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Title: Estimation of the burden of varicella in Europe before the introduction of universal childhood immunization
Authors: Riera-Montes, Margarita
Heininger, Ulrich
HENS, Niel 
Gabutti, Giovanni
Gil, Angel
Nozad, Bayad
Mirinaviciute, Grazina
Flem, Elmira
Souverain, Audrey
Verstraeten, Thomas
Hartwig, Susanne
Issue Date: 2017
Source: BMC INFECTIOUS DISEASES, 17, p. 1-16 (Art N° 353)
Abstract: Background: Varicella is generally considered a mild disease. Disease burden is not well known and country-level estimation is challenging. As varicella disease is not notifiable, notification criteria and rates vary between countries. In general, existing surveillance systems do not capture cases that do not seek medical care, and most are affected by underreporting and underascertainment. We aimed to estimate the overall varicella disease burden in Europe to provide critical information to support decision-making regarding varicella vaccination. Methods: We conducted a systematic literature review to identify all available epidemiological data on varicella IgG antibody seroprevalence, primary care and hospitalisation incidence, and mortality. We then developed methods to estimate age-specific varicella incidence and annual number of cases by different levels of severity (cases in the community, health care seekers in primary care and hospitals, and deaths) for all countries belonging to the European Medicines Agency (EMA) region and Switzerland. Results: In the absence of universal varicella immunization, the burden of varicella would be substantial with a total of 5.5 million (95% CI: 4.7-6.4) varicella cases occurring annually across Europe. Variation exists between countries but overall the majority of cases (3 million; 95% CI: 2.7-3.3) would occur in children < 5 years. Annually, 3-3.9 million patients would consult a primary care physician, 18,200-23,500 patients would be hospitalised, and 80 varicella-related deaths would occur (95% CI: 19-822). Conclusions: Varicella disease burden is substantial. Most cases occur in children < 5 years old but adults require hospitalisation more often and are at higher risk of death. This information should be considered when planning and evaluating varicella control strategies. A better understanding of the driving factors of country-specific differences in varicella transmission and health care utilization is needed. Improving and standardizing varicella surveillance in Europe, as initiated by the European Centre for Disease Prevention and Control (ECDC), is important to improve data quality to facilitate inter-country comparison.
Notes: [Riera-Montes, Margarita; Bollaerts, Kaatje; Verstraeten, Thomas] P95 Pharmacovigilance & Epidemiol Serv, Koning Leopold 3 Laan 1, B-3001 Leuven, Belgium. [Heininger, Ulrich] Univ Basel, Childrens Hosp, Div Paediat Infect Dis & Vaccinol, CH-4056 Basel, Switzerland. [Hens, Niel] Hasselt Univ, Interuniv Inst Biostat & Stat Bioinformat, Antwerp, Belgium. [Hens, Niel] Univ Antwerp, Ctr Hlth Econ Res & Modelling Infect Dis, Vaccine & Infect Dis Inst, Antwerp, Belgium. [Hens, Niel] Univ Antwerp, Ctr Evaluat Vaccinat, Vaccine & Infect Dis Inst, Antwerp, Belgium. [Gabutti, Giovanni] Univ Ferrara, Dept Med Sci, Ferrara, Italy. [Gil, Angel] Univ Rey Juan Carlos, Madrid, Spain. [Nozad, Bayad] Imperial Coll London, Dept Primary Care & Publ Hlth, London, England. [Mirinaviciute, Grazina; Flem, Elmira] Norwegian Inst Publ Hlth, Dept Infect Dis Epidemiol & Modelling, Oslo, Norway. [Souverain, Audrey] Aixial, 4 Rue Danjou, F-92513 Boulogne, France. [Hartwig, Susanne] Sanofi Pasteur MSD, 162 Ave Jean Jaures, F-69007 Lyon, France.
Keywords: Varicella; Disease burden; Europe;varicella; disease burden; Europe
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e-ISSN: 1471-2334
DOI: 10.1186/s12879-017-2445-2
ISI #: 000401863100003
Rights: © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated
Category: A1
Type: Journal Contribution
Validations: ecoom 2018
Appears in Collections:Research publications

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