Chickenpox vaccine reduces incidence of paediatric shingles

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Children who receive the chickenpox (varicella) vaccine are significantly less likely to contract shingles, according to a study led by researchers at the Kaiser Permanente Centre for Health Research.

Shingles, or herpes zoster, is caused by the varicella-zoster virus, the same virus that causes chickenpox. According to the Centres for Disease Control and Prevention, there are an estimated 1m cases of HZ each year in the US. However, paediatric HZ is a rare disease, and the symptoms are usually milder for children compared with adults, who typically report a painful, burning, and blistering skin rash.

“Since the introduction of the chickenpox vaccine, we have known how effective it is in preventing children from contracting that itchy and painful disease, but we set out to determine if the vaccine would also reduce risk of herpes zoster,” explained lead investigator Dr Sheila Weinmann. “Our findings demonstrate that the vaccine does reduce the likelihood of shingles in kids, highlighting the dual benefits of the chickenpox vaccine.”

The study, funded by the CDC, looked at the electronic health records of more than 6.3m children between 2003 and 2014, using data from 6 integrated health care organisations. Approximately 50% of the children were vaccinated for some or all of the study period.

Researchers found that, overall, HZ risk is much lower in vaccinated than unvaccinated children. Specifically, they concluded the following: over the 12-year period of the study, the rate of pediatric HZ declined by 72% overall as the number of vaccinated children rose; incidence of HZ was 78% lower in vaccinated children than in unvaccinated children; and rates for immunosuppressed children, who were unable to receive the vaccination, were 5- to 6-times higher than for those who were not immunosuppressed.

“We looked at the incidence rates of HZ overall, at how many cases there were per 100,000 person-years, including by age and gender,” noted Weinmann. Person-years refers to the type of measurement that takes into account both the number of children who were included in the HZ study and the amount of time each child spent in the study over its 12-year course. “We saw the highest rates of HZ in the early years of the study when there was a higher proportion of children, particularly older children, who had not received the varicella vaccine.”

The rate of HZ among children who were unvaccinated climbed from 2003 to 2007 and then declined sharply through the end of the study period. Increasing rates of vaccination over the study period reduced the risk of contracting HZ overall for all children, including those who were unvaccinated. The decline could also have been related to the introduction of the second vaccine dose beginning in 2007, as HZ incidence was much lower in those children who received the 2-dose vaccinations rather than 1-dose vaccination.

Abstract
Background and objectives: After the 1996 introduction of routine varicella vaccination in the United States, most studies evaluating pediatric herpes zoster (HZ) incidence reported lower incidence over time, with varying degrees of decline. Using the combined databases of 6 integrated health care organizations, we examined HZ incidence in children over a 12-year period in the varicella vaccine era.
Methods: This study included children aged 0 through 17 years from 2003 through 2014. Using electronic medical records, we identified HZ cases through International Classification of Diseases, Ninth Revision diagnosis code 053. We calculated HZ incidence rates per 100 000 person years of health plan membership for all children and among children who were vaccinated versus unvaccinated. We calculated rates for the 12-year period and examined temporal trends. Among children who were vaccinated, we compared HZ rates by month and year of age at vaccination.
Results: The study included 6 372 067 children with ≥1 month of health plan membership. For the 12-year period, the crude HZ incidence rate for all subjects was 74 per 100 000 person years, and the rate among children who were vaccinated was 38 per 100 000 person years, which was 78% lower than that among children who were unvaccinated (170 per 100 000 person years; P < .0001). Overall HZ incidence declined by 72% (P < .0001) from 2003 through 2014. Annual rates in children who were vaccinated were consistently lower than in children who were unvaccinated.
Conclusions: With this population-based study, we confirm the decline in pediatric HZ incidence and the significantly lower incidence among children who are vaccinated, reinforcing the benefit of routine varicella vaccination to prevent pediatric HZ.

Authors
Sheila Weinmann, Allison L Naleway, Padma Koppolu, Roger Baxter, Edward A Belongia, Simon J Hambidge, Stephanie A Irving, Michael L Jackson, Nicola P Klein, Bruno Lewin, Elizabeth Liles, Mona Marin, Ning Smith, Eric Weintraub, Colleen Chun

Kaiser Permanente material
Pediatrics abstract


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