#VisualAbstract: Incidence of Herpes Zoster Among Children: 2003–2014

1. In a retrospective cohort study, researchers discovered that children vaccinated with the varicella vaccine were significantly less likely to have herpes zoster (HZ) than unvaccinated children.

2. Over the 12-year time period assessed, researchers found the overall rate of HZ decreased significantly, with the incidence among vaccinated children being lower than those who were unvaccinated.

Evidence Rating Level: 2 (Good)

Study Rundown: In 1996, the Advisory Committee on Immunization Practices (ACIP) recommended universal vaccination with the varicella zoster vaccine, a live attenuated vaccine. The vaccine can, like the wild-type virus, be associated with reactivation of the latent herpes zoster (HZ) virus. Prior studies demonstrated that children in certain age groups had a lower rate of HZ after vaccination with the varicella vaccine while others, particularly younger children, experienced higher rates of HZ after vaccination. In this retrospective cohort study, researchers explored whether varicella vaccination was associated with a lower incidence of HZ, the trends in HZ rates overall, and the rate of varicella vaccination. During the study period, about half of the children included were vaccinated at some point. The incidence of HZ was significantly lower among patients who were vaccinated, and the rate of HZ declined over the 12-year period investigated. The study is strengthened by the observation of a large population of children over many years. This longitudinal nature allows the study to more accurately compare the risk of long-term reactivation between vaccinated and wild-type infected children. In the commentary linked below, it is noted that the increased incidence of HZ in younger children seen in previous studies was likely secondary to vaccination at a young age, prior to many children contracting wild-type varicella.  Though the study is limited by the variability in vaccination schedule employed across the various study sites, the results still affirm the ACIP recommendation for universal vaccination for varicella given the efficacy in decreasing reactivated zoster demonstrated despite this variability.

Click here to read the study in Pediatrics

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