
10
Discipline of Paediatrics and Child Health, University of Sydney, Australia.
11
Children's Hospital Westmead, Sydney, Australia.
12
Australian Paediatric Surveillance Unit, Westmead, Australia.
13
Department of Medical Entomology, Centre for Infectious Disease Microbiological Laboratory Services, Pathology West-ICPMR, Westmead Hospital, Sydney, Australia.
14
Lady Cilento Children's Hospital, Brisbane, Australia.
15
Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia.
16
Children's Hospital at Westmead, Sydney, Australia.

Abstract

Background:

This national, sentinel prospective study aimed to identify children with severe hospitalized varicella, despite availability of universal 1-dose vaccination since 2005, and determine associations between virus genotypes and disease severity.

Methods:

Children with varicella or zoster from 5 Paediatric Active Enhanced Disease Surveillance hospitals were enrolled. Lesions were swabbed for genotyping. Associations with disease severity were analyzed using multiple regression.

Results:

From 2007 to 2015, 327 children with confirmed varicella (n = 238) or zoster (n = 89) were enrolled. Two hundred three (62%) were immunocompetent children; including 5 of 8 children who required intensive care unit management. Eighteen percent (36 of 203) of immunocompetent children had been previously vaccinated. Vaccinated children aged >18 months were less likely to have severe disease (9%; 5 of 56) than unvaccinated children (21%; 21 of 100; P = .05). Three of 126 children who had virus genotyping (2 immunocompromised) had varicella (n = 2) or zoster (n = 2) due to the Oka/vaccine strain. European origin clades predominated and were independently associated with more severe disease (odds ratio = 3.2; 95% confidence interval, 1.1- 9.5; P = .04).

Conclusions:

Severe hospitalized varicella still occurs with a 1-dose varicella program, although predominantly in unvaccinated children. Most 1-dose vaccine recipients were protected against severe disease. Viral genotyping in complex hospitalized cases is important to assist in monitoring disease due to Oka-vaccine strain.

PMID:
30184182
DOI:
10.1093/infdis/jiy518
[Indexed for MEDLINE]

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