Varicella deaths in US have ‘practically been eliminated’ by vaccination
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WASHINGTON — Since its start 25 years ago, the varicella vaccine program in the United States has led to high vaccination coverage, resulting in a 97% decrease in cases of the disease also known as chickenpox, according to data presented at IDWeek.
“Once a vaccination program is implemented, CDC routinely assesses the program’s impact and monitors changes in the epidemiology of the disease,” Mona Marin, MD, medical epidemiologist for the CDC, told Healio. “The varicella vaccination program began in the United States in 1995. Although most people usually recover without serious complications, varicella can cause significant morbidity and mortality in otherwise healthy people.”
According to Marin, before the vaccine was introduced, up to 13,500 hospitalizations and between 100 and 150 deaths were recorded in the U.S. each year. She added that more than 90% of cases, two-thirds of hospitalizations and about half the deaths occurred in children.
“With 25 years of the program now complete, we describe the nation’s experience with the varicella vaccine, summarizing the successes and challenges in implementing and monitoring the program,” Marin said.
To assess the impact of the vaccination program, Marin and colleagues reviewed published data and analyzed overall and age-specific trends for rates from the pre-vaccine period, specified as 1990 to 1994, through 2019 for varicella incidence using data from the National Notifiable Diseases Surveillance System, hospitalizations using data from the National Inpatient Sample and deaths using data from the National Center for Health Statistics.
The review revealed that high vaccination coverage was attained and maintained, which Marin said was “paramount in the dramatic reduction in the varicella burden” in the U.S. over 25 years. Marin and colleagues estimated that vaccination prevents more than 3.8 million cases, 10,500 hospitalizations and 100 deaths in the U.S. annually.
According to the study, cases declined overall by more than 97% and fell in all age groups — including infants, who are not recommended to receive the vaccine, and adults, who are not routinely vaccinated and who can experience a more severe disease.
Additionally, varicella hospitalizations and deaths declined 94% and 97% in people aged younger than 50 years, although the greatest declines for both hospitalizations and deaths were among people aged 20 years or younger, born during the varicella vaccination program, with 97% and more than 99%, respectively. Marin added that in this age group, varicella hospitalizations have become rare and varicella deaths have “practically been eliminated” in the U.S.
Marin said these data show that varicella vaccine program implementation was highly successful and has made a significant public health and economic impact since its start in 1995.
“The success of the varicella vaccine program in the U.S. calls for celebration but also continued vigilance,” Marin said. “Because it is rare now, providers should keep varicella in the differential diagnosis when seeing a patient with a maculopapular or vesicular rash and be aware that the presentation of varicella is most commonly atypical and milder in a vaccinated person.”
She added, ‘The prompt recognition and diagnosis of varicella is important because clinical and public health measures need to be taken swiftly.”
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Marin M, et al. Abstract 1534. Presented at: IDWeek; Oct. 19-23, 2022. Washington. (hybrid meeting).
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