Burden of varicella in Latin America and the Caribbean: findings from a systematic literature review

Luiza Helena Falleiros Arlant,Cintia Irene Parellada,Maria L Avila Aguero,Miguel Cashat,Maria Catalina Pirez Garcia,Lara J Wolfson

doi:10.1186/s12889-019-6795-0

Abstract

BackgroundVaricella is typically mild and self-limiting, but can be associated with complications and even death. The limited data available on varicella in Latin America and the Caribbean (LAC) indicate substantial burden in countries where varicella vaccine is not part of publicly funded childhood national immunization programs.MethodsA systematic literature review of published studies was complemented by “gray” literature on varicella incidence, complications, mortality, and economic consequences, in the absence and presence of universal varicella vaccination (UVV) in LAC.ResultsSeroprevalence data indicate that varicella is usually a disease of childhood in LAC. Varicella incidence rates, while unreliable in the absence of mandatory reporting, show a trend to increased incidence due to greater urbanization and population density. The introduction of UVV in national immunization programs has led to significant reductions in varicella incidence in these areas.ConclusionsVaricella continues to pose a substantial healthcare burden in LAC. The future introduction of UVV in additional countries is predicted to provide substantial reductions in cases, with important economic benefits. For countries that have already implemented UVV, the challenge is to maintain high rates of coverage and, where relevant, consider inclusion of a second dose to reduce breakthrough cases. Given the significant proportion of the region now implementing UVV, a regional recommendation in order to prevent any potential for age-shifts in varicella infection might be considered.

Highlights

Varicella is typically mild and self-limiting, but can be associated with complications and even death
This review aims to describe trends relevant to improving the understanding, prevention, and management of varicella across Latin America and the Caribbean (LAC) and is part of a broader systematic literature review (SLR), undertaken to assess the epidemiology and burden of varicella infection and the status of varicella vaccination programs in global regions
The full texts of 552 studies were assessed for eligibility, resulting in 210 studies (221 publications) for inclusion in the overarching SLR across the four global regions, including LAC (Fig. 2); 24 of the identified studies were relevant to LAC

Summary

Introduction

Varicella is typically mild and self-limiting, but can be associated with complications and even death. VZV is transmitted by direct contact and by inhalation of aerosols from vesicular fluid of skin lesions of varicella or herpes zoster. Varicella is a mild and self-limiting disease, characterized by a generalized itchy rash, headache, fever, and malaise [2, 3]. In high-income countries with a temperate climate, varicella is usually a childhood disease, showing seasonal variation; in the pre-vaccination era, more than 90% of infections occurred before adolescence, with fewer than one in 20 adults remaining susceptible [4]. By contrast, for reasons still unclear, the average age of infection is higher, with adolescents and adults showing increased susceptibility compared

Objectives

Methods

Results

Discussion

Conclusion