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Herpes zoster (HZ) is an infectious disease caused by latent varicella‐zoster virus reactivation. There are conflicting reports on the varicella vaccine's effect on the incidence of HZ in children and adolescents. This study aimed to determine the impact of the single dose of varicella vaccination on HZ prevalence during childhood and adolescence. The study included children and adolescents aged <18 years who presented to the dermatology outpatient clinic between 2005 and 2019 and were diagnosed with HZ. Considering that the universal vaccination program started to be implemented in Turkey in 2013, non‐vaccinated cases in the prevaccination period, vaccinated cases in the postvaccination period, and non‐vaccinated patients in the postvaccination period were compared in terms of HZ prevalence and demographic features. After the initiation of the varicella vaccination program, the prevalence of HZ was found to decrease by 24.7% in all. The HZ prevalence was significantly reduced in vaccinated children, while the rate of decrease in non‐vaccinated children was low (58.6% and 16.4%, respectively). The median age of the non‐vaccinated cases in the postvaccination period (10 [min 0.5‐max 17] years) was significantly higher compared to the other groups (p < 0.001). The number of cases aged <2 years was the highest in the vaccinated group (p < 0.001). Administration of a single dose of varicella vaccine was insufficient to decrease the prevalence of HZ <18 years of age. In the post‐vaccination period, the frequency of HZ in unvaccinated cases increased in adolescence. In vaccinated children, HZ seems to develop at an earlier age. [ABSTRACT FROM AUTHOR]

Aim: Chickenpox is a viral infectious disease capable of causing severe morbidity, and even mortality. The purpose of this study was to determine the current position and demographic characteristics of cases of chickenpox following the addition of chickenpox vaccination to the routine vaccine schedule in Turkey. Mateial and Methods: Patients aged 0-17 years presented to Adiyaman University Training and Research Hospital Pediatrics clinics and diagnosed with chickenpox between January 2013 and December 2016 were included in the study. Data were analyzed on Statistical Package for the Social Sciences (SPSS, version 22.0, Chicago, IL, USA) software. p<0.05 was regarded as statistically significant. Results: 314 patients diagnosed with chickenpox were included in the study. Mean age of the subjects included was 84.76 ± 41.67 months, and 54.1% were males and 46.9% females. A significant difference was observed between the groups in terms of age (p=0.001). Cases' ages decreased on a year-by-year basis. Fifty (15.9%) cases of chickenpox were identified as having been infected despite vaccine. A significant difference was determined between the mean ages of vaccinated and non-vaccinated patients with chickenpox. Conclusion: Although the addition of a single dose chickenpox vaccine to the national immunization schedule in Turkey reduces both severe complication and the incidence of the disease. In the light of our study we think that the addition of a second dose of chickenpox vaccination to our routine vaccine schedule will further reduce hospitalization numbers resulting from chickenpoxrelated complications. More comprehensive studies on the subject are now needed. [ABSTRACT FROM AUTHOR]

Aim: Although varicella is a common, contagious, self-limited childhood disease, it can cause significant long-term sequelae and mortality in both immunocompetent and immunocompromised children. The aim of the present study is to identify and review varicella-related hospitalizations, admissions and complications of primary varicella infection among immunocompetent and immunocompromised children of a large unselected local population in a governmental institution. Materials and Methods: Demographic aspects, clinical features, microbiological findings, complications, managements and outcome of the patients hospitalized for varicella were analyzed retrospectively. Results: Among 100 such children, 66 were immunocompetent and 34 were immunocompromised. Secondary bacterial infection was the most common complication in both groups. The second most common complication in the immunocompetent group was neurological complications (21%) followed by varicella-zoster virus (VZV) pneumonia (2%). In the immunocompromised group neurological complications and VZV pneumonia were not observed. Hematological complications were seen in 5% of the immunocompetent patients and 6% of the immunocompromised patients. Mortality was seen in 2% in the study group, one patient in the immunocompetent and one in the immunocompromised group. Conclusion: Despite a common perception of varicella infection being highly contagious but harmless, complications requiring hospitalization are frequent, potentially serious and costly even in healthy children. Since varicella virus vaccine prevents most of the morbidity and mortality caused by primary varicella in children, prevention rather than the treatment will be the optimal approach. [ABSTRACT FROM AUTHOR]

Introduction Varicella in previously immunized individuals, known as “breakthrough varicella”. While the majority of breakthrough cases are mild, some may be severe, requiring hospitalization in previously healthy children or children with an underlying condition. Methods This report, as a part of the prospective national pediatric varicella hospitalizations study (including 29 centers, represent 50% of pediatric population) in Turkey, is aimed to evaluate breakthrough varicella infection requiring hospitalization before the routine use of single-dose live varicella vaccine in national program from 2008 to 2013 (<10% of the pediatric age group received a single-dose vaccine). Results In the time period, 1939 children were hospitalized due to varicella infection in Turkey; 36 children (20 boys, 16 girls, mean age 68.0 + 37.6 months, all received single dose live varicella vaccine) with breakthrough varicella infection. Breakthrough varicella infection might be severe in previously healthy children (61.1%) and children with immune-compromising conditions (38.9%). The time elapsed between vaccination and hospitalization was approximately 5 years, and neurological complications, mainly encephalitis and meningitis, were the most common reason for hospitalization in previously healthy children. Conclusion Pediatric breakthrough varicella requiring hospitalization have been seen in Turkey, is mainly observed in previously healthy children at 5 years after a single-dose varicella vaccine. The varicella vaccine has been implemented as part of the National Immunization Program in Turkey in 2013 (a single dose at age 12 months). Further surveillance in the same settings could evaluate the effectiveness of national immunization with single-dose varicella vaccine at 12 months of age and potential need for second dose of vaccine. [ABSTRACT FROM AUTHOR]

