Specific Varicella-Related Complications and Their Decrease in Hospitalized Children after the Introduction of
Christine Hagemann1,2, Alexander Krämer3, Veit Grote4
1Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
Insights
Universal varicella vaccination (UVV) significantly reduced varicella-related complications in hospitalized children by 77% within seven years. This public health achievement was most pronounced in younger children and for respiratory tract complications.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Public health surveillance
Background:
- Universal varicella vaccination (UVV) was implemented in Germany in 2004.
- UVV led to a notable decrease in varicella-related hospitalizations (VRHs).
- The study examines the impact of UVV on specific varicella-related complications (VRCs) in children over the first seven years post-introduction.
Purpose of the Study:
- To investigate the incidence of specific types of VRCs in hospitalized children.
- To assess the impact of UVV on VRCs in children under 17 years of age.
- To analyze trends in VRCs and their reduction following UVV implementation.
Main Methods:
- Retrospective analysis of hospitalized children (<17 years) with varicella diagnoses in Bavaria (2005-2011).
- Data collected via standardized queries of hospital databases, including VRCs, demographics, and immune status.
- Linear regression used to assess VRC trends over time.
Main Results:
- A total of 1263 VRHs were reported, with 76% experiencing specific VRCs.
- Overall complication rates per hospital per year decreased by 77% from 2005 to 2011.
- Significant reductions observed across all VRC categories, including respiratory tract (90-97%), skin (81%), gastrointestinal (78%), and neurological (65%).
- A substantial 87% decrease in VRCs was noted in immunocompromised children.
Conclusions:
- UVV implementation in Germany resulted in a significant 77% decrease in VRC incidence within seven years.
- The most substantial reductions were observed in the primary target group for UVV (children <5 years) and for respiratory tract complications.
- These findings underscore the effectiveness of UVV in reducing severe varicella outcomes in pediatric populations.
Background:
Universal varicella vaccination (UVV) for children introduced in Germany in 2004 resulted in a significant overall decline of varicella-related hospitalizations (VRHs). We investigated the incidence of specific types of varicella-related complications (VRCs) in hospitalized children and the impact of UVV on VRCs during the first 7 years of UVV.
Methods:
Children < 17 years of age hospitalized with an ICD-10-based (International Classification of Diseases, 10th Revision) discharge diagnosis of varicella were identified as VRH in pediatric hospitals in Bavaria by annual standardized data queries of the hospital databases (2005-2011). For each VRH, the hospitals reported basic demographic data, duration of hospital stay, all diagnostic and procedural codes, and outcome. VRCs were reported overall, per year, and by immune status. Complication rates were calculated as mean number per complication category per hospital and per year; VRC trends over time were assessed by linear regression.
Results:
Between 78% (2005) and 61% (2011) of Bavarian hospitals participated and reported a total of 1263 VRHs. Specific VRCs were reported in 954 (76%) children. Complication rates per hospital and year decreased from 6.7 [95% confidence interval (CI): 5.1-8.3] in 2005 to 1.5 (95% CI: 0.8-2.3) in 2011, with the strongest reduction of 90% in children < 5 years of age from 5.3 (95% CI: 4.0-6.6) in 2005 to 0.5 (95% CI: 0.1-0.9) in 2011. Significant decreases were observed for children with upper respiratory tract (URT, by 97%), lower respiratory tract (LRT, by 90%), skin (by 81%), gastrointestinal (by 78%), and neurologic (by 65%) VRCs. Forty-eight children with VRCs were immunocompromised; their annual rate decreased by 87%.
Discussion:
Corresponding to increasing varicella vaccination coverage in the population, the incidence of VRC decreased by 77% from 2005 to 2011, with the most substantial decrease in the target group for UVV.
Conclusion:
Within 7 years, UVV in Germany led to a decrease of about 77% of all types of VRCs, with the highest reductions observed for VRCs of the respiratory tract.
Related Concept Videos
01:51Vaccinations
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:22Development of Immunocompetence
The initial cells that migrate from the fetal thymus settle within the skin and epithelial tissues lining the mouth, digestive tract, and in females, the uterus and vagina. These cells, including skin-based dendritic cells, serve as antigen-presenting cells, playing a key role in T cell activation.
Subsequent T...
01:30Pneumonia III: Complications and Assessment
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:14Myocarditis III: Medical Management