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Title: Perspectives on the Impact of Varicella Immunization on Herpes Zoster. A Model-Based Evaluation from Three European Countries
Authors: Poletti, Piero
Melegaro, Alessia
Ajelli, Marco
DEL FAVA, Emanuele 
Guzzetta, Giorgio
Faustini, Luca
Tomba, Giampaolo Scalia
Lopalco, Pierluigi
Rizzo, Caterina
Merler, Stefano
Manfredi, Piero
Issue Date: 2013
Source: PLOS ONE, 8 (4)
Abstract: The introduction of mass vaccination against Varicella-Zoster-Virus (VZV) is being delayed in many European countries because of, among other factors, the possibility of a large increase in Herpes Zoster (HZ) incidence in the first decades after the initiation of vaccination, due to the expected decline of the boosting of Cell Mediated Immunity caused by the reduced varicella circulation. A multi-country model of VZV transmission and reactivation, is used to evaluate the possible impact of varicella vaccination on HZ epidemiology in Italy, Finland and the UK. Despite the large uncertainty surrounding HZ and vaccine-related parameters, surprisingly robust medium-term predictions are provided, indicating that an increase in HZ incidence is likely to occur in countries where the incidence rate is lower in absence of immunization, possibly due to a higher force of boosting (e.g. Finland), whereas increases in HZ incidence might be minor where the force of boosting is milder (e.g. the UK). Moreover, a convergence of HZ post vaccination incidence levels in the examined countries is predicted despite different initial degrees of success of immunization policies. Unlike previous model-based evaluations, our investigation shows that after varicella immunization an increase of HZ incidence is not a certain fact, rather depends on the presence or absence of factors promoting a strong boosting intensity and which might or not be heavily affected by changes in varicella circulation due to mass immunization. These findings might explain the opposed empirical evidences observed about the increases of HZ in sites where mass varicella vaccination is ongoing.
Notes: Bruno Kessler Fdn, Ctr Informat Technol, Trento, Italy. Bocconi Univ, DONDENA Ctr Res Social Dynam, Milan, Italy. Univ Hasselt, Ctr Stat, Diepenbeek, Belgium. ISTAT Reg Off Tuscany, Florence, Italy. Univ Roma Tor Vergata, Dept Math, Poletti, P (reprint author), Rome, Italy. European Ctr Dis Prevent & Control, Stockholm, Sweden. Ist Super Sanita, Natl Ctr Epidemiol Surveillance & Hlth Promot, I-00161 Rome, Italy. Univ Pisa, Dept Stat & Math Appl Econ, Pisa, Italy.
Keywords: Multidisciplinary Sciences
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ISSN: 1932-6203
e-ISSN: 1932-6203
DOI: 10.1371/journal.pone.0060732
ISI #: 000317907200011
Rights: © 2013 Poletti et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Category: A1
Type: Journal Contribution
Validations: ecoom 2014
Appears in Collections:Research publications

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