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. 1998 Dec;79(6):478–480. doi: 10.1136/adc.79.6.478

Risk factors for breakthrough varicella in healthy children

Y Lim 1, F Chew 1, A Tan 1, B Lee 1
PMCID: PMC1717776  PMID: 10210990

Abstract

AIM—To evaluate the risk factors for breakthrough varicella in a follow up study of a cohort of 181 healthy children immunised when aged 9-24 months with a reformulated Oka strain varicella vaccine (SmithKline Beecham Biologicals/Oka).
DESIGN—The children were randomised in a double blind manner into one of four groups to receive one of two production lot vaccine batches, at two different titres (high titre, 103.9 and 104.0 plaque forming units (pfu); low titre (heat exposed), 102.7 and 102.8 pfu). The overall seroconversion rate after immunisation was 99%.
RESULTS—One hundred and sixty eight patients were available for review after a mean (SD) follow up of 35 (9) months after vaccination. Multivariate analysis indicated that risk factors for breakthrough varicella were household contact with varicella (adjusted odds ratio (OR), 19.89; 95% confidence interval (CI), 18.39 to 21.39), vaccination age of ⩽ 14 months (adjusted OR, 2.30; 95% CI, 1.69to 2.90), and receiving low titre (102.7 pfu) vaccine (adjusted OR, 2.13; 95% CI, 1.54 to 2.73). All children who developed breakthrough varicella, had a modified varicella illness, except for three, all of whom had received low titre vaccine.
CONCLUSION—The identification of young immunisation age (⩽ 14 months) and low titre vaccine as risk factors for breakthrough varicella have important implications for the implementation of varicella vaccination programmes in healthy children. 



