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The Epidemiology of Chickenpox Disease in England 2016-2022: An Observational Study Using General Practitioner Consultations
19 Pages Posted: 13 Sep 2023
More...Abstract
Background: Chickenpox is a common childhood disease caused by varicella zoster virus (VZV). VZV vaccination is not part of the UK childhood immunisation programme but its potential inclusion is regularly assessed. It is therefore important to understand the ongoing burden of VZV in the community to inform vaccine policy decisions.
Methods: Daily general practitioner (GP) chickenpox consultations in England were studied from 1 September 2016 to 9 December 2022. Mean weekly consultation rates per 100,000 population and rate ratios (RR) were calculated by age group and sex, before the COVID-19 pandemic (consultations made before week ending 8 March 2020) and during the COVID-19 period (9 March 2020 to 9 December 2022).
Findings: Over the study period the mean weekly chickenpox consultation rate was 3·4 (range 0·2 to 9·8), with a regular peak occurring between weeks 13-15. Overall, rates decreased over time, from a mean weekly rate of 5·5 in 2017 to 4·2 in 2019. Highest mean weekly rates were among children aged 1-4 years (rate 38·0, RR 1·3 compared to <1-year). There was no typical epidemic peak during 2020 or 2021. Whilst there was an increase in 2022, the peak was delayed (peaking in week 21). In 2022, rates were proportionally higher among those <1-year compared to pre-pandemic years (RR 1·16, 1-4 years compared to <1-year between 9 March 2020 and 9 December 2022, vs. RR 1·33 between 1 September 2016 and 8 March 2020).
Interpretation: Chickenpox GP consultation rates decreased in England, continuing a longer-term decline in the community. The COVID-19 pandemic impacted rates, likely caused by the introduction of non-pharmaceutical interventions to prevent SARS-CoV-2 transmission. The lasting impact of interruption of typical disease transmission remains to be seen but it is important to monitor the declining chickenpox burden to inform decisions on vaccine programmes.
Funding: None.
Declaration of Interest: None. SdeL is Director of the RCGP Research and Surveillance Centre; through his University he has had grants not directly relating to this work from Wellcome and UK Food Standards Agency, and from AstraZeneca, Sanofi and Seqirus for vaccine related research; and he has membership of advisory boards for AstraZenca, Sanofi and Seqirus.
Ethical Approval: Analyses were limited to secondary use of datasets routinely collected as part of the public health function of the UKHSA. This study is not considered research as defined by the UK Policy Framework for Health and Social Care Research, determined using the Health Research Authority decision tool; therefore, review by a research ethics committee was not required.
Keywords: Varicella, chickenpox, general practitioner, primary care, vaccination, syndromic surveillance
Suggested Citation: Suggested Citation