THEORETICAL EPIDEMIOLOGIC AND MORBIDITY EFFECTS OF ROUTINE VARICELLA IMMUNIZATION OF PRESCHOOL-CHILDREN IN THE UNITED-STATES

The authors studied the effects of routine varicella immunization of US preschool children and of implementation of a catch-up program in older children on the age distribution of cases and on overall morbidity, with emphasis on the sensitivity of the results to level of vaccine coverage, duration of protection, responsiveness to boosting, relative residual susceptibility and infectiousness, and degree of morbidity among vaccine breakthrough cases. An age-structured theoretical transmission model was used, with values for vaccine efficacy based on a review of the literature by an expert panel. Although implementation of a vaccination program resulted in a shift in the age distribution of remaining varicella cases toward older ages with higher complication rates, the overall reduction in cases resulted in decreased morbidity as measured by overall number of hospitalizations and number of primary cases. Routine immunization with live-virus varicella vaccine would probably result in a substantial reduction in the number of uncomplicated primary cases of chickenpox, as well as a decreased number of complicated cases requiring hospitalization. The number and age distribution of vaccinated cases would depend strongly on the characteristics of the vaccine. Vaccine efficacy studies in the field should be designed to obtain better estimates of residual susceptibility, residual infectiousness, duration of protection, and effects of boosting by wildtype reinfection.