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. 2017 Apr 27;22(17):30521.
doi: 10.2807/1560-7917.ES.2017.22.17.30521.

Assessing varicella vaccine effectiveness and its influencing factors using health insurance claims data, Germany, 2006 to 2015

Thorsten Rieck  1   2 , Marcel Feig  1 , Matthias An der Heiden  1 , Anette Siedler  1 , Ole Wichmann  1
Affiliations

Assessing varicella vaccine effectiveness and its influencing factors using health insurance claims data, Germany, 2006 to 2015

Thorsten Rieck et al. Euro Surveill. .

Abstract

In Germany, routine childhood varicella vaccination was implemented in 2004 with two doses recommended since 2009. We used an immunisation information system based on countrywide health insurance claims data to analyse vaccine effectiveness (VE) and factors influencing VE. We applied proportional hazard models to estimate VE under various conditions and compared the risk of acquiring varicella among unvaccinated children in regions with high vs low vaccination coverage (VC). Among 1.4 million children we identified 29,404 varicella cases over a maximum follow-up of 8 years post-vaccination. One-dose VE was 81.9% (95% confidence interval (CI): 81.4-82.5), two-dose VE 94.4% (95% CI: 94.2-94.6). With dose one given 1-27 days after measles-containing vaccine (MCV), one-dose VE was 32.2% (95% CI: 10.4-48.6), two-dose VE 92.8% (95% CI: 84.8-96.6). VE was not associated with age at vaccination (11-14 vs ≥ 15 months), time since vaccination, or vaccine type. Unvaccinated children had a twofold higher risk of acquiring varicella in low VC regions. Our system generated valuable data, showing that two-dose varicella vaccination provides good protection for at least 8 years. Unvaccinated children benefit from herd effects. When the first varicella vaccine dose is given shortly after MCV, a second dose is essential.

Keywords: administrative data; herd immunity; immunization information system; vaccination coverage; vaccine effectiveness; varicella virus infection (chickenpox).

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Cumulative coverage by age in the federal state of Saxony (n = 179,162) and other regions of Germany (n = 1,760,220) for one and two varicella vaccinations for all ASHIPs and birth cohorts selected for time-series analysis to estimate vaccine effectiveness, 2006–2015
Figure 2
Figure 2
Cumulative hazard in ASHIP/year of birth/sex strata by analysis time in time-series analysis and linear fit among unvaccinated children in the federal state of Saxony (n = 52,441) and other regions of Germany (n = 223,373), 2006–2015
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