Varicella

doi:10.1016/S0140-6736(06)69561-5

The Lancet

Volume 368, Issue 9544, 14–20 October 2006, Pages 1365-1376

https://doi.org/10.1016/S0140-6736(06)69561-5 Get rights and content

Summary

Varicella-zoster virus, a herpesvirus, causes varicella (chickenpox) and, after endogenous reactivation, herpes zoster (shingles). Varicella, which is recognised by a characteristic vesicular rash, arises mainly in young children, although older individuals can be affected. In immunocompetent patients, symptoms are usually mild to moderate, but an uncomplicated severe case can have more than 1000 lesions and severe constitutional symptoms. Serious complications—including central nervous system involvement, pneumonia, secondary bacterial infections, and death—are sometimes seen. Varicella can be prevented by vaccination. Vaccine is about 80–85% effective against all disease and highly (more than 95%) effective in prevention of severe disease. In the USA, a routine childhood immunisation programme has reduced disease incidence, complications, hospital admissions, and deaths in children and in the general population, indicating strong herd immunity. Similar immunisation programmes have been adopted by some other countries, including Uruguay, Germany, Taiwan, Canada, and Australia, and are expected to be implemented more widely in future.

Section snippets

Pathogenesis

Varicella-zoster virus is one of eight herpesviruses of the Herpesviridae family that are known to cause disease in people and some other primates.²⁹ The virus is a DNA α-herpesvirus with a genome of about 125 000 bp that encode 70 genes.³⁰ During primary lytic infection with varicella virus, these genes are expressed sequentially, in much the same way as they are in herpes simplex virus.³¹ Sequential expression leads to the production of groups of immediate to early non-structural proteins,

Epidemiology

The epidemiology of varicella differs in temperate and tropical climates.5, 63, 64 In most temperate climates more than 90% of people are infected before adolescence,8, 9, 65, 66 whereas in many tropical climates the disease is acquired later in life and adults are more susceptible than are children.63, 64, 67, 68 Epidemiological variation might relate to differences in population density and risk of exposure, differences in transmissibility of the heat-labile varicella-zoster virus in hot,

Clinical features

Clinical illness is characterised by onset of fever, which is usually concurrent with appearance of the self-limited, pruritic, vesicular rash; various mucosal sites (ie, conjunctivae, oropharynx, and introitus of the genito–urinary tract) can also be affected. The rash starts as macules, and progresses rapidly through papular and vesicular stages, before beginning to crust within a short period (24–48 h). The vesicles appear in crops, so that on any one part of the body the rash can be in

Diagnosis

In most cases, the characteristic features of the vesicular varicella rash establish the clinical diagnosis. If doubt remains, a recent history of exposure to varicella (or herpes zoster) or the occurrence of secondary cases in close contacts can help diagnosis. The differential diagnosis consists mainly of allergic reactions (especially Stevens-Johnson syndrome), generalised herpes zoster or herpes simplex infections, enterovirus infections, pityriasis lichenoides et varioliformis acuta

Treatment

In almost all cases, varicella is a self-limited disease, and symptomatic treatment (with acetaminophen to control fever, lotions for pruritus, and fluid substitution to maintain hydration) is sufficient. Treatment with acetyl salicylic acid is strongly discouraged in children because of its association with Reye's syndrome.¹²⁴ Moreover, the use of non-steroidal anti-inflammatory drugs in children with varicella might increase the risk of necrotising soft tissue infections and invasive group A

Prevention

The available varicella vaccines are a single antigen vaccine and a combination vaccine against measles, mumps, rubella, and varicella (MMRV). The live, attenuated varicella vaccine is available worldwide as Varivax (Merck, NJ, USA), Varilrix (GlaxoSmithKline, Rixensart, Belgium), and Okavax (Biken, Osaka Japan). The vaccine was developed in Japan.¹³¹ All vaccines use the Oka strain of varicella-zoster virus, which was isolated from a healthy child with varicella and attenuated by sequential

