The objectives of this review were to evaluate the vaccine effectiveness (VE) of the two-dose varicella vaccine for healthy children in China and explore the application of the approach of Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) in observational studies on VE. We searched for observational studies on two-dose varicella VE for children in China aged 1–12 years that were published from 1997 to 2019, and assessed the quality of each study using the Newcastle Ottawa Scale (NOS). We used meta-analysis models to obtain the pooled two-dose VE, and the studies were divided into subgroups and analysed according to whether or not it was an outbreak investigation and its NOS score. The quality of evidence of VEs were rated by approach of the GRADE system. A total of 12 studies and 87,196 individuals were included. The pooled two-dose VE was 90% (95% confidence interval [CI]: 69–97%). The VE of outbreak studies (87% [95% CI: 76–93%]) was lower than non-outbreak studies (99% [95% CI: 98–99%]). There was no significant difference in VEs by different NOS quality. The quality of the evidence assessment of pooled two-dose VE was “low”, which was rated down by one category in limitations and publication bias respectively and rated up by two category in large effect. The quality of evidence assessment in subgroup of NOS score ≥ 7 was “moderate”. The VE of two-dose varicella vaccine is relatively high in preventing varicella, and is recommended for countries which need further control for varicella. However, higher quality evidence is needed as a supplement for stronger recommendations. The approach of GRADE could be applied for rating the quality of evidence in observational study.

/pdf/two-dose-varicella-vaccine-effectiveness-in-china-a-meta-2qp94daj7x.pdf

Two-dose varicella vaccine effectiveness in China: a meta-analysis and evidence quality assessment.

Varicella outbreak trends in school settings during the voluntary single-dose vaccine era from 2006 to 2017 in Shanghai, China.

Impact of a 2-dose voluntary vaccination strategy on varicella epidemiology in Beijing, 2011–2017

As China implements the voluntary vaccination programme of one-dose of varicella vaccine (VarV) for decades, robust estimates of the impact of voluntary vaccination era on epidemiology of varicella are needed. We estimated the vaccination coverage (VC) of VarV by using surveillance data on immunisation. The descriptive epidemiological method was used to describe the changing epidemiology of varicella from 2007 to 2018. The screening method was used to estimate the vaccine effectiveness (VE) of VarV. The overall VC for VarV was 71.7%, ranged from 47.7% to 79.5% among 2008-2017 birth cohorts. In total, 16 660 varicella cases were reported during 2007-2018, the incidence increased from 10.0 cases per 100 000 population in 2007 to 65.2 cases per 100 000 population in 2018. A shift in age group of varicella was observed since 2012, with the age increased from 5-9 years to 10-14 years. The overall VE was 79.9%, and the VE increased from 60.1% in 2008 birth cohort to 96.2% in 2017 birth cohort. We found that the overall VE for VarV is moderate, but appears highly effective within 5 years after vaccination. In addition, a shift varicella infection to older ages has occurred at the long-term moderate level VC of one-dose VarV. Therefore, to contain the incidence of varicella and prevent any potential shift to older ages, the introduction of VarV into routine immunisation programme is likely needed in Lu'an.

/pdf/the-impact-of-long-term-moderate-level-of-vaccination-2xugwm9ddk.pdf

The impact of long-term moderate level of vaccination coverage for epidemiology of varicella in Lu'an, China: should we change immunisation strategy now?

