Dinleyici Ener Cagri, Kurugol Zafer, Devrim Ilker, Bayram Nuri, Dalgic Nazan, Yasa Olcay, Tezer Hasan, Ozdemir Halil, Ciftci Ergin, Tapisiz Anil, Celebi Solmaz, Hacimustafaoglu Mustafa, Yilmaz Dilek, Hatipoglu Nevin, Kara Ates
From the Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, Eskisehir, Turkey.
Ege University Faculty of Medicine, Pediatric Infectious Disease Unit, Izmir, Turkey.
Pediatr Infect Dis J. 2025 Jan 1;44(1):83-89. doi: 10.1097/INF.0000000000004521. Epub 2024 Sep 4.
A single-dose varicella vaccine at 12 months of age was introduced to the National Immunization Program in February 2013 in Turkey. This study aimed to evaluate varicella-related hospitalization in children and the impact of a single-dose live attenuated varicella vaccine over the first 5.5 years of introducing a universal varicella vaccination.
We analyzed data collected from the medical records of children <18 years old who required hospitalization due to varicella in 17 cities representing 50% of the childhood population in Turkey between 2008 and 2018. We calculated the rate of hospitalization for varicella per 100,000 children during the study period. The main objective of this study was to determine the yearly rate of hospitalization due to varicella and to compare these rates in the pre-vaccine and post-vaccine periods. The secondary objective was to compare demographic features, varicella-related complications, and outcomes between the pre-vaccine and post-vaccine periods.
A total of 4373 children (2458 boys and 1915 girls; 72.3% previously healthy) were hospitalized for varicella over a 10-year period, including 2139 children during the pre-vaccine period and 2234 children during the post-vaccine period. Overall, varicella hospitalization rates decreased significantly after the introduction of varicella vaccination [pre-vaccine vs. post-vaccine period; 3.79 vs. 2.87 per 100,000 per year; P < 0.001; odds ratio 0.75; 95% confidence interval 0.64-0.88]. The incidence of varicella-related hospitalization among children between 1 and 5 years of age was significantly lower in the post-vaccine era than in the pre-vaccine era, with a 60.2% decrease in hospitalizations (2.43 vs. 6.12 per 100,000 children; P < 0.001, odds ratio 0.39; 95% confidence interval 0.34-0.46). In both the <1-year and 6- to 10-year age groups, the incidence of varicella-related hospitalizations was similar in the pre-vaccine and post-vaccine periods. The incidence of varicella-related hospitalization was higher in the post-vaccine era among 11-15 years and >15-year-old groups ( P < 0.01 and P < 0.05). The mean age was higher during the post-vaccine period than during the pre-vaccine period ( P < 0.001). The absolute number of secondary bacterial infections ( P < 0.01), respiratory complications ( P < 0.01), and neurological complications ( P < 0.001) was significantly lower during the post-vaccine period. The incidence of severe varicella was lower during the post-vaccine period than during the pre-vaccine period ( P < 0.001).
After 5.5 years of routine single-dose varicella vaccine use, we observed the impact of varicella vaccination on the incidence of varicella-related hospitalizations, especially in the target age group. However, we did not observe herd protection in the other age groups. The implementation of a second dose of the varicella vaccine in the National Immunization Program would help control disease activity.
2013年2月，土耳其国家免疫规划引入了12月龄单剂量水痘疫苗。本研究旨在评估儿童水痘相关住院情况以及通用水痘疫苗接种头5.5年中，单剂量减毒活水痘疫苗的影响。
我们分析了2008年至2018年间从土耳其17个城市收集的18岁以下因水痘需住院治疗儿童的病历数据，这些城市代表了土耳其50%的儿童人口。我们计算了研究期间每10万名儿童的水痘住院率。本研究的主要目的是确定每年因水痘住院的比率，并比较疫苗接种前和接种后的比率。次要目的是比较疫苗接种前和接种后时期的人口统计学特征、水痘相关并发症及结局。
在10年期间，共有4373名儿童（2458名男孩和1915名女孩；72.3%之前健康）因水痘住院，其中疫苗接种前时期有2139名儿童，疫苗接种后时期有2234名儿童。总体而言，水痘疫苗接种后，水痘住院率显著下降[疫苗接种前与接种后时期；每年每10万分别为3.79和2.87；P<0.001；比值比0.75；95%置信区间0.64 - 0.88]。1至5岁儿童中，水痘相关住院发生率在疫苗接种后时期显著低于疫苗接种前时期，住院率下降了60.2%（每10万名儿童分别为2.43和6.12；P<0.001，比值比0.39；95%置信区间0.34 - 0.46）。在<1岁和6至10岁年龄组中，疫苗接种前和接种后时期水痘相关住院发生率相似。在11至15岁和>15岁年龄组中，疫苗接种后时期水痘相关住院发生率较高（P<0.01和P<0.05）。疫苗接种后时期平均年龄高于疫苗接种前时期（P<0.001）。疫苗接种后时期继发性细菌感染（P<0.01）、呼吸道并发症（P<0.01）和神经系统并发症（P<0.001）的绝对数量显著更低。严重水痘的发生率在疫苗接种后时期低于疫苗接种前时期（P<0.001）。
在常规使用单剂量水痘疫苗5.5年后，我们观察到水痘疫苗对水痘相关住院发生率的影响，尤其是在目标年龄组。然而，我们未在其他年龄组观察到群体保护作用。在国家免疫规划中实施第二剂水痘疫苗将有助于控制疾病活动。
