American Journal of Epidemiology Vol. 140, No. 2: 81-104
Copyright © 1994 by The Johns Hopkins University School of Hygiene and Public Health
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Theoretical Epidemiologic and Morbidity Effects of Routine Varicella Immunization of Preschool Children in the United States
1Division of Biostatistics, Emory University School of Public Health Atlanta, GA
2National Immunization Program, Centers for Disease Control and Prevention Atlanta, GA
3Robert Wood Johnson Clinical Scholars Program, University of California San Francisco, CA
4Epidemiology Program Office, Centers for Disease Control and Prevention Atlanta, GA
Reprint requests to Dr. M. Elizabeth Halloran, Division of Biostatistics, Emory University School of Public Health, 1599 Clifton Road NE, Atlanta, GA 30329
The authors studied the effects of routine varicella immunization of US preschool children and of implementation of a catch-up program in older children on the age distribution of cases and on overall morbidity, with emphasis on the sensitivity of the results to level of vaccine coverage, duration of protection, responsiveness to boosting, relative residual susceptibility and infectiousness, and degree of morbidity among vaccine breakthrough cases. An age-structured theoretical transmission model was used, with values for vaccine efficacy based on a review of the literature by an expert panel. Although implementation of a vaccination program resulted in a shift in the age distribution of remaining vancella cases toward older ages with higher complication rates, the overall reduction in cases resulted in decreased morbidity as measured by overall number of hospitalizations and number of primary cases. Routine immunization with live virus varicella vaccine would probably result in a substantial reduction in the number of uncomplicated primary cases of chickenpox, as well as a decreased number of complicated cases requiring hospitalization. The number and age distribution of vaccinated cases would depend strongly on the characteristics of the vaccine. Vaccine efficacy studies in the field should be designed to obtain better estimates of residual susceptibility, residual infectiousness, duration of protection, and effects of boosting by wildtype reinfection.
chickenpox; immunization; immunization schedule; models; theoretical; vaccination; viral vaccines
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