Perella Dana, Fiks Alexander G, Jumaan Aisha, Robinson Donovan, Gargiullo Paul, Pletcher Jonathan, Forke Christine M, Schmid D Scott, Renwick Mia, Mankodi Foram, Watson Barbara, Spain C Victor
Varicella Active Surveillance Project, Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA 19146, USA.
Pediatrics. 2009 May;123(5):e820-8. doi: 10.1542/peds.2008-3310.
We assessed the validity of reported varicella history as a marker for varicella zoster virus immunity among unvaccinated persons 1 to 29 years of age, and we examined varicella disease characteristics associated with varicella zoster virus immunity among those reporting positive histories.
We conducted a cross-sectional study at 7 community-based sites in Philadelphia, Pennsylvania, between June 2004 and May 2006 and recruited 1476 participants 1 to 29 years of age who had not been vaccinated against varicella. Sensitivity, specificity, and positive predictive value were determined by comparing self-reported or parent-reported varicella histories from a standardized study interview with varicella zoster virus immunoglobulin G serological results for each participant. We performed multivariate logistic regression analyses to determine which disease characteristics best predicted seropositivity.
The sensitivity of reported varicella history was highest (81%-89%) among participants > or =10 years of age, whereas specificity was highest among participants 1 to 4 years of age (99%) and > or =20 years (88%). Reported varicella history was highly predictive of seropositivity (>95%) only among participants > or =15 years of age. For participants 10 to 14 years of age, parental reports of a generalized itchy rash with 1 of the following were highly predictive of seropositivity: varicella transmission to another household member or being raised in a household with no other children. Among participants < or =9 years of age, no combination of disease characteristics was both highly predictive of seropositivity and common.
The validity of reported varicella history varies according to age, and a reported history is no longer highly predictive of seropositivity among cohorts born since 1994 (participants < or =9 years of age). Universal varicella vaccination, regardless of history, for these children should be considered, as should simplified criteria for varicella zoster virus immunity among unvaccinated persons born before 1994.
我们评估了报告的水痘病史作为1至29岁未接种疫苗人群中水痘带状疱疹病毒免疫标志物的有效性，并研究了报告水痘病史阳性者中与水痘带状疱疹病毒免疫相关的水痘疾病特征。
2004年6月至2006年5月期间，我们在宾夕法尼亚州费城的7个社区站点开展了一项横断面研究，招募了1476名1至29岁未接种水痘疫苗的参与者。通过将标准化研究访谈中自我报告或家长报告的水痘病史与每位参与者的水痘带状疱疹病毒免疫球蛋白G血清学结果进行比较，确定敏感性、特异性和阳性预测值。我们进行了多因素逻辑回归分析，以确定哪些疾病特征最能预测血清阳性。
报告的水痘病史敏感性在≥10岁的参与者中最高（81%-89%），而特异性在1至4岁的参与者中最高（99%）以及≥20岁的参与者中最高（88%）。仅在≥15岁的参与者中，报告的水痘病史对血清阳性具有高度预测性（>95%）。对于10至14岁的参与者，家长报告出现全身性瘙痒性皮疹并伴有以下情况之一对血清阳性具有高度预测性：水痘传染给另一个家庭成员或在没有其他孩子的家庭中长大。在≤9岁的参与者中，没有任何一组疾病特征既能高度预测血清阳性又很常见。
报告的水痘病史的有效性因年龄而异，对于1994年以后出生的队列（≤9岁的参与者），报告的病史不再能高度预测血清阳性。对于这些儿童，应考虑无论病史如何都进行普遍的水痘疫苗接种，对于1994年以前出生的未接种疫苗人群，也应考虑简化的水痘带状疱疹病毒免疫标准。