Varicella vaccination programmes

Varicella vaccine has now been licensed and is widely available throughout the world. The goal of a vaccination programme determines the strategy used. Because varicella is mainly a childhood disease, prevention of varicella and its attendant morbidity and mortality is best accomplished through universal vaccination of children. Targeted programmes (eg, for health-care workers, household contacts of immunocompromised people, susceptible adolescents or adults) offer either direct or indirect

Postvaccine epidemiology

In the USA, since the introduction of the childhood varicella vaccination, varicella cases, hospital admissions, and deaths have fallen by more than 80% in children, and to a lesser extent in adults and infants, who are protected by indirect effects (so-called herd immunity).181, 186, 187, 188, 189 By 2000, when vaccine coverage in young children ranged from 74–84%, varicella cases were reduced by 71–84% in active surveillance sites.¹⁸⁶ By 1999–2001, the rate of deaths in which varicella was

Future directions

In developed countries, if varicella costs and medical and social benefits are considered, universal childhood vaccination programmes will probably be cost-saving.19, 20, 192 Wider availability of a combination MMRV vaccine could aid implementation of such programmes. Studies that include models of the expected increase and then fall in prevalence of herpes zoster suggest that a varicella vaccination programme will probably be cost saving only in the longer term, as vaccinated cohorts reach

Search strategy and selection criteria

We used the PUBMED database to search for publications with “varicella” and “VZV” as keywords, plus additional terms including “vaccine”, “complications”, “hospitalization”, “death”, “treatment”, and “side-effects”. Citations were selected from articles published in English and German. For treatment and prophylaxis we focused on published randomised controlled trials whenever available. Reference lists in key textbook chapters and review articles were also checked for relevant

References (194)

RE Hope-Simpson
Infectiousness of communicable diseases in the household (measles, chickenpox and mumps)
Lancet
(1952)
M Wharton
The epidemiology of varicella-zoster virus infections
Infect Dis Clin North Am
(1996)
C Aebi et al.
Age-specific seroprevalence to varicella-zoster virus: study in Swiss children and analysis of European data
Vaccine
(2001)
L Coudeville et al.
The value of varicella vaccination in healthy children: cost-benefit analysis of the situation in France
Vaccine
(1999)
E Somekh et al.
The burden of uncomplicated cases of chickenpox in Israel
J Infect
(2002)
TC Mettenleiter
Budding events in herpesvirus morphogenesis
Virus Res
(2004)
M Tsolia et al.
Live attenuated varicella vaccine: evidence that the virus is attenuated and the importance of skin lesions in transmission of varicella-zoster virus. National institute of allergy and infectious diseases varicella vaccine collaborative study group
J Pediatr
(1990)
JJ Chen et al.
Mannose 6-phosphate receptor dependence of varicella zoster virus infection in vitro and in the epidermis during varicella and zoster
Cell
(2004)
A Sauerbrei et al.
Immunofluorescence test for sensitive detection of varicella-zoster virus-specific IgG: an alternative to fluorescent antibody to membrane antigen test
J Virol Methods
(2004)
A Etzioni et al.
Fatal varicella associated with selective natural killer cell deficiency
J Pediatr
(2005)

BP Yawn et al.

Community impact of childhood varicella infections

J Pediatr

(1997)

KG Chant et al.

Varicella-zoster virus infection in Australia

Aust N Z J Public Health

(1998)

JH Harger et al.

Frequency of congenital varicella syndrome in a prospective cohort of 347 pregnant women

Obstet Gynecol

(2002)

G Enders et al.

Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases

Lancet

(1994)

MP Tan et al.

Chickenpox in pregnancy: revisited

Reprod Toxicol

(2006)

TH Weller et al.

The etiologic agents of varicella and herpes zoster; isolation, propagation, and cultural characteristics in vitro

J Exp Med

(1958)

AM Arvin

Varicella-zoster virus

Clin Microbiol Rev

(1996)

AA Gershon et al.

Varicella vaccine

M Brisson et al.

Epidemiology of varicella zoster virus infection in Canada and the United Kingdom

Epidemiol Infect

(2001)

U Heininger et al.

