Incidence rate of breakthrough varicella observed in healthy children after 1 or 2 doses of varicella vaccine: Results from a meta-analysis

  • Author Footnotes
    1 These authors contributed equally to this work.
    Sui Zhu
    1 These authors contributed equally to this work.
    Department of Epidemiology and Biostatistics, School of Public Health, Sichuan University, Chengdu, Sichuan, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Fangfang Zeng
    1 These authors contributed equally to this work.
    Department of Epidemiology, School of Basic Medical Sciences, Jinan University, Guangzhou, Guangdong, China

    Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
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  • Lan Xia
    Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, China
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  • Hong He
    Health Care and Physical Examination Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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  • Juying Zhang
    Address correspondence to Juying Zhang, PhD, Department of Epidemiology and Biostatistics School of Public Health, Sichuan University, No. 17 Section 3, Renmin South Rd, Sichuan 610044, China. (J. Zhang).
    Department of Epidemiology and Biostatistics, School of Public Health, Sichuan University, Chengdu, Sichuan, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
Published:September 18, 2017DOI:


      • Average breakthrough varicella incidence rate varied in different study designs and types of vaccine.
      • Second dose of varicella vaccine may achieve higher efficacy than that achieved with only a single dose in healthy children.
      • Three to four years apart after the first vaccination may provide more vaccine effectiveness.


      Although extensive varicella vaccination coverage has been reported in many countries, breakthrough varicella (BV) still occurs in healthy children. We performed a meta-analysis to understand whether 2 varicella vaccine doses are needed in children and, if so, to determine the best time to vaccinate.


      The BV incidence rates after 1 or 2 doses of varicella vaccine were pooled using random effects, and 95% confidence intervals (CI) were used to estimate the risk factors after vaccination.


      A total of 27 original articles were included in this meta-analysis. The pooled average BV incidence rate in children vaccinated with 1 dose was 8.5 cases per 1,000 person years (PY) (95% confidence interval [CI], 5.3-13.7; random effects model) and 2.2 cases per 1,000 PY (95% CI, 0.5-9.3; random effects model) in children vaccinated with 2 doses. The pooled trend of the annual BV incidence rate from the first to eighth year fluctuated, with a peak annual incidence rate of 35.3 cases per 1,000 population in the fourth year. The meta-regression showed that design type, type of vaccine, and their interaction accounted for approximately 71.74% of the heterogeneity in the average BV incidence rate after 1 vaccine dose.


      Two doses of varicella vaccine are more effective than a single dose, and 3-4 years between the first and second vaccinations may achieve higher efficacy.

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