title: Low varicella-related consultation rate in the Netherlands in primary care data.
abstract: BACKGROUND
  In the Netherlands, a relatively low varicella disease burden compared to other European countries is observed within routine surveillance. To validate this, we estimated the varicella-related consultation rate using The Integrated Primary Care Information database.
  
  
  METHODS
  In this retrospective cohort study, varicella patients in 2006-2008 were identified by the International Classification of Primary Care (A72) and free text in the electronic medical records, and manually reviewed to be categorised as 'varicella' or 'probable varicella'. The incidence of GP-consultation, specialist referral, emergency department contact and hospitalisation due to varicella was calculated, standardised to the Dutch population.
  
  
  RESULTS
  We identified 1881 varicella cases (2348 including probable cases), 14 patients were hospitalised. The overall incidence of GP-consultation due to varicella per 100,000 person-years was at least 281 (95%CI 268-294) and when probable cases were also included at maximum 354 (95%CI 340-369). The overall incidence of specialist referral, emergency department contact and hospitalisation per 100,000 person-years was 3.9 (95%CI 2.7-5.6), 2.5 (95%CI 1.5-4.0) and 2.0 (95%CI 1.2-3.4) respectively.
  
  
  CONCLUSIONS
  This study confirms the relatively low disease burden due to varicella in the Netherlands. In this study, using primary care data, similar incidences of GP consultation and referral to secondary care due to varicella were found as in routine surveillance. The lower varicella-related consultation rate might be linked to more conservative GP consultation behaviour in the Netherlands, and the relatively young age of infection. This is highly relevant for the decision-making process whether or not to introduce universal childhood varicella vaccination in the Netherlands.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Electronic address: alies.van.lier@rivm.nl.
authors.forename: Alies
authors.initials: A
authors.lastname: van Lier
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Electronic address: jolandavanerp@hotmail.com.
authors.forename: Jolanda
authors.initials: J
authors.lastname: van Erp
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. Electronic address: g.donker@nivel.nl.
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Electronic address: nicoline.van.der.maas@rivm.nl.
authors.forename: Nicoline A T
authors.initials: NA
authors.lastname: van der Maas
authors.affiliation: Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: m.sturkenboom@erasmusmc.nl.
authors.forename: Miriam C J M
authors.initials: MC
authors.lastname: Sturkenboom
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Electronic address: hester.de.melker@rivm.nl.
authors.forename: Hester E
authors.initials: HE
authors.lastname: de Melker
mesh_terms: D000293:Adolescent; D000328:Adult; D002644:Chickenpox / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D057286:Electronic Health Records; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Complications; General practitioner; Hospital admission; Incidence; Varicella