Effectiveness of vaccination against varicella in children under 5 years in Puglia, Italy 2006-2012

Abstract

In Italy, between 2003 and 2010, 8/21 Regions recommended varicella routine vaccination (URV). The National Immunization Plan (PNPV) 2012-2014 scheduled the introduction of URV nationwide in 2015, following the results achieved by the eight Regions. Puglia adopted varicella URV in 2006. This study describes epidemiology and costs of varicella in Puglia between 2003 and 2012. One-dose Vaccine Effectiveness (VE) against varicella of any severity and severe hospitalized cases in children was also evaluated. Vaccination coverage (VC) was estimated from the regional immunization registry. Incidence and hospitalization rates were calculated from computerised surveillance system for communicable diseases and hospital discharge registry (ICD9-CM codes: 052.x), respectively. URV impact was assessed by Incidence Rate Ratios (IIRs) and Hospitalization Risk Ratios (HRRs). Hospitalization costs were also evaluated. VE was estimated using the screening method, where PPV was VC in children aged <72 months and PCV was the proportion of cases vaccinated among notified or hospitalized cases, respectively. One-dose VC in children aged ≤ 24 months increased from 49% in the birth cohort 2006 to 91.1% in the cohort 2010; 2-dose VC was 64.8% and 28.8% in the 2005 and 1997 cohort, respectively. Comparing pre and post-vaccination era, incidence declined from 122.5 ×100 000 in 2003-2005 to 13.7 in 2009-2012 (IRR = 0.11, 95% CI = 0.10-0.12), hospitalization rate from 3.9 ×100 000 to 1.1 (HRR = 0.29, 95% CI = 0.21-0.4), hospitalization costs from 319 000 Euros/year to 106 000. One-dose VE against varicella of any severity and severe hospitalized disease was 98.8% and 99%, respectively. Our findings strongly support varicella URV introduction into the Italian Essential Health Interventions, as scheduled by 2015.

Keywords: Varicella; breakthrough; screening method; universal routine vaccination; vaccine effectiveness; vaccine failure.

Figure 1. Trends in notified (A) and hospitalized (B) varicella cases. Puglia, Italy, 2003–2012