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. 2025 Aug 18;25(1):1029.
doi: 10.1186/s12879-025-11415-2.

Varicella-zoster virus seroprevalence among reproductive-age women in Iran: a meta-analysis and implications for targeted immunization

Morteza Pourahmad  1 , Mohammad Javad Tarrahi  2 , Mahnaz Momenzadeh  3 , Kiana Shahzamani  4 , Abdolreza Sotoodeh Jahromi  5 , Ziba Farajzadegan  6 , Somayeh Haghighipour  1 , Behrooz Ataei  1 , Fatemeh Nikokar  7 , Nasim Kakavand  8
Affiliations

Varicella-zoster virus seroprevalence among reproductive-age women in Iran: a meta-analysis and implications for targeted immunization

Morteza Pourahmad et al. BMC Infect Dis. .

Abstract

Background: Primary varicella-zoster virus (VZV) infection during pregnancy poses significant risks to both mother and fetus, including congenital varicella syndrome (CVS) and serious maternal complications. In Iran, the absence of varicella vaccination in the national immunization program leaves many women susceptible. This systematic review and meta-analysis aimed to determine the overall seroprevalence of VZV antibodies among reproductive-age women in Iran.

Methods: A comprehensive search was conducted in both international and Iranian databases for studies published up to November 15, 2024. Eligible studies reporting VZV seroprevalence among Iranian women aged 15-49 years were identified. Screening, data extraction, and risk of bias assessment were independently performed by two reviewers. Pooled seroprevalence was estimated using a random-effects meta-analysis in STATA version 18. Heterogeneity was evaluated with the Cochrane Q test and I² statistic. Subgroup analyses and meta-regression explored sources of heterogeneity. Sensitivity analyses (leave-one-out) and publication bias (Doi plot, LFK index) were also performed. The protocol was registered in PROSPERO (CRD42025647813).

Results: Data from 20 studies, including 5,629 participants, were analyzed. A pooled VZV seroprevalence of 81% (95% CI: 77-85%) was found, indicating that approximately 19% of reproductive-age women in Iran remain susceptible. Higher seroprevalence was observed in pregnant women (88%) compared with non-pregnant women (79%), with the lowest rates among medical students (74%). Despite subgroup and meta-regression analyses, substantial heterogeneity remained unexplained. Sensitivity analyses supported the robustness of the results, while possible publication bias was suggested.

Conclusions: Nearly one in five reproductive-age women in Iran lack immunity to VZV. Targeted vaccination, especially among non-pregnant women and students, may reduce susceptibility. Preconception screening for VZV immunity could help prevent maternal and fetal complications. However, given the high unexplained heterogeneity, results should be interpreted with caution.

Keywords: Chickenpox; Human herpesvirus 3; Immunization; Iran; Seroepidemiologic studies; Varicella-Zoster virus; Women.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
PRISMA Flow Diagram of Study Selection for VZV Seroprevalence Among Reproductive-Age Women in Iran. *These references are not cited in the main text
Fig. 2
Fig. 2
Forest plot of varicella-zoster virus (VZV) seroprevalence among childbearing-age women in Iran
Fig. 3
Fig. 3
Subgroup analysis of varicella-zoster virus (VZV) seroprevalence based on pregnancy status (pregnant vs. non-pregnant women) using a random-effects model
Fig. 4
Fig. 4
Subgroup analysis of varicella-zoster virus (VZV) seroprevalence by population group (healthcare workers, students, general female population) using a random-effects model
See this image and copyright information in PMC

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References

    1. Moattari A, Ghanbari Asad A, Mansouri A, Malehi Vaziri M, Moradpour Shammami F. Evaluation of measles, rubella, mumps, hepatitis B and varicella Zoster antibodies in medical and dental students in shiraz, Iran. Novel Biomed. 2014;2(1):6–9.
    1. Sharifi Z, Emadi G. The seroepidemiology of varicella Zoster virus (VZV) in different age groups in tehran, Iran. Iran J Allergy Asthma Immunol. 1970;4(2). - PubMed
    1. Allami A, Mohammadi N. Varicella immunity in iran: an age-stratified systematic review and meta-analysis. Iran J Microbiol. 2014;6(6):372–81. - PMC - PubMed
    1. Amjadi O, Rafiei A, Haghshenas M, Navaei RA, Valadan R, Hosseini-Khah Z, et al. A systematic review and meta-analysis of Seroprevalence of varicella Zoster virus: A nationwide population-based study. J Clin Virol. 2017;87:49–59. - PubMed
    1. Riccò M, Ferraro P, Zaffina S, Camisa V, Marchesi F, Franzoso F et al. Immunity to Varicella Zoster Virus in Healthcare Workers: A Systematic Review and Meta-Analysis (2024). Vaccines. 2024;12:1021. - PMC - PubMed

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