Research article

The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccine coverage, 1998–2003

W Katherine Yih¹ , Daniel R Brooks² , Susan M Lett³ , Aisha O Jumaan⁴ , Zi Zhang⁵ , Karen M Clements⁶ and Jane F Seward⁷

¹  Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, USA

²  Department of Epidemiology, Boston University School of Public Health, Boston, USA

³  Division of Epidemiology and Immunization, Bureau of Communicable Disease Control, Massachusetts Department of Public Health, Boston, USA

⁴  Health Investigation Branch, Division of Health Studies, Agency for Toxic Substance and Disease Registry, Centers for Disease Control and Prevention, Atlanta, USA

⁵  Health Survey Program; Center for Health Information, Statistics, Research and Evaluation; Massachusetts Department of Public Health; Boston, USA

⁶  Applied Statistics, Evaluation and Technical Services; Bureau of Family and Community Health; Massachusetts Department of Public Health; Boston, USA

⁷  Viral Vaccine-Preventable Disease Branch, Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, USA

author email corresponding author email

BMC Public Health 2005, 5:68doi:10.1186/1471-2458-5-68

Published:	16 June 2005

Abstract

Background

The authors sought to monitor the impact of widespread varicella vaccination on the epidemiology of varicella and herpes zoster. While varicella incidence would be expected to decrease, mathematical models predict an initial increase in herpes zoster incidence if re-exposure to varicella protects against reactivation of the varicella zoster virus.

Methods

In 1998–2003, as varicella vaccine uptake increased, incidence of varicella and herpes zoster in Massachusetts was monitored using the random-digit-dial Behavioral Risk Factor Surveillance System.

Results

Between 1998 and 2003, varicella incidence declined from 16.5/1,000 to 3.5/1,000 (79%) overall with ≥66% decreases for all age groups except adults (27% decrease). Age-standardized estimates of overall herpes zoster occurrence increased from 2.77/1,000 to 5.25/1,000 (90%) in the period 1999–2003, and the trend in both crude and adjusted rates was highly significant (p < 0.001). Annual age-specific rates were somewhat unstable, but all increased, and the trend was significant for the 25–44 year and 65+ year age groups.

Conclusion

As varicella vaccine coverage in children increased, the incidence of varicella decreased and the occurrence of herpes zoster increased. If the observed increase in herpes zoster incidence is real, widespread vaccination of children is only one of several possible explanations. Further studies are needed to understand secular trends in herpes zoster before and after use of varicella vaccine in the United States and other countries.