title: Hospitalization with varicella and shingles before and after introduction of childhood varicella vaccination in Germany.
abstract: In Germany, one dose of varicella vaccination has been recommended for children aged <24 months since 2004, and 2 doses have been recommended since 2009. Vaccination coverage (VC) is above 80% for one dose and 60% for 2 doses. In this study, data on varicella- and shingles-associated hospitalizations before and after vaccine introduction were assessed. Based on ICD-coded data of the main diagnosis of hospitalized cases from 1995-2012 in Germany, annual age-adjusted and age-specific hospitalization incidences (cases/100,000; HI) were calculated. HI means 1995-2003 (pre-vaccination-period) versus 2005-2012 (post-vaccination-period) were compared. Age-specific trends and annual percentage change rates (APC) were assessed by joinpoint regression. Overall age-adjusted varicella-HI decreased from 3.3/100,000 pre-vaccination to 1.9/100,000 post vaccination. The decline was greatest in regions with the highest VC. The post-vaccination decline was greatest in children aged <1, 1-4, and 5-9 y, who had APCs of -18.2,-27.2 and -15.2, respectively, and significant joinpoints. In all other age groups no post-vaccination joinpoints were detected or they did not lead to a consistent trend. Age-adjusted shingles-HI increased from 8.8/100,000 (1995) to 16.8/100,000 (2012). Shingles-HI increased in all age groups with no significant post-vaccination joinpoints, except in children<1 and 1-4 y, where APCs of -5.6 and -3.6 were detected. Varicella vaccination significantly reduced varicella-HI in children below 10 y, but was not definitely related to varicella-HI in older age groups. A consistent increase of shingles-HI began before varicella vaccination was introduced and was not affected by vaccination.
authors.affiliation: a Robert Koch Institute; Department for Infectious Disease Epidemiology; Immunization Unit ; Berlin , Germany.
authors.forename: Anette
authors.initials: A
authors.lastname: Siedler
authors.forename: Marleen
authors.initials: M
authors.lastname: Dettmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002644:Chickenpox / Q000453:epidemiology*; D019433:Chickenpox Vaccine / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005858:Germany / Q000453:epidemiology; D006562:Herpes Zoster / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D014611:Vaccination
chemical_list: D019433:Chickenpox Vaccine
keywords: APC, annual percentage change rate; Germany; HI, hospitalization incidence; ICD, International Statistical Classification of Diseases and Related Health Problems; MMRV, Measles, Mumps, Rubella, Varicella; RR, reduction rate; VC, vaccination coverage; VZV, varicella zoster virus; hospitalization; joinpoint regression; shingles; vaccination coverage; varicella; varicella vaccination