Abstract
BackgroundVaricella is a common childhood disease. Only 5% of first varicella-zoster-virus infections occur asymptomatically. Most data on the burden of varicella stem from health service databases. This study aims to provide insight in the burden of varicella from a parent's perspective including cases outside the healthcare system.MethodsAn internet questionnaire was developed for parents in the Netherlands to report health care resource use and productivity losses during the varicella episode in their child younger than 6 years. 11,367 invitations were sent out to members with children of an internet panel of a market research agency. 4,168 (37%) parents started the questionnaire (response rate), of which 360 (9%) stopped before completion and 1,838 (44%) were out of the target group. In total 1,970 parents completed the questionnaire. The questionnaire provided a symptom list ranging from common symptoms, such as skin vesicles, itching to fits or convulsions. A posteriori, in the analyses, the symptoms 'skin infections', 'fits/convulsions', 'unconsciousness', and 'balance and movement disorders' were labelled as complications. There was no restriction to time since the varicella episode for inclusion in the analyses.ResultsThe 1,970 respondents had in total 2,899 children aged younger than six years, of which 2,564 (88%) children had had varicella. In 62% of the episodes the parent did not seek medical help. In 18% of all episodes symptoms labelled as complications were reported; in 11% of all episodes parents visited a medical doctor (MD) for a complication. Reporting of complications did not differ (X2 ; p = 0.964) between children with a recent (≤ 12 months ago) or a more distant (> 12 months) history of varicella. Prescription drugs were used in 12% of the children with varicella; OTC drugs in 72%. Parents reported work loss in 17% of the varicella-episodes (23% when MD visit; 14% when no MD-visit) for on average 14 hours, which equals to 2.5 hours of work loss for any given varicella-episode.ConclusionsThis study shows the full spectrum of varicella-episodes and associated healthcare use, including the large proportion of cases not seeking medical care and the societal impact associated with those cases.
Highlights
Introduction5% of first varicella-zoster-virus infections occur asymptomatically
The main points of uncertainty relate to the impact of varicella vaccination on the incidence of zoster infections later in life [5], and uncertainty related to the burden of complications following varicella infection, and the indirect nonmedical costs associated with varicella [2]
Data were available for 1,970 respondents with in total 2,899 children aged younger than six years, of which 2,564 (88%) children reported a history of varicella
Summary
5% of first varicella-zoster-virus infections occur asymptomatically. Most data on the burden of varicella stem from health service databases. About 5% of first varicella-zoster-virus (VZV) infections occur to 200 hospital admissions, and there are about two deaths each year on a population of 16 million [1]. Universal vaccination for varicella has been introduced in several developed countries (e.g. Germany, Australia, Japan, Canada and the United States), showing dramatic decline of disease incidence in the latter [4]. In the Netherlands the decision to include varicella in the national immunisation vaccination programme is pending. Most data we have on the burden of varicella stem from hospital data and GP-databases. The GP contact rate is only lower in Finland and Greece [6]
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