Background Chickenpox is an old but easily neglected infectious disease. Although chickenpox is preventable by vaccines, vaccine breakthroughs often occur, and the chickenpox epidemic is on the rise. Chickenpox is not included in the list of regulated communicable diseases that must be reported and controlled by public and health departments; therefore, it is crucial to rapidly identify and report varicella outbreaks during the early stages. The Baidu index (BDI) can supplement the traditional surveillance system for infectious diseases, such as brucellosis and dengue, in China. The number of reported chickenpox cases and internet search data also showed a similar trend. BDI can be a useful tool to display the outbreak of infectious diseases. Objective This study aimed to develop an efficient disease surveillance method that uses BDI to assist in traditional surveillance. Methods Chickenpox incidence data (weekly from January 2017 to June 2021) reported by the Yunnan Province Center for Disease Control and Prevention were obtained to evaluate the relationship between the incidence of chickenpox and BDI. We applied a support vector machine regression (SVR) model and a multiple regression prediction model with BDI to predict the incidence of chickenpox. In addition, we used the SVR model to predict the number of chickenpox cases from June 2021 to the first week of April 2022. Results The analysis showed that there was a close correlation between the weekly number of newly diagnosed cases and the BDI. In the search terms we collected, the highest Spearman correlation coefficient was 0.747. Most BDI search terms, such as “chickenpox,” “chickenpox treatment,” “treatment of chickenpox,” “chickenpox symptoms,” and “chickenpox virus,” trend consistently. Some BDI search terms, such as “chickenpox pictures,” “symptoms of chickenpox,” “chickenpox vaccine,” and “is chickenpox vaccine necessary,” appeared earlier than the trend of “chickenpox virus.” The 2 models were compared, the SVR model performed better in all the applied measurements: fitting effect, R2=0.9108, root mean square error (RMSE)=96.2995, and mean absolute error (MAE)=73.3988; and prediction effect, R2=0.548, RMSE=189.1807, and MAE=147.5412. In addition, we applied the SVR model to predict the number of reported cases weekly in Yunnan from June 2021 to April 2022 using the same period of the BDI. The results showed that the fluctuation of the time series from July 2021 to April 2022 was similar to that of the last year and a half with no change in the level of prevention and control. Conclusions These findings indicated that the BDI in Yunnan Province can predict the incidence of chickenpox in the same period. Thus, the BDI is a useful tool for monitoring the chickenpox epidemic and for complementing traditional monitoring systems.

/pdf/using-baidu-index-data-to-improve-chickenpox-surveillance-in-30yb5fnw.pdf

Using Baidu Index Data to Improve Chickenpox Surveillance in Yunnan, China: Infodemiology Study

Varicella breakthrough infection and effectiveness of 2-dose varicella vaccine in China.

Background Uterine incarceration is a rare obstetric complication that is always associated with retroversion and prone to misdiagnosis. Pelvic examination and imaging methods including ultrasound and magnetic resonance imaging (MRI) are used as the primary diagnostic tool. We present an asymptomatic anterior uterine incarceration complicated by placenta previa and placenta accreta spectrum (PAS) disorder, which could be diagnosed during the pregnancy periods, but was first diagnosed during the cesarean section (CS) and got the surgeons into trouble. Case Description A 28-year-old woman, gravidity 4, parity 1, was hospitalized due to placenta previa and PAS disorder diagnosed by ultrasound and MRI at 35.6 weeks of gestation. She had not experienced any discomfort. Given her history of a previous CS, she underwent a well-prepared cesarean delivery for the termination of the pregnancy. The patient had a series of periodical ultrasound and MRI examinations in which placenta previa and placenta accreta were described in disregard of the abnormal location of cervix; consequently, interior uterine incarceration was first diagnosed during the surgery, which caused significant difficulties in the operation which lasted 3 hours and 21 minutes. The patient developed severe hemorrhaging and lost approximately 5,000 mL of blood. Fortunately, she delivered a health male infant weighing 3,440 grams with quite good Apgar scores. During the follow-up, maternal and child health was confirmed. Conclusions With regard to patients who have undergone previous pelvic surgery, doctors need to pay close attention to the position of the cervix, the pelvic adhesion situation during the prenatal examination, and be on alert for uterine incarceration. Uterine incarceration can be accurately recognized by periodic sonography and MRI if the radiologist is aware of this unusual condition. We do suggest that special are must be taken to avoid unnecessary trauma by misdiagnosis because of lack of awareness.

/pdf/anterior-uterine-incarceration-complicated-by-placenta-1unkc87j.pdf

Anterior uterine incarceration complicated by placenta previa and placenta accreta spectrum disorder: a case report

