title: Current and future effects of varicella and herpes zoster vaccination in Germany - Insights from a mathematical model in a country with universal varicella vaccination.
abstract: Varicella zoster virus (VZV) is primarily known for causing varicella in childhood, but can reactivate again as herpes zoster (HZ) after a period of latency, mainly in persons older than 50 years. Universal varicella vaccination was introduced in Germany in 2004, while HZ vaccination has not been recommended yet. We aimed to quantify the potential long-term effects of universal childhood varicella vaccination and HZ vaccination of the elderly on varicella and HZ incidence in Germany over a time horizon of 100 years, using a transmission model calibrated to pre-vaccination data and validated against early post-vaccination data. Using current vaccination coverage rates of 87% (64%) with one (two) varicella vaccine dose(s), the model predicts a decrease in varicella cases by 89% for the year 2015. In the long run, the incidence reduction will stabilize at about 70%. Under the assumption of the boosting hypothesis of improved HZ protection caused by exposure to VZV, the model predicts a temporary increase in HZ incidence of up to 20% for around 50 years. HZ vaccination of the elderly with an assumed coverage of 20% has only limited effects in counteracting this temporary increase in HZ incidence. However, HZ incidence is shown to decrease in the long-term by 58% as vaccinated individuals get older and finally reach age-classes with originally high HZ incidence. Despite substantial uncertainties around several key variables, the model's results provide valuable insights that support decision-making regarding national VZV vaccination strategies.
authors.affiliation: a ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research , Braunschweig , Germany.|b PhD Programme "Epidemiology" Helmholtz Centre for Infection Research/Hannover Medical School , Braunschweig/Hannover , Germany .
authors.forename: Johannes
authors.initials: J
authors.lastname: Horn
authors.affiliation: a ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research , Braunschweig , Germany.|c German Center for Infection Research (DZIF) , Hannover-Braunschweig site , Germany.
authors.forename: André
authors.initials: A
authors.lastname: Karch
authors.affiliation: d Department of Health Economics and Health Care Management , School of Public Health, Bielefeld University , Bielefeld , Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Damm
authors.affiliation: e Julius Centre for Health Sciences & Primary Care, University Medical Centre Utrecht , Utrecht , The Netherlands.|f Centre for Infectious Disease Control, RIVM , Bilthoven , The Netherlands.
authors.forename: Mirjam E
authors.initials: ME
authors.lastname: Kretzschmar
authors.affiliation: g Immunization Unit, Robert Koch Institute , Berlin , Germany.
authors.forename: Anette
authors.initials: A
authors.lastname: Siedler
authors.affiliation: g Immunization Unit, Robert Koch Institute , Berlin , Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Ultsch
authors.affiliation: g Immunization Unit, Robert Koch Institute , Berlin , Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Weidemann
authors.affiliation: g Immunization Unit, Robert Koch Institute , Berlin , Germany.
authors.forename: Ole
authors.initials: O
authors.lastname: Wichmann
authors.affiliation: h Institute of Virology, Department of Medical Microbiology and Hygiene, University Medical Center , Freiburg , Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Hengel
authors.affiliation: d Department of Health Economics and Health Care Management , School of Public Health, Bielefeld University , Bielefeld , Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Greiner
authors.affiliation: a ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research , Braunschweig , Germany.|c German Center for Infection Research (DZIF) , Hannover-Braunschweig site , Germany.|i Hannover Medical School , Hannover , Germany.
authors.forename: Rafael T
authors.initials: RT
authors.lastname: Mikolajczyk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002644:Chickenpox / Q000453:epidemiology* / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000008:administration & dosage / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany / Q000453:epidemiology; D006562:Herpes Zoster / Q000453:epidemiology* / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000008:administration & dosage / Q000276:immunology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D019433:Chickenpox Vaccine; D053061:Herpes Zoster Vaccine
keywords: herpes zoster; transmission model; uncertainty; varicella; varicella vaccination; zoster vaccination
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