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Open Access Research article

An Outbreak of Varicella among Schoolchildren in Taipei

Chao-Chih Lai1, Szu-Ching Chen2 and Donald Dah-Shyong Jiang3*

Author Affiliations

1 Emergency Department of Taipei City Hospital, Ren-Ai Branch, Taiwan, R.O.C

2 Health Center of an Elementary School in Taipei, Taiwan, R.O.C

3 FETP, Centers for Disease Control, Taiwan, R.O.C

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BMC Public Health 2011, 11:226  doi:10.1186/1471-2458-11-226

Published: 12 April 2011

Abstract

Background

The reported cases with varicella have not decreased and outbreaks of varicella among vaccinated children continue to be reported 9 years after the public vaccination program in Taipei. We investigated an outbreak to determine varicella vaccine coverage and effectiveness.

Methods

An outbreak occurred in an elementary school which located in southern Taipei from April 2007 through May 2007. A retrospect cohort study was performed by using a self-administered questionnaire for parents.

Results

Ten out of sixteen varicella cases were vaccinated. Overall vaccine coverage was 71.2%. The common reasons for not receiving varicella vaccine were that varicella vaccine was unavailable because the student didn't live in Taipei (29.4%) or the children could not be vaccinated due to certain illnesses (23.5%). The sensitivity and specificity of self-reported vaccination status was 0.900 (95% CI: 0.864, 0.935) and 0.611 (95% CI: 0.514, 0.701).

The vaccine effectiveness was 69.3%-100.0% against any disease severity of varicella. Overall vaccine effectiveness against moderate or severe varicella was 85.5%. Attending cram school was associated with the risk of developing the varicella illness (RR: 13.39; 95% CI: 5.38, 33.31). Unvaccinated students tended to show moderate to severe (>50 lesions) afflictions of the disease (RR: 4.17; 95% CI: 1.15, 15.14).

Conclusions

Because of the low vaccination coverage, varicella outbreaks continue to be reported in Taipei. Increasing vaccine coverage and second dose vaccination for increasing vaccine effectiveness may be considered.