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. 2019 Dec;8(4):597-611.
doi: 10.1007/s40121-019-00273-6. Epub 2019 Oct 31.

Specific Varicella-Related Complications and Their Decrease in Hospitalized Children after the Introduction of General Varicella Vaccination: Results from a Multicenter Pediatric Hospital Surveillance Study in Bavaria (Germany)

Christine Hagemann  1   2 , Alexander Krämer  3 , Veit Grote  4 , Johannes G Liese  1 , Andrea Streng  1
Affiliations

Specific Varicella-Related Complications and Their Decrease in Hospitalized Children after the Introduction of General Varicella Vaccination: Results from a Multicenter Pediatric Hospital Surveillance Study in Bavaria (Germany)

Christine Hagemann et al. Infect Dis Ther. 2019 Dec.

Abstract

Background: Universal varicella vaccination (UVV) for children introduced in Germany in 2004 resulted in a significant overall decline of varicella-related hospitalizations (VRHs). We investigated the incidence of specific types of varicella-related complications (VRCs) in hospitalized children and the impact of UVV on VRCs during the first 7 years of UVV.

Methods: Children < 17 years of age hospitalized with an ICD-10-based (International Classification of Diseases, 10th Revision) discharge diagnosis of varicella were identified as VRH in pediatric hospitals in Bavaria by annual standardized data queries of the hospital databases (2005-2011). For each VRH, the hospitals reported basic demographic data, duration of hospital stay, all diagnostic and procedural codes, and outcome. VRCs were reported overall, per year, and by immune status. Complication rates were calculated as mean number per complication category per hospital and per year; VRC trends over time were assessed by linear regression.

Results: Between 78% (2005) and 61% (2011) of Bavarian hospitals participated and reported a total of 1263 VRHs. Specific VRCs were reported in 954 (76%) children. Complication rates per hospital and year decreased from 6.7 [95% confidence interval (CI): 5.1-8.3] in 2005 to 1.5 (95% CI: 0.8-2.3) in 2011, with the strongest reduction of 90% in children < 5 years of age from 5.3 (95% CI: 4.0-6.6) in 2005 to 0.5 (95% CI: 0.1-0.9) in 2011. Significant decreases were observed for children with upper respiratory tract (URT, by 97%), lower respiratory tract (LRT, by 90%), skin (by 81%), gastrointestinal (by 78%), and neurologic (by 65%) VRCs. Forty-eight children with VRCs were immunocompromised; their annual rate decreased by 87%.

Discussion: Corresponding to increasing varicella vaccination coverage in the population, the incidence of VRC decreased by 77% from 2005 to 2011, with the most substantial decrease in the target group for UVV.

Conclusion: Within 7 years, UVV in Germany led to a decrease of about 77% of all types of VRCs, with the highest reductions observed for VRCs of the respiratory tract.

Keywords: Complication; Hospitalization; Immunocompromised; Pediatric; Post-vaccination period; Varicella.

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Conflict of interest statement

Andrea Streng received further research grants, support for conference attendance, and honoraria for expert meetings from both manufacturers of the varicella vaccines, GSK and Sanofi Pasteur MSD, and from manufacturers of other vaccines. Johannes G. Liese received further research grants, support for conference attendance, and honoraria for expert meetings from both manufacturers of the varicella vaccines, GSK and Sanofi Pasteur MSD, and from manufacturers of other vaccines. Christine Hagemann, Alexander Krämer, and Veit Grote declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Change in the rate of varicella-related complications (VRCs) in 954 children in 22–29 participating hospitals from 2005 to 2011; average numbers per reporting hospital are provided per year. Multiple nominations of a patient in different VRC categories were possible. Patients with more than one diagnosis within a VRC category were listed only once per category
See this image and copyright information in PMC

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