Background In seven studies of the effectiveness of the varicellavaccine conducted since it was licensed, the effectiveness was71 to 100 percent against disease of any severity and 95 to100 percent against moderate and severe disease. We investigatedan outbreak of varicella in a population of children with ahigh proportion of vaccinees who were attending a day-care centerin a small community in New Hampshire.
Methods Using standardized questionnaires, we collected informationabout the children's medical and vaccination history from parentsand health care providers. The analysis of the effectivenessof the vaccine and of risk factors for vaccine failure was restrictedto children who were enrolled in the day-care center continuouslyduring the outbreak and attended for one week or more and whowere cared for in the building that represented the epicenterof the outbreak, since transmission was not documented in asecond building.
Results Varicella developed in 25 of 88 children (28.4 percent)between December 1, 2000, and January 11, 2001. The index caseoccurred in a healthy child who had been vaccinated three yearspreviously and who infected more than 50 percent of his classmateswho had no history of varicella. The effectiveness of the vaccinewas 44.0 percent (95 percent confidence interval, 6.9 to 66.3percent) against disease of any severity and 86.0 percent (95percent confidence interval, 38.7 to 96.8 percent) against moderateor severe disease. Children who had been vaccinated three yearsor more before the outbreak were at greater risk for vaccinefailure than those who had been vaccinated more recently (relativerisk, 2.6 [95 percent confidence interval, 1.3 to 5.3]).
Conclusions In this outbreak, vaccination provided poor protectionagainst varicella, although there was good protection againstmoderate or severe disease. A longer interval since vaccinationwas associated with an increased risk of vaccine failure. Breakthroughinfections in vaccinated, healthy persons can be as infectiousas varicella in unvaccinated persons.
Source Information
From the Centers for Disease Control and Prevention, Atlanta (K.G., B.L., T.S., A.L.B., J.S.); the New Hampshire Department of Health and Human Services, Concord (C.C., J.M.); and the College of Veterinary Medicine, Washington State University, Pullman (M.E.).
Address reprint requests to Dr. Galil at 65 Hayden Ave., Lexington, MA 02421, or at karin.galil{at}cubist.com.
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