Seroprevalence of varicella-zoster virus immunoglobulin G antibodies in Swiss adolescents and risk factor analysis for seronegativity

Pediatr Infect Dis J

(2001)

P Wutzler et al.

Seroprevalence of varicella-zoster in the German population

Vaccine

(2002)

SM Hunt et al.

Childhood chickenpox: its impact on child and family

Fam Pract

(1993)

A Jaeggi et al.

Complications of varicella in a defined central European population

Arch Dis Child

(1998)

KB Laupland et al.

Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group

Pediatrics

(2000)

PA Meyer et al.

Varicella mortality: trends before vaccine licensure in the United States, 1970–1994

J Infect Dis

(2000)

J Bonhoeffer et al.

Prospective surveillance of hospitalisations associated with varicella-zoster virus infections in children and adolescents

Eur J Pediatr

(2005)

B Law et al.

The Immunization Monitoring Program Active (IMPACT) prospective five year study of Canadian children hospitalised for chickenpox or an associated complication

Pediatr Infect Dis J

(2000)

AH Ross

Modification of chickenpox in family contacts by administration of gamma globulin

N Engl J Med

(1962)

JF Seward et al.

Contagiousness of varicella in vaccinated cases, a household contact study

JAMA

(2004)

Y Asano et al.

Protection against varicella in family contacts by immediate inoculation with live varicella vaccine

Pediatrics

(1977)

T Lieu et al.

Cost-effectiveness of a routine varicella vaccination program for U.S. children

JAMA

(1994)

B Law et al.

Cost of chickenpox in Canada: Part 1. Cost of uncomplicated cases

Pediatrics

(1999)

O Lungu et al.

Reactivated and latent varicella-zoster virus in human dorsal root ganglia

Proc Natl Acad Sci USA

(1995)

HE Hope-Simpson

The nature of herpes zoster: A long term study and a new hypothesis

Proc R Soc Med

(1965)

TH Weller et al.

The etiologic agents of varicella and herpes zoster; isolation, propagation, and cultural characteristics in vitro

J Exp Med

(1958)

J Katz et al.

Acute pain in herpes zoster and its impact on health-related quality of life

Clin Infect Dis

(2004)

MN Oxman et al.

A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults

N Engl J Med

(2005)

Product Approval Information—Licensing Action

(May 26, 2006)

D Padovan et al.

Varicella-like herpesvirus infections of nonhuman primates

Lab Anim Sci

(1986)

AJ Davison et al.

The complete DNA sequence of varicella-zoster virus

J Gen Virol

(1986)

RJ Cohrs et al.

Array analysis of viral gene transcription during lytic infection of cells in tissue culture with varicella-zoster virus

J Virol

(2003)

AJ Davison

Varicella-zoster virus. The fourteenth Fleming lecture

J Gen Virol

(1991)

C Grose

Glycoproteins encoded by varicella-zoster virus: biosynthesis, phosphorylation, and intracellular trafficking

Annu Rev Microbiol

(1990)

JH Martin et al.

Restriction endonuclease analysis of varicella-zoster vaccine virus and wild-type DNAs

J Med Virol

(1982)

W Barrett-Muir et al.

Genetic variation of varicella-zoster virus: evidence for geographical separation of strains

J Med Virol

(2003)

VN Loparev et al.

Global identification of three major genotypes of varicella-zoster virus: longitudinal clustering and strategies for genotyping

J Virol

(2004)

Y Gomi et al.

Comparison of the complete DNA sequences of the Oka varicella vaccine and its parental virus

J Virol

(2002)

S Kido et al.

Detection of varicella-zoster virus (VZV) DNA in clinical samples from patients with VZV by the polymerase chain reaction

J Clin Microbiol

(1991)

CM Koropchak et al.

Investigation of varicella-zoster virus infection by polymerase chain reaction in the immunocompetent host with acute varicella

J Infect Dis

(1991)

MH Sawyer et al.

