Children with breakthrough varicella infection requiring hospitalization in Turkey (VARICOMP Study 2008-2013)
Ener Cagri Dinleyici1, Zafer Kurugol2, Ates Kara3
1Eskisehir Osmangazi University, Faculty of Medicine, Department of Pediatrics, Eskisehir, Turkey.
Insights
Breakthrough varicella infections requiring hospitalization occurred in Turkish children, primarily healthy ones, about 5 years after a single varicella vaccine dose. This highlights potential gaps in single-dose vaccine effectiveness.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Public Health
Background:
- Breakthrough varicella (chickenpox) can occur in vaccinated individuals.
- While often mild, breakthrough varicella can lead to severe illness and hospitalization in children, including those with underlying health conditions.
Purpose of the Study:
- To evaluate breakthrough varicella infections requiring hospitalization in Turkey.
- To assess these cases prior to the widespread implementation of a single-dose live varicella vaccine in the national program.
Main Methods:
- Prospective national pediatric varicella hospitalization study across 29 centers in Turkey (2008-2013).
- Analysis of hospitalized children with varicella, focusing on those who had received a single dose of varicella vaccine.
Main Results:
- 36 children with breakthrough varicella were hospitalized; 61.1% were previously healthy.
- Hospitalizations occurred approximately 5 years post-vaccination.
- Neurological complications (encephalitis, meningitis) were common reasons for hospitalization in healthy children.
Conclusions:
- Pediatric breakthrough varicella requiring hospitalization is observed in Turkey, predominantly in healthy children 5 years after a single vaccine dose.
- Turkey introduced a single-dose varicella vaccine at 12 months in 2013.
- Further surveillance is needed to assess the effectiveness of the national single-dose vaccination strategy and the potential need for a second dose.
Introduction:
Varicella in previously immunized individuals, known as "breakthrough varicella". While the majority of breakthrough cases are mild, some may be severe, requiring hospitalization in previously healthy children or children with an underlying condition.
Methods:
This report, as a part of the prospective national pediatric varicella hospitalizations study (including 29 centers, represent 50% of pediatric population) in Turkey, is aimed to evaluate breakthrough varicella infection requiring hospitalization before the routine use of single-dose live varicella vaccine in national program from 2008 to 2013 (<10% of the pediatric age group received a single-dose vaccine).
Results:
In the time period, 1939 children were hospitalized due to varicella infection in Turkey; 36 children (20 boys, 16 girls, mean age 68.0+37.6 months, all received single dose live varicella vaccine) with breakthrough varicella infection. Breakthrough varicella infection might be severe in previously healthy children (61.1%) and children with immune-compromising conditions (38.9%). The time elapsed between vaccination and hospitalization was approximately 5 years, and neurological complications, mainly encephalitis and meningitis, were the most common reason for hospitalization in previously healthy children.
Conclusion:
Pediatric breakthrough varicella requiring hospitalization have been seen in Turkey, is mainly observed in previously healthy children at 5 years after a single-dose varicella vaccine. The varicella vaccine has been implemented as part of the National Immunization Program in Turkey in 2013 (a single dose at age 12 months). Further surveillance in the same settings could evaluate the effectiveness of national immunization with single-dose varicella vaccine at 12 months of age and potential need for second dose of vaccine.
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