title: The burden of varicella complications before the introduction of routine varicella vaccination in Germany.
abstract: BACKGROUND
  The true burden of varicella complications in Germany is not known. We investigated the incidence and pattern of varicella complications in children and adolescents using 3 independent surveillance sources.
  
  
  METHODS
  Prospective nationwide surveillance in all pediatric hospitals through the German Pediatric Surveillance Unit [Erhebungseinheit für Seltene Pädiatrische Erkrankungen in Deutschland (ESPED)] was used to ascertain hospitalized varicella cases in children <or=16 years of age between January 2003 and December 2004. In the federal state, North-Rhine Westphalia (NRW), a practice sentinel network [European Diabetes Study Group (EURODIAB)] and pediatric hospital based International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) surveillance were additionally used to refine incidence estimates via capture-recapture methodology.
  
  
  RESULTS
  A total of 918 hospitalized varicella patients (male-to-female: 55%/45%) with a median age of 3.3 years (interquartile range, 1.4-5.2) and a median hospital stay of 5 days (interquartile range, 3-8) were reported. Varicella associated complications occurred in 80% of the hospitalizations, most frequently being neurologic (25.4%), skin infectious (23.2%), and gastrointestinal tract complications (15.0%). Most hospitalizations (77%) occurred in previously healthy children. A predisposing condition existed in 207 children (23%): immunosuppression 7%, atopic dermatitis 7%, and other underlying chronic conditions 9%. Severity of varicella complications was related to increasing age and immunosuppression. Permanent or possible sequelae were reported in 15 (1.7%) and 78 (8.7%) of all children, respectively; 10 children died. Capture-recapture analyses yielded an incidence of 14.1 (95% confidence interval, 9.7-18.6) varicella hospitalizations/100,000 children, corresponding to 1996 (95% confidence interval, 1363-2629) varicella-related hospitalizations per year in Germany.
  
  
  CONCLUSIONS
  These data show that the severity of varicella complications in healthy children has been previously underestimated.
authors.affiliation: Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany. johannes.liese@med.uni-muenchen.de
authors.forename: Johannes G
authors.initials: JG
authors.lastname: Liese
authors.forename: Veit
authors.initials: V
authors.lastname: Grote
authors.forename: Eva
authors.initials: E
authors.lastname: Rosenfeld
authors.forename: Richela
authors.initials: R
authors.lastname: Fischer
authors.forename: Bernd H
authors.initials: BH
authors.lastname: Belohradsky
authors.forename: Rüdiger
authors.initials: R
authors.lastname: v Kries
mesh_terms: D000293:Adolescent; D002644:Chickenpox / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant
chemical_list: D019433:Chickenpox Vaccine