Detection of varicella-zoster virus DNA in the oropharynx and blood of patients with varicella

J Infect Dis

(1992)

Cited by (499)

Parental perceptions of chickenpox and the varicella vaccine: A qualitative systematic review
2024, Vaccine
In countries where varicella vaccination is not on the routine childhood immunisation schedule, such as those in the United Kingdom (UK), chickenpox is an almost universal disease of childhood. Chickenpox can cause serious complications, particularly in infants, pregnant women, and the immunocompromised. In November 2023 the varicella vaccine was recommended for inclusion in the UK routine childhood immunisation schedule. Successful rollout of the vaccine may be hindered by parental concerns about vaccine safety and efficacy, and perceptions of chickenpox as a mild illness.
To examine parental perceptions of chickenpox and varicella vaccination, which may be crucial to effective vaccination campaigns.
Qualitative systematic review and thematic analysis.
Six electronic databases were systematically searched for studies published between 2016 and 2023: CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, and Web of Science. The included studies were appraised against the Critical Appraisal Skills Program checklist for qualitative studies. Thematic analysis was used to analyse qualitative data, through the development of themes.
22 articles were included in this review, and five themes identified: perceptions that chickenpox is a mild illness, that parents have concerns about varicella vaccine efficacy and safety, a notion of natural immunity as superior, social determinants of health influence vaccine decision making, and vaccination is overwhelming perceived as a parental decision.
Whilst some parents displayed an acceptance and willingness to vaccinate against chickenpox, many expressed concerns, and perceived chickenpox as a routine unworrying childhood illness. Analysis demonstrated a knowledge gap in understanding UK parental opinions regarding chickenpox and varicella vaccination, highlighting the need for research in this area, particularly given ongoing reconsideration for inclusion in the UK vaccination schedule.
The review was registered on PROSPERO, registration ID CRD42021236120.
Immunogenicity and safety of an ORF7-deficient skin-attenuated and neuro-attenuated live vaccine for varicella: a randomised, double-blind, controlled, phase 2a trial
2024, The Lancet Infectious Diseases
The Oka varicella vaccine strain remains neurovirulent and can establish lifelong latent infection, raising safety concerns about vaccine-related herpes zoster. In this study, we aimed to evaluate the immunogenicity and safety of a skin-attenuated and neuro-attenuated varicella vaccine candidate (v7D vaccine).
We did this randomised, double-blind, controlled, phase 2a clinical trial in Jiangsu, China. Healthy children aged 3–12 years with no history of varicella infection or vaccination were enrolled and randomly assigned (1:1:1:1) to receive a single subcutaneous injection of the v7D vaccine at 3·3 log₁₀ plaque forming units (PFU; low-dose v7D group), 3·9 log₁₀ PFU (medium-dose v7D group), and 4·2 log₁₀ PFU (high-dose v7D group), or the positive control varicella vaccine (vOka vaccine group). All the participants, laboratory personnel, and investigators other than the vaccine preparation and management staff were masked to the vaccine allocation. The primary outcome was assessment of the geometric mean titres (GMTs) and seroconversion rates of anti-varicella zoster virus immunoglobulin G (IgG) induced by different dose groups of v7D vaccine at 0, 42, 60, and 90 days after vaccination in the per-protocol set for humoral immune response analysis. Safety was a secondary outcome, focusing on adverse events within 42 days post-vaccination, and serious adverse events within 6 months after vaccination. This study was registered on Chinese Clinical Trial Registry, ChiCTR2000034434.
On Aug 18–21, 2020, 842 eligible volunteers were enrolled and randomly assigned treatment. After three participants withdrew, 839 received a low dose (n=211), middle dose (n=210), or high dose (n=210) of v7D vaccine, or the vOka vaccine (n=208). In the per-protocol set for humoral immune response analysis, the anti-varicella zoster virus IgG antibody response was highest at day 90. At day 90, the seroconversion rates of the low-dose, medium-dose, and high-dose groups of v7D vaccine and the positive control vOka vaccine group were 100·0% (95% CI 95·8–100·0; 87 of 87 participants), 98·9% (93·8–100·0; 87 of 88 participants), 97·8% (92·4–99·7; 91 of 93 participants), and 96·4% (89·8–99·2; 80 of 83 participants), respectively; the GMTs corresponded to values of 30·8 (95% CI 26·2–36·0), 31·3 (26·7–36·6), 28·2 (23·9–33·2), and 38·5 (31·7–46·7). The v7D vaccine, at low dose and medium dose, elicited a humoral immune response similar to that of the vOka vaccine. However, the high-dose v7D vaccine induced a marginally lower GMT compared with the vOka vaccine at day 90 (p=0·027). In the per-protocol set, the three dose groups of the v7D vaccine induced a similar humoral immune response at each timepoint, with no statistically significant differences. The incidence of adverse reactions in the low-dose, medium-dose, and high-dose groups of v7D vaccine was significantly lower than that in the vOka vaccine group (17% [35 of 211 participants], 20% [41 of 210 participants], and 13% [27 of 210 participants] vs 24% [50 of 208 participants], respectively; p=0·025), especially local adverse reactions (10% [22 of 211 participants], 14% [30 of 210 participants] and 9% [18 of 210 participants] vs 18% [38 of 208 participants], respectively; p=0·016). None of the serious adverse events were vaccine related.
The three dose groups of the candidate v7D vaccine exhibit similar humoral immunogenicity to the vOka vaccine and are well tolerated. These findings encourage further investigations on two-dose vaccination schedules, efficacy, and the potential safety benefit of v7D vaccine in the future.
The National Natural Science Foundation of China, CAMS Innovation Fund for Medical Sciences, the Fundamental Research Funds for the Central Universities, and Beijing Wantai.
For the Chinese translation of the abstract see Supplementary Materials section.
Willingness to receive Herpes Zoster vaccination among adults and older people: A cross sectional study in Italy
2023, Vaccine
The objective of this study was to explore the Herpes Zoster (HZ) knowledge and the willingness to receive the HZ vaccination in adults and older people in Italy. The study was conducted on a sample of patients aged ≥65 years and over 50 years with chronic conditions who went to the clinics of general practitioners (GPs) in Campania region, Italy. Data was collected with a questionnaire administered through an interview. Multivariate logistic regression analysis was performed. 427 participants (83.2 %) had heard about HZ infection and correctly knew the main symptoms of the HZ disease, and 196 of them (45.9 %) were aware of the main complications of the infection, such as post-Herpetic Neuralgia (NPE) and Herpes Zoster ophthalmicus (HZO). Only 61 participants (11.8 %) had heard of the availability of a vaccination against HZ in Italy and 39 of them (63.9 %) knew that the vaccination is recommended in at-risk patients aged at least 50 years and for adults aged ≥65 years. 137 participants (26.6 %) had a positive attitude toward the willingness to receive the HZ vaccination. Participants aged 50–64 years, those who have more than one chronic disease, those who have received at least one recommended vaccination, those who had a positive attitude on the usefulness of HZ vaccination, and those who feel the need to receive additional information about HZ vaccination were more likely to have a positive attitude toward the willingness to receive the HZ vaccination. It is needed to implement effective strategies to improve HZ vaccination coverage in order to protect especially frail patients from the most serious complications of the disease.
Impacts of routine varicella vaccination program and COVID-19 pandemic on varicella and herpes zoster incidence and health resource use among children in Japan
2023, Vaccine
To determine the epidemiological trends in pediatric varicella and herpes zoster incidence and changes in healthcare resource use from 2005 to 2022 using a nationally representative database in Japan.
We conducted a retrospective observational study consisting of 3.5 million children with 177 million person-months during 2005–2022 using Japan Medical Data Center (JMDC) claims database in Japan. We investigated trends in incidence rates of varicella and herpes zoster and changes in healthcare resource use (e.g., antiviral use, office visits, and healthcare costs) over 18 years. Interrupted time-series analyses were used to investigate the impact of the routine varicella vaccination program in 2014 and infection prevention measures against COVID-19 on incidence rates of varicella and herpes zoster and related healthcare utilization.
After the introduction of the routine immunization program in 2014, we observed level changes in incidence rates (45.6 % reduction [95 %CI, 32.9–56.0] of varicella cases, antiviral use (40.9 % reduction [95 %CI, 25.1–53.3]), and relevant healthcare costs (48.7 % reduction [95 %CI, 38.2–57.3]). Furthermore, infection prevention measures against COVID-19 were associated with additional level changes in varicella rates (57.2 % reduction [95 %CI, 44.5–67.1]), antiviral use (65.7 % reduction [59.7–70.8]), and healthcare costs (49.1 % [95 %CI, 32.7–61.6]). In contrast, the changes in incidence and healthcare costs for herpes zoster were relatively small, which showed 9.4 % elevated level change with a decreasing trend and 8.7 % reduced level change with a decreasing trend after the vaccine program and the COVID-19 pandemic. The cumulative incidence of herpes zoster in children born after 2014 was lower than that before 2014.
