Active prospective national surveillance for congenital and neonatal varicella in Australia shows potential prevention opportunities

Jacina Walker; Suzy Teutsch; Anne Morris; Guy D Eslick; Mahmudul Hassan Al Imam; Arifuzzaman Khan; Robert Booy; Elizabeth J Elliott; Gulam Khandaker

doi:10.1016/j.jvacx.2023.100278

Active prospective national surveillance for congenital and neonatal varicella in Australia shows potential prevention opportunities

Vaccine X. 2023 Feb 18:13:100278. doi: 10.1016/j.jvacx.2023.100278. eCollection 2023 Apr.

Authors

Jacina Walker¹, Suzy Teutsch^{2

3}, Anne Morris^{2

3

4}, Guy D Eslick^{2

3}, Mahmudul Hassan Al Imam^{1

5}, Arifuzzaman Khan^{1

6}, Robert Booy^{2

7}, Elizabeth J Elliott^{2

3

4}, Gulam Khandaker^{1

2

5}

Affiliations

¹ Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.
² The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, New South Wales, Australia.
³ Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia.
⁴ The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia.
⁵ School Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia.
⁶ School of Public Health, The University of Queensland, Brisbane, Australia.
⁷ National Centre for Immunisation Research and Surveillance, Sydney, New South Wales, Australia.

Abstract

To compare the incidence and outcomes of congenital and neonatal varicella in Australia in the pre-vaccination (1995-1997) and post-vaccination era (after 2005 to November 2020), active prospective national surveillance for congenital varicella syndrome (CVS) and neonatal varicella infection (NVI) was conducted through the Australian Paediatric Surveillance Unit (APSU). Compared with 1995-1997, there was a 91.5% reduction in the incidence of CVS and a 91.3% reduction in the incidence of NVI in 2009-2020. However, almost half of the mothers in 2009-2020 were born overseas and came from countries without a vaccination program. Although there has been a substantial and sustained decrease in the reported incidence of CVS and NVI in Australia since 2006, congenital and neonatal varicella infections persist. Thus, there is an opportunity for targeted screening of varicella in young migrant, asylum seeker and refugee women at risk of varicella infection and prioritisation for vaccination to prevent CVS and NVI.

Keywords: APSU, Australian Paediatric Surveillance Unit; Australia; CIs, Confidence Intervals; CRF, Case Report Form; CVS, Congenital Varicella Syndrome; Congenital varicella; Epidemiology; NIP, National Immunisation Program; NVI, Neonatal Varicella Infection; Neonatal varicella infection; VZV, Varicella-Zoster Virus; Vaccination; ZIG, Zoster immune globulin.