Seroprevalence of varicella-zoster virus in the German population
Introduction
Varicella-zoster virus (VZV) is an ubiquitous human α-herpesvirus that causes varicella (chickenpox) in virtually everyone by adulthood [1]. After primary infection the virus establishes latency in cells of dorsal root ganglia and reactivates as herpes zoster (shingles) in approximately 15% of the infected individuals over a lifetime. Most primary VZV infections occur during the 1st decade of life, however, an upward shift in the age distribution of varicella became evident in some countries [2], [3], [4], [5].
Although usually a mild disease in otherwise healthy children, varicella can be a complicated and even life-threatening disease in adolescents, young adults, and in immunocompromised patients. Varicella occurring in pregnant women during the 1st trimester of gestation are occasionally associated with the congenital varicella syndrome [6], [7]. During the perinatal period, a primary maternal infection may be responsible for severe neonatal varicella.
The disease burden can be diminished by immunization for which a safe attenuated vaccine is available, that proved to provide long-term protective immunity against varicella infection [8], [9]. Universal vaccination in childhood is expected to reduce substantially the number of uncomplicated cases of chickenpox as well as to decrease the number of complicated cases requiring hospitalization [10]. Immunization against VZV also has the potential to lower the risk of herpes zoster [11]. While in the USA a routine varicella vaccination program targeting healthy children has been implemented recently [12], in most European countries, strategies for varicella prevention are still a matter of debate. In Germany, where about 760,000 varicella cases per year occur [13], varicella vaccine is licensed for use in special indication groups such as seronegative children with leukemia, solid tumors, severe neurodermatitis, and before starting immunosuppressive treatment [14]. Vaccination is also recommended for family contacts of at-risk patients, health-care workers and women who want to become pregnant.
The present survey was conducted to generate data on the epidemiology of VZV infections in Germany which should serve as basis for ongoing health economic evaluations of varicella vaccination strategies. The aims of the study were: (1) to examine the age-specific antibody prevalence in the population at the age of 0 to <70 years; (2) to measure the antibody levels; and (3) to compare the seroprevalences between inhabitants of the old and new (territory of the former GDR) federal states.
Section snippets
Sample design and study population
The survey was designed as a cross-sectional, age-stratified study of VZV seroprevalence in the German population between 0 and ≥70 years of age. The sample size was calculated on the basis of a 95% confidence interval using the prevalence rates detected in a previous study for age-groups >2 years as “expected seropositivity” [15] in order to obtain estimates of ±2% accuracy for seropositive rates of about 95%, ±4% accuracy for rates between 85 and 90% and ±6% accuracy for rates between 20 and
Results
Data on seropositivity for VZV in the study population are shown in the Fig. 1. The frequency of positive samples declined from 79.4% (95% CI; 62.3–91.0) during the 1st 3 months of life to 8.6% (95% CI; 4.4–15.2) by the end of the 1st year of life. Afterwards, the antibody prevalence increased steeply from 33.6% (95% CI; 28.0–40.0) among the 2–3 years old to 62.5% (95% CI; 56.0–68.5) among the 4–5 years old. In the 10–11 years age-group, 94.2% (95% CI; 91.0–96.0) of the children had been
Discussion
The present study provides epidemiological data on VZV infections in Germany based on the determination of specific anti-VZV antibodies. It could be shown that after waning of maternal antibodies over the period of 6–9 months of life seropositivity rates remained low by the end of the 1st year of live. Afterwards seroprevalence increased steeply. By the age 4–5 years 62% of the pre-school population had already been infected with VZV and at the age of 10–11 years, >90% of children were positive
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