Varicella incidence and healthcare resource use were largely affected by the routine immunization program and infection prevention measures against COVID-19, while these impacts on herpes zoster were relatively small. Our study indicates that immunization and infection prevention measures largely changed pediatric infectious disease practices.
The necessity for popularizing varicella-zoster virus vaccine programs worldwide: An age-period-cohort analysis for the Global Burden of Disease study 2019
2023, Journal of Infection and Public Health
Varicella-zoster virus (VZV) causes varicella and herpes zoster (VHZ), which is endemic worldwide. Although infection with VZV represents a considerable health threat, the global, regional and national burden of VZV infection, especially the probable relationship between VZV vaccines and the epidemiology of VZV infection, is poorly known. We sought to estimate the global spatial patterns and temporal trends of VHZ burden in 204 countries and territories from 1990 to 2019.
Numbers and age-standardized rates (ASR) of VHZ incidence, and disability-adjusted life years (DALYs) were estimated using data from the Global Burden of Diseases Study (GBD) 2019. Spatiotemporal trends in ASR were evaluated by estimated annual percentage change (EAPC).
Worldwide, in 2019, there were approximately 84.0 million incidence and 0.9 million DALYs due to VHZ. The corresponding ASIR (age-standardized incidence rate) and ASDR (age-standardized DALY rate) drastically decreased in children (aged <20 years old), while the ASIR and ASDR of VHZ significantly increased in middle- and old-aged adults (aged >50 years old), with highest ASIR and ASDR in the High-income Asia Pacific and Western Sub-Saharan Africa, respectively. From 1990–2019, the corresponding EAPC in ASIR were 0.03 (95% uncertainty interval [UI]: 0.02–0.04). Whereas the global EAPC in ASDR decreased in all regions (−1.59, 95% UI: −1.64 to −1.55), expect for Australasia (0.46, [0.05, 0.88]). Notably, in 2019, age-specific rates of VHZ DALYs presented a rapid growth trend after 70 years old.
The spatiotemporal trends of VHZ were heterogeneous across countries from 1990 to 2019. The spatiotemporal trend in ASIR is highest in the High sociodemographic index (SDI) region, however the EAPC in ASDR is lowest, in part probably due to VHZ vaccination. Therefore, reducing morbidity and burden strategies such as vaccines programs for the prevention of VHZ should be promoted in those regions with high growth incidence and/or burden, especially for the population after 70 years old.
Seroprevalence of varicella-zoster virus antibody and immunogenicity of live attenuated varicella vaccine in healthcare workers in Taiwan
2023, Journal of Microbiology, Immunology and Infection
Healthcare workers (HCWs) without evidence of immunity to varicella-zoster virus (VZV) are recommended to undergo varicella vaccination. Immunogenicity of live attenuated varicella vaccine has rarely been investigated among HCWs in Taiwan.
Anti-VZV immunoglobulin G (IgG) titer was checked for all HCWs at Changhua Christian Hospital from 2011 to 2017. One-dose and two-dose (separated by 4–8 weeks) vaccines were administered to HCWs with equivocal and negative anti-varicella IgG results, respectively. Follow-up anti-VZV IgG was determined at least 4 weeks after completion of vaccination. Factors associated with seroconversion to varicella vaccination were analyzed.
Among 2406 included HCWs, the anti-VZV IgG serostatus was tested positive, equivocal and negative in 1924 (79.9%), 117 (4.9%) and 365 (15.2%), respectively. The seroprevalence had decreased from 88.0% (235/267) in 2011 to 72.2% (270/374) in 2017 (p for trend <0.05). A total of 67.8% (327/482) HCWs completed scheduled vaccination and serological follow-up. The seroconversion rates for HCWs with baseline equivocal and negative anti-VZV IgG results were 100% (80/80) and 79.4% (196/247) after one- and two-dose vaccination, respectively. In multivariate analysis, obesity (adjusted odds ratio, 0.308; 95% confidence interval [CI], 0.11–0.94, p = 0.039) was the only factor statistically significantly associated with seroconversion to vaccination.
Decreasing trends of seroprevalence of VZV were observed among HCWs from 2011 to 2017. HCWs who were obese were less likely to respond to varicella vaccination.

