title: Partial uptake of varicella vaccine and the epidemiological effect on varicella disease in 11 day-care centers in North Carolina.
abstract: BACKGROUND
  The increasing use of varicella vaccine in children attending day care has rapidly decreased the incidence of wild-type varicella disease. The herd immunity noted is significant and will have an effect on the epidemiology of natural varicella.
  
  
  OBJECTIVE
  To monitor the change in varicella incidence in day-care attendees after the licensure of varicella vaccine.
  
  
  METHODS
  A prospective observational cohort study design.
  
  
  METHODS
  Eleven private day-care centers and preschools in North Carolina participated in the study from January 1, 1995, through December 31, 1999.
  
  
  METHODS
  All children in the 11 centers were eligible for participation. Some participated more actively, supplying information on a regular basis. Others participated passively. Day-care personnel provided information about all cases of varicella.
  
  
  METHODS
  None.
  
  
  METHODS
  The change in the incidence of varicella disease was documented as the use of varicella vaccine increased.
  
  
  RESULTS
  Varicella vaccine coverage increased substantially from 4.4% in 1995 to 63.1% in December 1999. The vaccination rate accelerated dramatically in 1996 and 1997, leveled off in 1998, and rose again in 1999. Cumulative varicella incidence decreased from 16.74 cases per 1000 person-months in July 1996 to 1.53 cases per 1000 person-months in December 1999 in unvaccinated children.
  
  
  CONCLUSIONS
  The varicella vaccination rate continued to increase slowly in the day-care population after an initial rapid uptake. The decrease in varicella disease is greater than the increase in varicella vaccination. This herd effect is welcome and even apparent in the unvaccinated children younger than 1 year.
authors: Campus Box 3810, Duke University Medical Center, Durham, NC 27710, USA. cleme002@mc.duke.edu
authors: D A
authors: DA
authors: Clements
authors: J I
authors: JI
authors: Zaref
authors: C L
authors: CL
authors: Bland
authors: E B
authors: EB
authors: Walter
authors: P M
authors: PM
authors: Coplan
mesh_terms: D017677:Age Distribution; D002644:Chickenpox / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000627:therapeutic use*; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D011446:Prospective Studies
chemical_list: D019433:Chickenpox Vaccine