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Selected References

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  1. Asano Y., Nagai T., Miyata T., Yazaki T., Ito S., Yamanishi K., Takahashi M. Long-term protective immunity of recipients of the OKA strain of live varicella vaccine. Pediatrics. 1985 Apr;75(4):667–671. [PubMed] [Google Scholar]
  2. Asano Y., Suga S., Yoshikawa T., Kobayashi I., Yazaki T., Shibata M., Tsuzuki K., Ito S. Experience and reason: twenty-year follow-up of protective immunity of the Oka strain live varicella vaccine. Pediatrics. 1994 Oct;94(4 Pt 1):524–526. [PubMed] [Google Scholar]
  3. Bernstein H. H., Rothstein E. P., Watson B. M., Reisinger K. S., Blatter M. M., Wellman C. O., Chartrand S. A., Cho I., Ngai A., White C. J. Clinical survey of natural varicella compared with breakthrough varicella after immunization with live attenuated Oka/Merck varicella vaccine. Pediatrics. 1993 Dec;92(6):833–837. [PubMed] [Google Scholar]
  4. Ellis R. W. Varicella vaccine. Vaccine. 1995;13(15):1387–1388. doi: 10.1016/0264-410x(95)00135-n. [DOI] [PubMed] [Google Scholar]
  5. Gershon A. A. Varicella vaccine: its past, present and future. Pediatr Infect Dis J. 1995 Sep;14(9):742–744. [PubMed] [Google Scholar]
  6. Hardy I., Gershon A. A., Steinberg S. P., LaRussa P. The incidence of zoster after immunization with live attenuated varicella vaccine. A study in children with leukemia. Varicella Vaccine Collaborative Study Group. N Engl J Med. 1991 Nov 28;325(22):1545–1550. doi: 10.1056/NEJM199111283252204. [DOI] [PubMed] [Google Scholar]
  7. Krause P. R., Klinman D. M. Efficacy, immunogenicity, safety, and use of live attenuated chickenpox vaccine. J Pediatr. 1995 Oct;127(4):518–525. doi: 10.1016/s0022-3476(95)70106-0. [DOI] [PubMed] [Google Scholar]
  8. Leventon-Kriss S., Yoffe R., Rannon L., Modan M. Seroepidemiologic aspects of varicella zoster virus infections in an Israeli Jewish population. Isr J Med Sci. 1978 Jul;14(7):766–770. [PubMed] [Google Scholar]
  9. Levin M. J., Hayward A. R. The varicella vaccine. Prevention of herpes zoster. Infect Dis Clin North Am. 1996 Sep;10(3):657–675. doi: 10.1016/s0891-5520(05)70319-6. [DOI] [PubMed] [Google Scholar]
  10. ROSS A. H. Modification of chicken pox in family contacts by administration of gamma globulin. N Engl J Med. 1962 Aug 23;267:369–376. doi: 10.1056/NEJM196208232670801. [DOI] [PubMed] [Google Scholar]
  11. Ross L. F., Lantos J. D. Immunisation against chickenpox. BMJ. 1995 Jan 7;310(6971):2–3. doi: 10.1136/bmj.310.6971.2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Tan A. Y., Connett C. J., Connett G. J., Quek S. C., Yap H. K., Meurice F., Lee B. W. Use of a reformulated Oka strain varicella vaccine (SmithKline Beecham Biologicals/Oka) in healthy children. Eur J Pediatr. 1996 Aug;155(8):706–711. doi: 10.1007/BF01957158. [DOI] [PubMed] [Google Scholar]
  13. Terada K., Kawano S., Yoshihiro K., Morita T. Varicella-zoster virus (VZV) reactivation is related to the low response of VZV-specific immunity after chickenpox in infancy. J Infect Dis. 1994 Mar;169(3):650–652. doi: 10.1093/infdis/169.3.650. [DOI] [PubMed] [Google Scholar]
  14. Tynell E., Aurelius E., Brandell A., Julander I., Wood M., Yao Q. Y., Rickinson A., Akerlund B., Andersson J. Acyclovir and prednisolone treatment of acute infectious mononucleosis: a multicenter, double-blind, placebo-controlled study. J Infect Dis. 1996 Aug;174(2):324–331. doi: 10.1093/infdis/174.2.324. [DOI] [PubMed] [Google Scholar]
  15. Varis T., Vesikari T. Efficacy of high-titer live attenuated varicella vaccine in healthy young children. J Infect Dis. 1996 Nov;174 (Suppl 3):S330–S334. doi: 10.1093/infdis/174.supplement_3.s330. [DOI] [PubMed] [Google Scholar]
  16. Watson B. M., Piercy S. A., Plotkin S. A., Starr S. E. Modified chickenpox in children immunized with the Oka/Merck varicella vaccine. Pediatrics. 1993 Jan;91(1):17–22. [PubMed] [Google Scholar]
  17. Weibel R. E., Neff B. J., Kuter B. J., Guess H. A., Rothenberger C. A., Fitzgerald A. J., Connor K. A., McLean A. A., Hilleman M. R., Buynak E. B. Live attenuated varicella virus vaccine. Efficacy trial in healthy children. N Engl J Med. 1984 May 31;310(22):1409–1415. doi: 10.1056/NEJM198405313102201. [DOI] [PubMed] [Google Scholar]
  18. White C. J. Clinical trials of varicella vaccine in healthy children. Infect Dis Clin North Am. 1996 Sep;10(3):595–608. doi: 10.1016/s0891-5520(05)70315-9. [DOI] [PubMed] [Google Scholar]
  19. White C. J., Kuter B. J., Hildebrand C. S., Isganitis K. L., Matthews H., Miller W. J., Provost P. J., Ellis R. W., Gerety R. J., Calandra G. B. Varicella vaccine (VARIVAX) in healthy children and adolescents: results from clinical trials, 1987 to 1989. Pediatrics. 1991 May;87(5):604–610. [PubMed] [Google Scholar]
  20. White C. J., Kuter B. J., Ngai A., Hildebrand C. S., Isganitis K. L., Patterson C. M., Capra A., Miller W. J., Krah D. L., Provost P. J. Modified cases of chickenpox after varicella vaccination: correlation of protection with antibody response. Pediatr Infect Dis J. 1992 Jan;11(1):19–23. doi: 10.1097/00006454-199201000-00006. [DOI] [PubMed] [Google Scholar]
  21. White C. J. Varicella-zoster virus vaccine. Clin Infect Dis. 1997 May;24(5):753–763. doi: 10.1093/clinids/24.5.753. [DOI] [PubMed] [Google Scholar]

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