View all citing articles on Scopus

View full text

SeminarVaricella

Summary

Section snippets

Pathogenesis

Epidemiology

Clinical features

Diagnosis

Treatment

Prevention

Varicella vaccination programmes

Postvaccine epidemiology

Future directions

Search strategy and selection criteria

Lancet

Infect Dis Clin North Am

Vaccine

Vaccine

J Infect

Virus Res

J Pediatr

Cell

J Virol Methods

J Pediatr

J Pediatr

Aust N Z J Public Health

Obstet Gynecol

Lancet

Reprod Toxicol

The etiologic agents of varicella and herpes zoster; isolation, propagation, and cultural characteristics in vitro

J Exp Med

Varicella-zoster virus

Clin Microbiol Rev

Varicella vaccine

Epidemiology of varicella zoster virus infection in Canada and the United Kingdom

Epidemiol Infect

Seroprevalence of varicella-zoster virus immunoglobulin G antibodies in Swiss adolescents and risk factor analysis for seronegativity

Pediatr Infect Dis J

Seroprevalence of varicella-zoster in the German population

Vaccine

Childhood chickenpox: its impact on child and family

Fam Pract

Complications of varicella in a defined central European population

Arch Dis Child

Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group

Pediatrics

Varicella mortality: trends before vaccine licensure in the United States, 1970–1994

J Infect Dis

Prospective surveillance of hospitalisations associated with varicella-zoster virus infections in children and adolescents

Eur J Pediatr

The Immunization Monitoring Program Active (IMPACT) prospective five year study of Canadian children hospitalised for chickenpox or an associated complication

Pediatr Infect Dis J

Modification of chickenpox in family contacts by administration of gamma globulin

N Engl J Med

Contagiousness of varicella in vaccinated cases, a household contact study

JAMA

Protection against varicella in family contacts by immediate inoculation with live varicella vaccine

Pediatrics

Cost-effectiveness of a routine varicella vaccination program for U.S. children

JAMA

Cost of chickenpox in Canada: Part 1. Cost of uncomplicated cases

Pediatrics

Reactivated and latent varicella-zoster virus in human dorsal root ganglia

Proc Natl Acad Sci USA

The nature of herpes zoster: A long term study and a new hypothesis

Proc R Soc Med

The etiologic agents of varicella and herpes zoster; isolation, propagation, and cultural characteristics in vitro

J Exp Med

Acute pain in herpes zoster and its impact on health-related quality of life

Clin Infect Dis

A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults

N Engl J Med

Product Approval Information—Licensing Action

Varicella-like herpesvirus infections of nonhuman primates

Lab Anim Sci

The complete DNA sequence of varicella-zoster virus

J Gen Virol

Array analysis of viral gene transcription during lytic infection of cells in tissue culture with varicella-zoster virus

J Virol

Varicella-zoster virus. The fourteenth Fleming lecture

J Gen Virol

Seminar
Varicella