Ovarian hyperstimulation syndrome (OHSS) is a type of clinical syndrome including enlargement of ovaries, increased capillary permeability, a shift of protein-rich fluid from the intravascular system to the third space and blood concentration (Gomez et al. 2010, Fiedler and Ezcurra 2012, Balint et al. 2020). The main symptoms of the disorder are abdominal pain, distension, nausea, dyspnoea, ascites, pleural effusion, oliguria, enlargement of ovaries with multiple follicles and luteal cysts inside (Chai et al. 2020). For severe cases, OHSS can cause low blood volume shock, acute respiratory distress syndrome, renal failure and even death (Fiedler and Ezcurra 2012, Hansen et al. 2014). OHSS is usually considered as a serious iatrogenic complication of controlled ovarian stimulation (COS), patients with polycystic ovarian syndrome (PCOS) receiving treatment for infertility with COS are at high risk for OHSS (Tso et al. 2020). Early onset OHSS occurs within nine days after oocyte retrieval, triggered by administration of exogenous human chorionic gonadotropin (HCG) for follicular maturation, and usually resolves spontaneously within 7–14 days if no pregnancy occurs (Grossman et al. 2010, Fiedler and Ezcurra 2012, Jinghua et al. 2018). Late onset OHSS appears 10 days after oocyte retrieval (Jinghua et al. 2018) as a result of continuous stimulation by endogenous HCG from trophoblast of the embryo transplanted, however, symptoms of OHSS gradually resolve within 1–2 months in most cases (Haimov-Kochman et al. 2004, Grossman et al. 2010, Humaidan et al. 2016, Jinghua et al. 2018). However, spontaneous form of OHSS in the absence of COS have been reported in the literature, and have nearly always presented between 8 and 15 weeks of pregnancy (Kasum et al. 2013, Sridev and Barathan 2013, Nwafor and Nsikak 2020, Oliveira E. Souza et al. 2021), and also in the non-pregnant (Chai et al. 2020) or postpartum women (He et al. 2008) but has been considered rare in late pregnancy. Categorised as severe in the hypertensive disorders of pregnancy (HDP) (Wilkerson and Ogunbodede 2019), preeclampsia is defined as a newly onset hypertension after 20 weeks of gestation and proteinuria or as evidence of end-organ dysfunction such as thrombocytopenia, renal insufficiency, impaired liver function, cardiac dysfunction, pulmonary edoema, haemolysis, or cerebral or visual symptoms (Leeman 2016, Committee on Practice Bulletins-Obstetrics 2017, Wilkerson and Ogunbodede 2019, Marwan and Maged 2020). Preeclampsia affects up to 1.5% 16.7% of pregnancies worldwide and results in 60,000 maternal deaths (Ma’ayeh et al. 2020). However, preeclampsia complicated with spontaneous OHSS is rare. Herein, we report a case of a pregnant patient who presented with spontaneous OHSS complicated with preeclampsia in the third trimester. She had a favourable outcome upon close surveillance.

Spontaneous ovarian hyper-stimulation syndrome complicated with preeclampsia in the third trimester: a case report

Objective A 2-dose varicella vaccine immunization strategy has been implemented in many cities in China, but there is few evidence on a long-term evaluation of the efficacy of the 2-dose varicella vaccine from China. This study aims to assess the long-term vaccine efficacy of the two doses varicella vaccine and analysis of its influencing factors. Methods A retrospective study was carried out in 837,144 children born between 2011 and 2017 in Ningbo, Easten China. The logistic regression was performed to estimate varicella vaccine effectiveness (VE). Results The overall VE of 2 doses of varicella vaccine compared without the vaccine was 90.31% (89.24–91.26%), and the overall incremental VE of 2 doses of varicella vaccine compared to the 1-dose was 64.71% (59.92–68.93%). Moreover, the varicella vaccination age of the second dose and the interval between 2 doses were both associated with VE. The VE compared to that without the vaccine in children vaccinated at <4 years old was 91.22% (95%CI: 90.16–92.17%) which was higher than in children vaccinated at ≥4 years old (VE: 86.79%; 95%CI: 84.52–88.73). And the effectiveness of the vaccine was 93.60% (95%CI: 92.19–94.75%) in children with the interval of the 2 doses ≤ 24 months significantly higher than in children with the interval of ≥36 months (VE: 85.62%, 95%CI: 82.89–87.91%). Conclusions This study provides evidence for long-term VE of the 2-dose varicella vaccine and the better age for 2-dose vaccination and the interval between 2 doses of the vaccine in China.

https://www.frontiersin.org/articles/10.3389/fpubh.2022.1039537/pdf

Long-term vaccine efficacy of a 2-dose varicella vaccine in China from 2011 to 2021: A retrospective observational study

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Papers

Varicella breakthrough infection and effectiveness of 2-dose varicella vaccine in China.

Anterior uterine incarceration complicated by placenta previa and placenta accreta spectrum disorder: a case report

Spontaneous ovarian hyper-stimulation syndrome complicated with preeclampsia in the third trimester: a case report

Long-term vaccine efficacy of a 2-dose varicella vaccine in China from 2011 to 2021: A retrospective observational study