Severe and complicated varicella and associated genotypes 10 years after introduction of a one-dose varicella vaccine program

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dc.contributor.authorMarshall, H.
dc.contributor.authorClarke, M.
dc.contributor.authorHeath, C.
dc.contributor.authorQuinn, H.
dc.contributor.authorRichmond, P.
dc.contributor.authorCrawford, N.
dc.contributor.authorElliott, E.
dc.contributor.authorToi, C.
dc.contributor.authorKynaston, A.
dc.contributor.authorBooy, R.
dc.contributor.authorMacartney, K.
dc.date.issued2019
dc.description.abstractBackground: 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.
dc.description.statementofresponsibilityHelen S. Marshall, Michelle Clarke, Christine Heath, Helen Quinn, Peter C. Richmond, Nigel Crawford, Elizabeth Elliott, Cheryl Toi, Anne Kynaston, Robert Booy, and Kristine Macartney
dc.identifier.citationJournal of Infectious Diseases, 2019; 219(3):391-399
dc.identifier.doi10.1093/infdis/jiy518
dc.identifier.issn0022-1899
dc.identifier.issn1537-6613
dc.identifier.orcidMarshall, H. [0000-0003-2521-5166]
dc.identifier.orcidClarke, M. [0000-0001-9635-8784]
dc.identifier.urihttp://hdl.handle.net/2440/118836
dc.language.isoen
dc.publisherOxford University Press
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1084951
dc.rights© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
dc.source.urihttps://doi.org/10.1093/infdis/jiy518
dc.subjectChildren; herpes zoster; varicella; immunization
dc.titleSevere and complicated varicella and associated genotypes 10 years after introduction of a one-dose varicella vaccine program
dc.typeJournal article
pubs.publication-statusPublished

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