The impact of 2-dose routine measles, mumps, rubella, and varicella vaccination in France on the epidemiology of varicella and zoster using a dynamic model with an empirical contact matrix.
OBJECTIVE
Varicella has a high incidence affecting the vast majority of the population in France and can lead to severe complications. Almost every individual infected by varicella becomes susceptible to herpes zoster later in life due to reactivation of the latent virus. Zoster is characterized by pain that can be long-lasting in some cases and has no satisfactory treatment. Routine varicella vaccination can prevent varicella. The vaccination strategy of replacing both doses of measles, mumps, and rubella (MMR) with a combined MMR and varicella (MMRV) vaccine is a means of reaching high vaccination coverage for varicella immunization. The objective of this analysis was to assess the impact of routine varicella vaccination, with MMRV in place of MMR, on the incidence of varicella and zoster diseases in France and to assess the impact of exogenous boosting of zoster incidence, age shift in varicella cases, and other possible indirect effects.


METHODS
A dynamic transmission population-based model was developed using epidemiological data for France to determine the force of infection, as well as an empirically derived contact matrix to reduce assumptions underlying these key drivers of dynamic models. Scenario analyses tested assumptions regarding exogenous boosting, vaccine waning, vaccination coverage, risk of complications, and contact matrices.


RESULTS
The model provides a good estimate of the incidence before varicella vaccination implementation in France. When routine varicella vaccination is introduced with French current coverage levels, varicella incidence is predicted to decrease by 57%, and related complications are expected to decrease by 76% over time. After vaccination, it is observed that exogenous boosting is the main driver of change in zoster incidence. When exogenous boosting is assumed, there is a temporary increase in zoster incidence before it gradually decreases, whereas without exogenous boosting, varicella vaccination leads to a gradual decrease in zoster incidence. Changing vaccine efficacy waning levels and coverage assumptions are still predicted to result in overall benefits with varicella vaccination.


CONCLUSIONS
In conclusion, the model predicted that MMRV vaccination can significantly reduce varicella incidence. With suboptimal coverage, a limited age shift of varicella cases is predicted to occur post-vaccination with MMRV. However, it does not result in an increase in the number of complications. GSK study identifier: HO-12-6924.
Mapi Consultancy, Houten, the Netherlands.
Mario J N M
MJ
Ouwens
Mapi Consultancy, Houten, the Netherlands.
Kavi J
KJ
Littlewood
Health Economics, GSK Vaccines, Wavre, Belgium. Electronic address: christophe.j.sauboin@gsk.com.
Christophe
C
Sauboin
Pharmaco Epidemiology Unit, GSK France, Marly-le-Roi, France.
Bertrand
B
Téhard
CHU de Limoges, Service de Bactériologie Virologie-Hygiène, Limoges, France.
François
F
Denis
Université Pierre et Marie Curie, Service de Biostatistique - INSERM U707, Paris, France.
Pierre-Yves
PY
Boëlle
CHU de Limoges, Service de Bactériologie Virologie-Hygiène, Limoges, France; Université de Limoges, Faculté de Médecine, Service de Bactériologie, INSERM UMR 1092, Limoges, France.
Sophie
S
Alain
D000293:Adolescent; D000328:Adult; D000368:Aged; D002644:Chickenpox / Q000453:epidemiology / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005602:France / Q000453:epidemiology; D006562:Herpes Zoster / Q000453:epidemiology / Q000517:prevention & control*; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage*; D008875:Middle Aged; D014611:Vaccination; D017778:Vaccines, Combined / Q000008:administration & dosage; D055815:Young Adult
D019433:Chickenpox Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D017778:Vaccines, Combined; C050102:measles, mumps, rubella, varicella vaccine
France; dynamic model; vaccination; varicella; zoster