Abstract
BackgroundStrategies to control varicella vary across Europe. Evidence from established programmes has prompted the United Kingdom to re-evaluate the need for universal vaccination. The burden of complicated varicella is a key parameter in the cost-effectiveness analysis.AimOur objective was to estimate the burden of complicated varicella in England.MethodsThis electronic health record surveillance study used data from all NHS hospitals in England to identify varicella admissions between 2004 and 2017. The incidence of pre-defined complications of varicella was estimated using ICD-10 codes. Inpatient costs were calculated based on the payment rules for providers of NHS services.ResultsThere were 61,024 admissions with varicella between 2004 and 2017 and 38.1% had a recognised varicella complication. Incidence of hospitalisation increased by 25% and the proportion with complicated varicella by 24% from 2004/05 to 2016/17. The most common complications were bacterial skin infections (11.25%), pneumonia (4.82%), febrile convulsions (3.39%) and encephalitis (2.44%). Complication rates were higher in older age groups and the type of complications more severe. Length of stay for complicated varicella was 3.1 times longer than for uncomplicated varicella and inpatient costs were 72% greater.ConclusionComplicated varicella has a substantial health and economic burden. These data together with data on impact on quality of life are important in informing the cost-effectiveness analysis of universal varicella vaccination.
Highlights
Strategies to control varicella vary across Europe, with some countries including the United Kingdom (UK) adopting a selective programme and others (Finland, Germany, Greece, Italy, Latvia, Luxembourg and Spain) recommending universal vaccination using a twodose schedule of the live-attenuated vaccine [1]
The decision not to introduce a universal varicella vaccination programme in the UK has been primarily based on two factors: firstly, suggestions that vaccination of children may reduce a protective boosting effect in adults against herpes zoster; secondly, a reasoning that, while common, varicella infection in children generally causes mild, self-limiting illness, so the net benefits from the programme do not outweigh the potential harms from an increase in zoster [2,3]
Universal varicella vaccination is being reconsidered in the UK for several reasons: firstly, more time has passed since varicella programmes were introduced in other countries, providing an opportunity to examine whether predicted increases in zoster have been seen
Summary
Strategies to control varicella vary across Europe, with some countries including the United Kingdom (UK) adopting a selective programme and others (Finland, Germany, Greece, Italy, Latvia, Luxembourg and Spain) recommending universal vaccination using a twodose schedule of the live-attenuated vaccine [1]. Universal varicella vaccination is being reconsidered in the UK for several reasons: firstly, more time has passed since varicella programmes were introduced in other countries, providing an opportunity to examine whether predicted increases in zoster have been seen. Conclusion: Complicated varicella has a substantial health and economic burden These data together with data on impact on quality of life are important in informing the cost-effectiveness analysis of universal varicella vaccination
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