Vaccination against Varicella Zoster Virus Infection in Less Developed Regions of Guangdong, China: A Cross-Sectional Serosurveillance Study

Abstract

Vaccination is the key to prevent varicella zoster virus (VZV) infection in children. Voluntary and self-funded strategies have led to variable vaccination rates against VZV in China. For low-income populations, in particular, the effects of VZV vaccination have been insufficiently estimated. Community-based serosurveillance was conducted in two less developed regions, Zhanjiang and Heyuan, of Guangdong, China. Anti-VZV IgG antibodies in serum were detected by ELISA. The vaccination data were derived from the Guangdong Immune Planning Information System. A total of 4221 participants were involved, of which 3377 were from three counties of Zhanjiang and the other 844 were from one county of Heyuan, Guangdong, China. The total VZV IgG seropositivity rate in vaccinated individuals was 34.30% and 42.76%, while it was 89.61% and 91.62% in non-vaccinated populations of Zhanjiang and Heyuan, respectively. The seropositivity rate increased gradually with age, reaching ~90% in the >20- to 30-year-old group. The VarV vaccination rates of children aged 1-14 years were 60.47% for one dose and 6.20% for two doses in Zhanjiang, and 52.24% for one dose and 4.48% for two doses in Heyuan. Compared with the non-vaccinated group (31.19%) and one-dose group (35.47%), the positivity rate of anti-VZV IgG antibodies was significantly higher in the two-dose group (67.86%). Before the VarV policy was reformed, the anti-VZV IgG positivity rate was 27.85% in the one-dose-vaccinated participants, which increased to 30.43% after October 2017. The high seroprevalence in participants was due to infection of VZV in Zhanjiang and Heyuan, not vaccination against VZV. Children aged 0-5 years are still vulnerable to varicella, so a two-dose vaccination program should be implemented to prevent onward transmission of VZV.

Keywords: Guangdong; anti-VZV IgG; seroprevalence; undeveloped; vaccination; varicella.

Figure 1

(A) Seroprevalence of anti-VZV IgG in non-VarV-vaccinated participants in Zhanjiang; (B) seroprevalence of anti-VZV IgG in non-VarV-vaccinated participants in Heyuan.

Figure 2

(A) Seroprevalence of anti-VZV IgG in VarV-vaccinated participants in Zhanjiang; (B) seroprevalence of anti-VZV IgG in VarV-vaccinated participants in Heyuan. %, the proportion of the participants with anti-VZV IgG; 0, non-vaccinated group; 1, one-dose-vaccinated group; 2, two-dose-vaccinated group; ns, p > 0.05; * p < 0.05; ** p < 0.01.

Figure 3

The persistence of anti-VZV IgG in participants with different vaccination histories. (A) The anti-VZV IgG level of non-vaccinated participants; (B) the anti-VZV IgG level of one-dose participants; (C) the anti-VZV IgG level of two-dose participants; (D) the anti-VZV IgG level of non-vaccinated participants in different age groups; (E) the anti-VZV IgG level of one-dose-vaccinated participants in different age groups.