Global Varicella Vaccine Effectiveness: A Meta-analysis

CONTEXT: Several varicella vaccines are available worldwide. Countries with a varicella vaccination program use 1- or 2-dose schedules. OBJECTIVE: We examined postlicensure estimates of varicella vaccine effectiveness (VE) among healthy children. DATA SOURCES: Systematic review and descriptive and meta-analysis of Medline, Embase, Cochrane libraries, and CINAHL databases for reports published during 1995–2014. STUDY SELECTION: Publications that reported original data on dose-specific varicella VE among immunocompetent children. DATA EXTRACTION: We used random effects meta-analysis models to obtain pooled one dose VE estimates by disease severity (all varicella and moderate/severe varicella). Within each severity category, we assessed pooled VE by vaccine and by study design. We used descriptive statistics to summarize 1-dose VE against severe disease. For 2-dose VE, we calculated pooled estimates against all varicella and by study design. RESULTS: The pooled 1-dose VE was 81% (95% confidence interval [CI]: 78%–84%) against all varicella and 98% (95% CI: 97%–99%) against moderate/severe varicella with no significant association between VE and vaccine type or study design (P > .1). For 1 dose, median VE for prevention of severe disease was 100% (mean = 99.4%). The pooled 2-dose VE against all varicella was 92% (95% CI: 88%–95%), with similar estimates by study design. LIMITATIONS: VE was assessed primarily during outbreak investigations and using clinically diagnosed varicella. CONCLUSIONS: One dose of varicella vaccine was moderately effective in preventing all varicella and highly effective in preventing moderate/severe varicella, with no differences by vaccine. The second dose adds improved protection against all varicella.