一项人口数据库分析，旨在描述2004年至2022年期间意大利（一个高疫苗接种覆盖率地区）水痘的残余负担。
A population database analysis to describe the residual burden of varicella in Italy-a high vaccination coverage area-from 2004 to 2022.
作者信息
Barbieri Elisa, Cocchio Silvia, Furlan Patrizia, Scamarcia Antonio, Cantarutti Luigi, Giaquinto Carlo, Baldo Vincenzo
机构信息
Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy.
Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy.
出版信息
Front Public Health. 2025 Mar 3;13:1412620. doi: 10.3389/fpubh.2025.1412620. eCollection 2025.
INTRODUCTION
In Italy, universal varicella vaccination (VV) started in 2017 with a two-dose schedule administered in children aged 12-15 months and 5-6 years, achieving 90% coverage in 2019, though with regional variations. To address the limitations in surveillance databases for capturing varicella episodes, the study aimed to evaluate the burden of varicella disease in the pediatric population using a primary care database.
METHODS
This cohort study used data from Pedianet, a comprehensive database of 193 family pediatricians in Italy. The incidence rate (IR) of varicella (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 052 and 052.0-52.9) was evaluated in children aged below 15 years, from January 2004 to April 2022, categorized by calendar year and region. Subjects were followed up from 2004 or their enrollment date until the end of assistance or the study period. Comorbidities and complications were identified.
RESULTS
A total of 253,221 children aged below 15 years (resulting in a total follow-up of 1,430,249 person-years) were included in the study. A total of 35,614 varicella index cases were identified in 35,199 subjects (13.9%), with 1.2% experiencing two infections. Complications following varicella occurred in 467 children (1.3%), primarily affecting the skin and soft tissue (46.3%) and the respiratory tract (22.3%). The IR in regions that implemented the VV program before 2017 ranged from 38.3 per 1,000 person-years in 2007 to 0.8 per 1,000 person-years in 2022, while in those that implemented the VV in 2017, the IR decreased from 49.8 per 1,000 person-years in 2017 to 3.2 per 1,000 person-years in 2022. In the Veneto Region, following the implementation of VV in 2006, the IR significantly decreased by 20.5 annually (95% CI: -23.4, -17.5), ranging from 50.2 per 1,000 person-years in 2006 to 1.2 per 1,000 person-years in 2022.
CONCLUSION
The implementation of VV drastically reduced the IR of varicella, further confirming the importance of universal VV coverage.
引言
在意大利，2017年开始实施普遍的水痘疫苗接种（VV），采用两剂接种方案，针对12至15个月和5至6岁的儿童，到2019年覆盖率达到90%，不过存在地区差异。为解决监测数据库在捕获水痘发病情况方面的局限性，本研究旨在使用初级保健数据库评估儿科人群中水痘疾病的负担。
方法
这项队列研究使用了来自Pedianet的数据，Pedianet是意大利193名家庭儿科医生的综合数据库。对2004年1月至2022年4月期间15岁以下儿童的水痘发病率（国际疾病分类第九版临床修订本[ICD - 9 - CM]编码052和052.0 - 52.9）进行评估，按日历年和地区分类。研究对象从2004年或其入组日期开始随访，直至援助结束或研究期结束。确定合并症和并发症。
结果
共有253,221名15岁以下儿童纳入研究（总随访时间为1,430,249人年）。在35,199名受试者（13.9%）中确定了35,614例水痘索引病例，其中1.2%经历了两次感染。467名儿童（1.3%）出现水痘后并发症，主要影响皮肤和软组织（46.3%）以及呼吸道（22.3%）。2017年前实施VV计划的地区发病率从2007年的每1000人年38.3例降至2022年的每1000人年0.8例，而2017年实施VV的地区，发病率从2017年的每1000人年49.8例降至2022年的每1000人年3.2例。在威尼托地区，2006年实施VV后，发病率每年显著下降20.5（95%可信区间：-23.4，-17.5），从2006年的每1000人年50.2例降至2022年的每1000人年1.2例。
结论
VV的实施大幅降低了水痘发病率，进一步证实了普遍VV覆盖的重要性。
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