Fallach Noga, Lasalvia Pieralessandro, Pawaskar Manjiri, Chodick Gabriel, Greenberg David, Kujawski Stephanie A
From the Kahn-Sagol-Maccabi Research and Innovation Institute, Tel Aviv, Israel.
NeuroEconomix, Bogota, Colombia.
Pediatr Infect Dis J. 2025 Jun 1;44(6):593-598. doi: 10.1097/INF.0000000000004787. Epub 2025 Mar 19.
Two-dose universal varicella vaccination (UVV) was included in Israel's national immunization program in 2008. We aimed to evaluate the impact of the UVV program on varicella incidence and healthcare costs in Israel.
A retrospective observational study was conducted using the Maccabi Healthcare Services database between 2003 and 2020. Varicella incidence and varicella-related healthcare costs were assessed in the pre- (2003-2007) and post-UVV (2010-2020) periods. We used time-series analyses with seasonal autoregressive integrated moving average models to estimate the impact of UVV on varicella incidence and regression models with gamma distributions and log-link functions to assess the impact on healthcare costs. Analyses were conducted for the overall population and vaccine-targeted (1-7 years) and nontargeted (<1 and >7 years) populations.
Annual incidence rates per 100,000 declined from 5709.6 (pre-UVV) to 1062.9 (post-UVV) in the vaccine-targeted population and from 1269.8 to 409.6 in the overall population. Time-series analysis suggested 81.8% (95% prediction interval [PI], 67.5-87.4) and 67.1% (95% PI, 48.2-75.9) reductions in the vaccine-targeted vaccination and overall populations, respectively. The largest estimated reduction in varicella incidence was in children 1 to 2 years of age [91.2% (95% PI, 53.4-95.3)]. Mean direct medical costs decreased between pre- and post-UVV periods by 82% (95% confidence interval, 77-86) in the vaccine-targeted group and 51% (95% confidence interval, 44-58) overall.
This real-world study demonstrates the substantial reduction in the disease and economic burden of varicella in the vaccine-targeted and overall population following the introduction of a 2-dose UVV program in Israel.
2008年，以色列国家免疫规划纳入了两剂次通用水痘疫苗接种（UVV）。我们旨在评估UVV计划对以色列水痘发病率和医疗费用的影响。
利用2003年至2020年期间的Maccabi医疗服务数据库进行了一项回顾性观察研究。在UVV计划实施前（2003 - 2007年）和实施后（2010 - 2020年）评估水痘发病率和与水痘相关的医疗费用。我们使用带有季节性自回归积分滑动平均模型的时间序列分析来估计UVV对水痘发病率的影响，并使用具有伽马分布和对数链接函数的回归模型来评估对医疗费用的影响。对总体人群以及疫苗接种目标人群（1 - 7岁）和非目标人群（<1岁和>7岁）进行了分析。
疫苗接种目标人群中每10万人的年发病率从UVV计划实施前的5709.6降至实施后的1062.9，总体人群中从1269.8降至409.6。时间序列分析表明，疫苗接种目标人群和总体人群中水痘发病率分别降低了81.8%（95%预测区间[PI]，67.5 - 87.4）和67.1%（95% PI，48.2 - 75.9）。水痘发病率估计降低幅度最大的是1至2岁儿童[91.2%（95% PI，53.4 - 95.3）]。在疫苗接种目标人群中，UVV计划实施前后的平均直接医疗费用下降了82%（95%置信区间，77 - 86），总体下降了51%（95%置信区间，44 - 58）。
这项实际研究表明，在以色列引入两剂次UVV计划后，疫苗接种目标人群和总体人群中水痘的疾病负担和经济负担大幅降低。
