Effectiveness of the varicella vaccine in the real world, a matched case-control study

Fang Liu; Zhen Li; Hongyu Wang; Yang Cao; Nan Zhang; Fang Wang; Rui Wei; Jian Zhang; Yuqian Zhao

doi:10.1016/j.vaccine.2024.05.006

Effectiveness of the varicella vaccine in the real world, a matched case-control study

Vaccine. 2024 May 10:S0264-410X(24)00552-8. doi: 10.1016/j.vaccine.2024.05.006. Online ahead of print.

Authors

Fang Liu¹, Zhen Li², Hongyu Wang³, Yang Cao², Nan Zhang², Fang Wang², Rui Wei², Jian Zhang², Yuqian Zhao²

Affiliations

¹ Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China. Electronic address: liu1210@126.com.
² Beijing Chaoyang District Center for Disease Control and Prevention, Beijing, China.
³ Haidian District Maternal and Child Health Care Hospital, Beijing, China.

PMID: 38734496
DOI: 10.1016/j.vaccine.2024.05.006

Abstract

Background: Universal varicella vaccination has been introduced in many countries, but there are a number of important differences in their vaccination strategies. It is essential to establish a vaccination program that can maximize the benefits of varicella vaccine, but there is a lack of comprehensive research on the effectiveness of varicella vaccine in different vaccination status.

Methods: Using data from population-based surveillance platforms we conducted a 1:2 matched case-control study. The cases were clinically diagnosed varicella with onset from 2017 to 2021, 1-14 years old in Chaoyang District, Beijing. The controls were matched according to date of birth (±1 month), sex and residence. The vaccination data of the subjects were obtained from the Childhood Immunization Information Management System in Beijing. Using conditional logistic regression models with or without interaction terms, we evaluated the effectiveness of varicella vaccine in different vaccination status.

Results: A total of 2528 cases and 5056 controls were enrolled. This study found that whether the time since last vaccination was adjusted had a substantial effect on the comparing vaccine effectiveness (VE) between subgroups. After adjustment for the time since last vaccination, 1) the incremental VE of 2-dose was 49.6 % (95 % Confidence Interval [CI], 38.8-58.6) compared with 1-dose (93.9 % vs. 88.0 %); 2) Among children who received one dose, the risk of chickenpox in children vaccinated at 18-23 months was 1.382 (95 %CI, 1.084-1.762) times that in children vaccinated at 12-17 months. 3) the VE with less than one, two, and three year intervals is higher than that with six-year-intervals (P < 0.05), respectively.

Conclusions: When comparing VE between subgroups of different vaccination status, the time since last vaccination should be adjusted. The first dose of varicella vaccine should be given as early as the second year of life, and the second dose can improve vaccine effectiveness.

Keywords: Chickenpox; Matched case-control study; Vaccination; Vaccine effectiveness; Varicella.