Published online April 1, 2005
PEDIATRICS Vol. 115 No. 4 April 2005, pp. 900-905 (doi:10.1542/peds.2004-1162)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (13)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Marin, M.
Right arrow Articles by Seward, J. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Marin, M.
Right arrow Articles by Seward, J. F.
Related Collections
Right arrow Infectious Disease & Immunity

Importance of Catch-up Vaccination: Experience From a Varicella Outbreak, Maine, 2002–2003

Mona Marin, MD*,{ddagger}, Huong Q. Nguyen, MPH{ddagger}, Julie Keen, MPH§, Aisha O. Jumaan, PhD, MPH{ddagger}, Patricia M. Mellen, MSN, PNP||, Edward B. Hayes, MD§, Kathleen F. Gensheimer, MD, MPH§, Jennifer Gunderman-King, MPH§ and Jane F. Seward, MBBS, MPH{ddagger}

* Epidemic Intelligence Service, Epidemiology Program Office
{ddagger} National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
§ Maine Bureau of Health, Augusta, Maine
|| School A, Maine

Objective. During December 2002 to January 2003, a varicella outbreak occurred in an elementary school in Maine. Just 1 month before detecting the outbreak, Maine implemented varicella vaccine requirements for child care but did not require vaccination for school entry. We investigated this outbreak to examine reasons for its occurrence, including vaccine failure.

Methods. A self-administered questionnaire was sent to all students' parents to determine student disease status, medical conditions, and vaccination status, which was further confirmed by review of medical records. Parental reporting of chickenpox/varicella that occurred since September 1, 2002, in a student who attended the school was used to define a case. Parents of cases were interviewed by telephone about disease characteristics. Disease severity was classified on the basis of the number of skin lesions and the occurrence of complications. Vaccine effectiveness was calculated by comparing varicella attack rates for any disease, for moderate to severe disease, and for severe disease among vaccinated and unvaccinated students.

Results. We obtained complete information for 296 (81%) of 364 students. Varicella vaccine coverage was 74% overall and decreased by grade, from 90% in kindergarten to 60% in third grade. Attack rates increased significantly from 14% in kindergarten to 37% in third grade. Of the 53 varicella cases, 36 (68%) were unvaccinated, 12 (22%) were vaccinated, and 5 (10%) had previous disease history. Vaccine effectiveness was 89% (95% confidence interval [CI]: 79–94%) against disease of any severity, 96% (95% CI: 88–99%) against moderate to severe disease, and 100% (95% CI: undefined) against severe disease. Twenty-two percent of unvaccinated students had severe disease and 1 was hospitalized for a skin infection, whereas none of the vaccinated cases reported severe disease.

Conclusion. This outbreak was attributable primarily to failure to vaccinate, especially among children in grades 1 through 3. Catch-up vaccination of susceptible older children and adolescents is especially important to prevent accumulation of susceptibility in these groups, in which the natural disease is more severe. School entry requirements will contribute to a more rapid implementation of the existing recommendations for vaccination.

Key Words: varicella • breakthrough varicella • vaccine • catch-up vaccination • school requirements • vaccine effectiveness • vaccine failure • chickenpox

Abbreviations: VZV, varicella-zoster virus • AAP, American Academy of Pediatrics • ACIP, Advisory Committee on Immunization Practices • MBoH, Maine Bureau of Health • CDC, Centers for Disease Control and Prevention • PCR, polymerase chain reaction • VE, vaccine effectiveness • ARU, attack rates among unvaccinated students • ARV, attack rates among vaccinated students • RR, risk ratio • CI, confidence interval

Accepted Aug 9, 2004.




This article has been cited by other articles:


Home page
 PediatricsHome page
K. R. Broder, A. C. Cohn, B. Schwartz, J. D. Klein, M. M. Fisher, D. B. Fishbein, C. Mijalski, G. R. Burstein, M. E. Vernon-Smiley, M. M. McCauley, et al.
Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?
Pediatrics, January 1, 2008; 121(Supplement_1): S25 - S34.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
Committee on Infectious Diseases
Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule
Pediatrics, July 1, 2007; 120(1): 221 - 231.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. M. Davis, M. Marin, A. E. Cowan, D. Guris, and S. J. Clark
Physician Attitudes Regarding Breakthrough Varicella Disease and a Potential Second Dose of Varicella Vaccine
Pediatrics, February 1, 2007; 119(2): 258 - 264.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. A. Goss and P. R. Beninger
Eczema and Postvaccination Varicella Breakthrough
Pediatrics, December 1, 2005; 116(6): 1613 - 1613.
[Full Text] [PDF]