Incidence and Use of Resources for Chickenpox and Herpes Zoster in Latin America and the Caribbean-A Systematic Review and Meta-analysis

From the *Institute for Clinical Effectiveness and Health Policy
The Pediatric Infectious Disease Journal (Impact Factor: 3.14). 12/2012; 31(12):1263-8. DOI: 10.1097/INF.0b013e31826ff3a5
Source: PubMed

ABSTRACT : Varicella-zoster virus causes chickenpox and herpes zoster. More than 90% of varicella cases occur in childhood. The aim of this study was to gather all relevant information on epidemiology and resource use in Latin America and the Caribbean since 2000.
: Epidemiologic studies published since 2000 with at least 50 cases of varicella or herpes zoster, or at least 10 cases of congenital disease were included. Gray literature was also searched. Outcomes included incidence, admission rate, mortality and case-fatality ratio. Use of resources and both direct and indirect costs associated were extracted.
: From the 495 records identified, 23 were included in the meta-analysis to report varicella-zoster virus outcomes and 3 in the herpes zoster analysis. The global pooled varicella incidence in subjects under 15 years of age was 42.9 cases per 1000 individuals per year (95% confidence interval: 26.9-58.9); children under 5 years of age were the most affected. Pooled general admission rate was 3.5 per 100,000 population (95% confidence interval: 2.9-4.1) and median hospitalization was 5-9 days. The most common varicella complications reported in studies were skin infections (3-61%), followed by respiratory infections (0-15%) and neurologic problems (1-5%). Direct costs averaged (2011/international dollar [I$]) $2040 per admission (range, I$ 298-5369) and I$70 per clinical visit (range, 11-188 I$).
: Limited information was available on the outcomes studied. Improvements in the surveillance of ambulatory cases are required to obtain a better epidemiologic picture. As of 2011, only 2 countries introduced the vaccine in national immunization programs in Latin America and the Caribbean.

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    ABSTRACT: Introduction The reactivation of the varicella-zoster virus in adults causes a rash known as herpes-zoster. Complications affecting the central nervous system and can cause postherpetic neuralgia. Objective To evaluate the efficacy and safety of the vaccine for the prevention of re-infection by varicella-zoster virus in adults. Methods Systematic review of the literature (2005-2013). A literature search was performed in electronic databases such MedLine or Embase, and hand search in journals. Inclusion criteria were clinical trials in adults vaccinated against herpes-zoster, recording results of efficacy and safety. Quality of the studies was assessed by CASPe checklist. Results Twelve clinical trials of moderate quality were included. The ranges of antibody titters (GMT) were higher in the vaccinated group compared to placebo (471-810 vs. 292-391 gpELISA/mL). GMFR ranges were also higher (2.3-1.9 vs. 1). Vaccination reduced the incidence of herpes zoster, with a protective efficacy of 51-70%. Local adverse effects (60% vs. 14.7%) and systemic (13% vs. 8%) were higher in the vaccinated groups, the most frequent reactions pain, redness, and swelling. Serious adverse events and deaths were not different between groups. Conclusions The vaccine against herpes-zoster shows good efficacy and safety profile. Vaccine has good immunogenicity and reduces the incidence of herpes zoster and postherpetic neuralgia. Serious adverse effects are rare and occur similarly in studied groups.
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