title: Integrating between-host transmission and within-host immunity to analyze the impact of varicella vaccination on zoster.
abstract: Varicella-zoster virus (VZV) causes chickenpox and reactivation of latent VZV causes herpes zoster (HZ). VZV reactivation is subject to the opposing mechanisms of declining and boosted VZV-specific cellular mediated immunity (CMI). A reduction in exogenous re-exposure 'opportunities' through universal chickenpox vaccination could therefore lead to an increase in HZ incidence. We present the first individual-based model that integrates within-host data on VZV-CMI and between-host transmission data to simulate HZ incidence. This model allows estimating currently unknown pivotal biomedical parameters, including the duration of exogenous boosting at 2 years, with a peak threefold to fourfold increase of VZV-CMI; the VZV weekly reactivation probability at 5% and VZV subclinical reactivation having no effect on VZV-CMI. A 100% effective chickenpox vaccine given to 1 year olds would cause a 1.75 times peak increase in HZ 31 years after implementation. This increase is predicted to occur mainly in younger age groups than is currently assumed.
authors.affiliation: Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
authors.forename: Benson
authors.identifier: http://orcid.org/0000-0002-0831-2063
authors.initials: B
authors.lastname: Ogunjimi
authors.affiliation: Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
authors.forename: Lander
authors.initials: L
authors.lastname: Willem
authors.affiliation: Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Beutels
authors.affiliation: Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
authors.forename: Niel
authors.initials: N
authors.lastname: Hens
mesh_terms: D019433:Chickenpox Vaccine / Q000008:administration & dosage* / Q000276:immunology*; D006562:Herpes Zoster / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D007111:Immunity, Cellular; D008954:Models, Biological; D015233:Models, Statistical; D018570:Risk Assessment; D018140:Varicellovirus / Q000276:immunology* / Q000502:physiology; D014775:Virus Activation
chemical_list: D019433:Chickenpox Vaccine
keywords: boosting; epidemiology; global health; human; infectious disease; microbiology; modeling; shingles; vaccination; varicella; zoster