Perspectives on the impact of varicella immunization on herpes zoster. A model-based evaluation from three European countries

PLoS One. 2013 Apr 17;8(4):e60732. doi: 10.1371/journal.pone.0060732. Print 2013.

Abstract

The introduction of mass vaccination against Varicella-Zoster-Virus (VZV) is being delayed in many European countries because of, among other factors, the possibility of a large increase in Herpes Zoster (HZ) incidence in the first decades after the initiation of vaccination, due to the expected decline of the boosting of Cell Mediated Immunity caused by the reduced varicella circulation. A multi-country model of VZV transmission and reactivation, is used to evaluate the possible impact of varicella vaccination on HZ epidemiology in Italy, Finland and the UK. Despite the large uncertainty surrounding HZ and vaccine-related parameters, surprisingly robust medium-term predictions are provided, indicating that an increase in HZ incidence is likely to occur in countries where the incidence rate is lower in absence of immunization, possibly due to a higher force of boosting (e.g. Finland), whereas increases in HZ incidence might be minor where the force of boosting is milder (e.g. the UK). Moreover, a convergence of HZ post vaccination incidence levels in the examined countries is predicted despite different initial degrees of success of immunization policies. Unlike previous model-based evaluations, our investigation shows that after varicella immunization an increase of HZ incidence is not a certain fact, rather depends on the presence or absence of factors promoting a strong boosting intensity and which might or not be heavily affected by changes in varicella circulation due to mass immunization. These findings might explain the opposed empirical evidences observed about the increases of HZ in sites where mass varicella vaccination is ongoing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Chickenpox / epidemiology
  • Chickenpox / immunology*
  • Chickenpox / prevention & control*
  • Child
  • Child, Preschool
  • Evaluation Studies as Topic
  • Finland / epidemiology
  • Herpes Zoster / epidemiology
  • Herpes Zoster / immunology*
  • Herpes Zoster / prevention & control*
  • Herpesvirus 3, Human / immunology
  • Humans
  • Immunization*
  • Incidence
  • Infant
  • Infant, Newborn
  • Italy / epidemiology
  • Middle Aged
  • Models, Biological*
  • Seroepidemiologic Studies
  • United Kingdom / epidemiology
  • Vaccination
  • Young Adult

Grants and funding

PP, GG, PM, AM would like to thank the ECDC GRANT/2009/002 project for research funding. MA and SM would like to thank the EU FP7 EPIWORK project (contract no. 231807) for research funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.