Published online April 27, 2009
PEDIATRICS Vol. 123 No. 5 May 2009, pp. e820-e828 (doi:10.1542/peds.2008-3310)
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ARTICLE

Validity of Reported Varicella History as a Marker for Varicella Zoster Virus Immunity Among Unvaccinated Children, Adolescents, and Young Adults in the Post–Vaccine Licensure Era

Dana Perella, MSPHa, Alexander G. Fiks, MD, MSCEb,c,d, Aisha Jumaan, PhD, MPHe, Donovan Robinson, MPHa, Paul Gargiullo, PhDe, Jonathan Pletcher, MDf, Christine M. Forke, MSN, RN, CRNPf, D. Scott Schmid, PhDe, Mia Renwick, MPHa, Foram Mankodi, MD, MPHa, Barbara Watson, MBChB, FRCP, FAAPa and C. Victor Spain, DVM, PhDa

a Varicella Active Surveillance Project, Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
b Pediatric Research Consortium
c Pediatric Generalist Research Group
f Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
d Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
e National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

OBJECTIVES. We assessed the validity of reported varicella history as a marker for varicella zoster virus immunity among unvaccinated persons 1 to 29 years of age, and we examined varicella disease characteristics associated with varicella zoster virus immunity among those reporting positive histories.

METHODS. We conducted a cross-sectional study at 7 community-based sites in Philadelphia, Pennsylvania, between June 2004 and May 2006 and recruited 1476 participants 1 to 29 years of age who had not been vaccinated against varicella. Sensitivity, specificity, and positive predictive value were determined by comparing self-reported or parent-reported varicella histories from a standardized study interview with varicella zoster virus immunoglobulin G serological results for each participant. We performed multivariate logistic regression analyses to determine which disease characteristics best predicted seropositivity.

RESULTS. The sensitivity of reported varicella history was highest (81%–89%) among participants ≥10 years of age, whereas specificity was highest among participants 1 to 4 years of age (99%) and ≥20 years (88%). Reported varicella history was highly predictive of seropositivity (>95%) only among participants ≥15 years of age. For participants 10 to 14 years of age, parental reports of a generalized itchy rash with 1 of the following were highly predictive of seropositivity: varicella transmission to another household member or being raised in a household with no other children. Among participants ≤9 years of age, no combination of disease characteristics was both highly predictive of seropositivity and common.

CONCLUSIONS. The validity of reported varicella history varies according to age, and a reported history is no longer highly predictive of seropositivity among cohorts born since 1994 (participants ≤9 years of age). Universal varicella vaccination, regardless of history, for these children should be considered, as should simplified criteria for varicella zoster virus immunity among unvaccinated persons born before 1994.

Key Words: varicella • chickenpox • immunity • varicella vaccine • sensitivity • specificity

Abbreviations: ACIP—Advisory Committee on Immunization Practices • CDC—Centers for Disease Control and Prevention • CHOP—Children's Hospital of Philadelphia • IgG—immunoglobulin G • PDPH—Philadelphia Department of Public Health • VZV—varicella zoster virus • PPV—positive predictive value • ELISA—enzyme-linked immunosorbent assay

Accepted Jan 28, 2009.


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