The epidemiology of varicella and herpes zoster in The Netherlands: Implications for varicella zoster virus vaccination
Introduction
The varicella zoster virus (VZV) causes two distinct diseases, varicella (chickenpox) and herpes zoster (shingles). Chickenpox is generally regarded a benign disease. However, complications like bacterial superinfections of the skin and acute neurological disorders can occur. Furthermore, latent infection of varicella zoster virus established during chickenpox can be reactivated (e.g. by aging, immunosuppresion) and results in shingles.
Some European countries are now considering introduction of routine VZV vaccination in their national immunization programmes. Recently, Germany and Sicily have included VZV vaccination in their routine vaccination schedule [1].
The European Working Group on Varicella (EuroVar) recommended routine VZV vaccination for all healthy children between 12 and 18 months and to all susceptible children before their 13th birthday, in addition to catch-up vaccination in older children and adults who have no reliable history of varicella and who are at high risk of transmission and exposure. This policy was recommended only when a very high coverage rate could be achieved [2]. The group stated that this could be reached with a measles–mumps–rubella–varicella (MMR–V) combined vaccine. In The Netherlands, the vaccine coverage for MMR amounts to 95% at 2 years of age [3].
Insight into the epidemiology of varicella and herpes zoster in The Netherlands is essential to assess the desirability of introduction of universal VZV vaccination. Subsequently, it will also be relevant to formulate an appropriate strategy for delivery of the vaccine. The present paper aims to describe the epidemiology of varicella and herpes zoster in The Netherlands. Data on seroprevalence of VZV in the general population, consultations of general practitioners (GPs) and hospital admissions for varicella and herpes zoster are presented.
Section snippets
Population-based seroprevalence study
In The Netherlands, between October 1995 and December 1996, a population-based serum bank was established of 8359 individuals. The primary aim of the study was to obtain insight into the immunity of the population against diseases included in the National Immunization Programme. Details of the study design have been published elsewhere [4]. A total of 40 municipalities were selected with sampling probabilities proportional to population size. Within each of these 40 municipalities, an
Age- and gender-specific seroprevalence
The seroprevalence of varicella zoster virus antibodies amounted to 95.6% (95% CI 94.9–96.3%) in persons 0–79 years of age (Fig. 1). The seroprevalence was slightly lower for men 93.6% (95% CI 92.2–95.0%) compared to women 95.6% (95% CI 94.7–96.5%). The seropositivity increased sharply with age from 18.4% for both 0- and 1-year-olds, to 48.9%, 59.0%, 75.7% and 93.0% for 2-, 3-, 4- and 5-year-olds, respectively. The seroprevalence amounted to 25%, 17%, 13% and 26% for infants aged 3–5 months (no
Discussion
Our study suggests that the epidemiology of varicella and herpes zoster in The Netherlands differs from that in other Western countries. This is likely to be relevant when considering VZV vaccination strategies. Firstly, the age-specific profile of VZV shows that the mean age of infection in The Netherlands is rather low in comparison to other countries [7], [8], [9], [10], [11], [12]. After waning of maternal antibodies in the first year of life, at the age of 3 years almost 60% of the
Acknowledgements
We thank Irina Tcherniaeva for technical assistance and Jan van Embden for his contribution to the study.
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