Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Effectiveness of Two-dose Varicella Vaccination: Bayesian Network Meta-analysis

  • Kwan Hong (Department of Preventive Medicine, Korea University College of Medicine) ;
  • Young June Choe (Department of Pediatrics, Korea University Anam Hospital) ;
  • Young Hwa Lee (Allergy Immunology Center, Korea University) ;
  • Yoonsun Yoon (Department of Pediatrics, Korea University Guro Hospital) ;
  • Yun-Kyung Kim (Department of Pediatrics, Korea University Anam Hospital)
  • Received : 2023.03.10
  • Accepted : 2024.01.11
  • Published : 2024.04.25
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Abstract

Purpose: A 2-dose varicella vaccination strategy has been introduced in many countries worldwide, aiming to increase vaccine effectiveness (VE) against varicella infection. In this network meta-analysis, we aimed to provide a comprehensive evaluation and an overall estimated effect of varicella vaccination strategies, via a Bayesian model. Methods: For each eligible study, we collected trial characteristics, such as: 1-dose vs. 2-dose, demographic characteristics, and outcomes of interest. For studies involving different doses, we aggregated the data for the same number of doses delivered into one arm. The preventive effect of 1-dose vs. 2-dose of varicella vaccine were evaluated in terms of the odds ratio (OR) and corresponding equal-tailed 95% confidence interval (95% CI). Results: A total of 903 studies were retrieved during our literature search, and 25 interventional or observational studies were selected for the Bayesian network meta-analysis. A total of 49,265 observed individuals were included in this network meta-analysis. Compared to the 0-dose control group, the OR of all varicella infections were 0.087 (95% CI, 0.046-0.164) and 0.310 (95% CI, 0.198-0.484) for 2-doses and one-dose, respectively, which corresponded to VE of 69.0% (95% CI, 51.6-81.2) and VE of 91.3% (95% CI, 83.6-95.4) for 1- and 2-doses, respectively. Conclusions: A 2-dose vaccine strategy was able to significantly reduce varicella burden. The effectiveness of 2-dose vaccination on reducing the risk of infection was demonstrated by sound statistical evidence, which highlights the public health need for a 2-dose vaccine recommendation.

목적: 수두 감염에 대한 백신 효과성을 높이기 위해 수두백신 2회접종 전략이 여러 국가에 도입이 되었다. 본 연구에서는 Bayesian 모델을 통해 수두 예방 접종 전략의 종합적인 평가와 효과를 제공하고자 한다. 방법: 체계적 문헌고찰을 통해 수집된 연구에 대해 1회 및 2회 접종, 인구특성 및 관심대상결과와 같은 결과값들을 수집했다. 다양한 접종 횟수를 포함하는 연구의 경우 동일한 투여 횟수에 대한 데이터를 하나의 그룹으로 집계했다. 수두 백신의 1회 및 2회 접종의 예방 효과는 오즈 비 (OR) 및 해당하는 95% 신뢰 구간 (95% CI)을 기준으로 평가하였다. 결과: 문헌 검색을 통해 총 903개의 연구가 검색되었고, Bayesian 네트워크 메타 분석을 위해 25개의 개입 또는 관찰 연구가 선택되었다. 총 49,265명의 관찰 대상자가 이 연구에 포함되었다. 미접종군과 비교하여, 모든 수두 감염의 OR은 각각 2회 및 1회 접종에 대해 0.087 (95% CI, 0.046-0.164) 및 0.310 (95% CI, 0.198-0.484)이었으며, 이는 각각 1회 및 2회의 VE가 각각 69.0% (95% CI, 51.6-81.2) 및 91.3% (95% CI, 83.6-95.4)에 해당한다. 결론: 체계적인 검토 및 네트워크 메타 분석 결과, 2회 접종 백신 전략은 수두 감염 부담을 크게 감소시키는 것을 확인하였고, 2회 접종을 받은 어린이들은 1회 접종을 받은 어린이들보다 수두 감염 위험이 낮았으며, 유행 발생 시 더 나은 보호를 받는 것을 확인하였다.

Keywords

Acknowledgement

This work was supported by the Korea Disease Control and Prevention Agency (grant number 2020E2406002). The funder only provided the raw data and research funding and were not involved in data analysis or manuscript writing.

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