title: Validity of a reported history of chickenpox in targeting varicella vaccination at susceptible adolescents in England.
abstract: BACKGROUND
  In the UK, primary varicella is usually a mild infection in children, but can cause serious illness in susceptible pregnant women and adults. The UK Joint Committee on Vaccination and Immunisation is considering an adolescent varicella vaccination programme. Cost-effectiveness depends upon identifying susceptibles and minimising vaccine wastage, and chickenpox history is one method to screen for eligibility. To inform this approach, we estimated the proportion of adolescents with varicella antibodies by reported chickenpox history.
  
  
  METHODS
  Recruitment occurred through secondary schools in England from February to September 2012. Parents were asked about their child's history of chickenpox, explicitly setting the context in terms of the implications for vaccination. 247 adolescents, whose parents reported positive (120), negative (77) or uncertain (50) chickenpox history provided oral fluid for varicella zoster virus-specific immunoglobulin-G (VZV-IgG) testing.
  
  
  RESULTS
  109 (90.8% [85.6-96.0%]) adolescents with a positive chickenpox history, 52 (67.5% [57.0-78.1%]) with a negative history and 42 (84.0% [73.7-94.3%]) with an uncertain history had VZV-IgG suggesting prior infection. Combining negative and uncertain histories, 74% had VZV-IgG (best-case). When discounting low total-IgG samples and counting equivocals as positive (worst-case), 84% had VZV-IgG. We also modelled outcomes by varying the negative predictive value (NPV) for the antibody assay, and found 74-87% under the best-case and 84-92% under the worst-case scenario would receive vaccine unnecessarily as NPV falls to 50%.
  
  
  CONCLUSIONS
  Reported chickenpox history discriminates between varicella immunity and susceptibility in adolescents, but significant vaccine wastage would occur if this approach alone were used to determine vaccine eligibility. A small but important proportion of those with positive chickenpox history would remain susceptible. These data are needed to determine whether reported history, with or without oral fluid testing in those with negative and uncertain history, is sufficiently discriminatory to underpin a cost-effective adolescent varicella vaccination programme.
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department, Health Protection Services, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom(1); Research Department of Infection & Population Health, University College London, Mortimer Market Centre, Off Capper Street, London WC1E 6JB, United Kingdom. Electronic address: nigel.field@ucl.ac.uk.
authors.forename: Nigel
authors.initials: N
authors.lastname: Field
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department, Health Protection Services, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom(1).
authors.forename: Gayatri
authors.initials: G
authors.lastname: Amirthalingam
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department, Health Protection Services, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom(1).
authors.forename: Pauline
authors.initials: P
authors.lastname: Waight
authors.affiliation: Statistics Modelling and Economics Department, Health Protection Services, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom(1).
authors.forename: Nick
authors.initials: N
authors.lastname: Andrews
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department, Health Protection Services, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom(1).
authors.forename: Shamez N
authors.initials: SN
authors.lastname: Ladhani
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department, Health Protection Services, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom(1).
authors.forename: Albert Jan
authors.initials: AJ
authors.lastname: van Hoek
authors.affiliation: Virus Reference Department, HPA Microbiology Services, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom(1).
authors.forename: Peter A C
authors.initials: PA
authors.lastname: Maple
authors.affiliation: Virus Reference Department, HPA Microbiology Services, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom(1).
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Brown
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department, Health Protection Services, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, United Kingdom(1).
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000032:analysis*; D002644:Chickenpox / Q000453:epidemiology / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000627:therapeutic use*; D002648:Child; D003362:Cost-Benefit Analysis; D004739:England / Q000453:epidemiology; D006801:Humans; D017589:Immunization Programs; D007074:Immunoglobulin G / Q000032:analysis; D008487:Medical History Taking; D011237:Predictive Value of Tests
chemical_list: D000914:Antibodies, Viral; D019433:Chickenpox Vaccine; D007074:Immunoglobulin G
keywords: Adolescent; Chickenpox; Reported history; Vaccination programme; Validity; Varicella