Vaccination should be timed to take into account the potential interference of maternal antibodies. The purpose of this study was to determine the persistence of maternally acquired antibodies to hepatitis A and varicella zoster in a group of healthy infants between 6 and 24 months of age. These infants were divided into four groups according to the age at the time of follow-up visits. The study group consisted of infants who were brought to the 6-month follow-up visit (group 1, n = 100), 12-month follow-up visit (group 2, n = 99), 18-month follow-up visit (group 3, n = 59), and 24-month follow-up visit (group 4, n = 59). Hepatitis A, varicella IgG, and IgM antibodies were analyzed qualitatively. Hepatitis A IgG seropositivity was determined as 71 % in group 1, 41.4 % in group 2, 0 % in group 3, and 8.5 % in group 4 ( p < 0.001). Varicella IgG seropositivity was found to be 5 % in group 1, 4 % in group 2, 4 % in group 3, and 1 % in group 4 ( p > 0.05). Conclusion: We found that maternal hepatitis A antibodies in children disappear between 12 and 18 months, whereas maternal varicella antibodies substantially diminish following the sixth month. Therefore, the vaccination timing should be based on factors such as the interference of maternal antibodies, disease susceptibility period, and immune maturation. [ABSTRACT FROM AUTHOR]

Varicella can cause complications that are potentially serious and require hospitalization. Our current understanding of the causes and incidence of varicella-related hospitalization in Turkey is limited and sufficiently accurate epidemiological and economical information is lacking. The aim of this study was to estimate the annual incidence of varicella-related hospitalizations, describe the complications, and estimate the annual mortality and cost of varicella in children. VARICOMP is a multi-center study that was performed to provide epidemiological and economic data on hospitalization for varicella in children between 0 and 15 years of age from October 2008 to September 2010 in Turkey. According to medical records from 27 health care centers in 14 cities (representing 49.3% of the childhood population in Turkey), 824 children (73% previously healthy) were hospitalized for varicella over the 2-year period. Most cases occurred in the spring and early summer months. Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age. The estimated incidence of varicella-related hospitalization was 5.29-6.89 per 100,000 in all children between 0-15 years of age in Turkey, 21.7 to 28 per 100,000 children under 1 year of age, 9.8-13.8 per 100,000 children under 5 years of age, 3.96-6.52 per 100,000 children between 5 and 10 years of age and 0.42 to 0.71 per 100,000 children between 10 and 15 years of age. Among the 824 children, 212 (25.7%) were hospitalized because of primary varicella infection. The most common complications in children were secondary bacterial infection (23%), neurological (19.1%), and respiratory (17.5%) complications. Secondary bacterial infections ( p < 0.001) and neurological complications ( p < 0.001) were significantly more common in previously healthy children, whereas hematological complications ( p < 0.001) were more commonly observed in children with underlying conditions. The median length of the hospital stay was 6 days, and it was longer in children with underlying conditions (<0.001). The median cost of hospitalization per patient was $338 and was significantly higher in children with underlying conditions ( p < 0.001). The estimated direct annual cost (not including the loss of parental work time and school absence) of varicella-related hospitalization in children under the age of 15 years in Turkey was $856,190 to $1,407,006. According to our estimates, 882 to 1,450 children are hospitalized for varicella each year, reflecting a population-wide occurrence of 466-768 varicella cases per 100,000 children. In conclusion, this study confirms that varicella-related hospitalizations are not uncommon in children, and two thirds of these children are otherwise healthy. The annual cost of hospitalization for varicella reflects only a small part of the overall cost of this disease, as only a very few cases require hospital admission. The incidence of this disease was higher in children <1 year of age, and there are no prevention strategies for these children other than population-wide vaccination. Universal vaccination is therefore the only realistic option for the prevention of severe complications and deaths. The surveillance of varicella-associated complications is essential for monitoring of the impact of varicella immunization. [ABSTRACT FROM AUTHOR]

Varicella is usually a mild self-limited benign disease in immunocompetent children. Although severe forms and complications were believed to be more frequent in immunocompromised people, secondary bacterial infections, neurological complications and even death can occur in healthy chidren. In the present study, we aimed to describe the incidence of varicella complications in Turkey, where varicella vaccination has not been routinely performed, and to emphasize the requirement for varicella vaccination. We performed a retrospective study which included the data collected from medical records and files of l44 immunocompetent children who were hospitalized for complications of varicella infections. Complications were mostly present in preschool children (mean age 4.6±3.2 years). Hospitalizations were most prominent in June (13.7%) and December (13.7%), and were lowest in March and September. The most prominent complications were secondary bacterial infections (53.4%); the other complications in decreasing order of frequency were neurological complications (25%), gastrointestinal and hepatic complications (8.3%), hematologic complications (6.4%), varicella pneumonia (2.8%), neonatal varicella (2.8 %) and disseminated varicella infection (1.4%). Nearly 70% of the secondary bacterial infections were soft tissue infections including abscess and impetigo. Cerebellar ataxia (55.5%) was the most common neurological complication. All patients with neurological complication had full recovery without any significant sequelae. Neurological complications were more common in older ages. Totally, three children (2%) in the study group died; two due to disseminated varicella infection and one with sepsis. In conclusion, since varicella infection are still associated with complications, universal routine varicella vaccination could help in reducing the incidence of varicella and its related complications. [ABSTRACT FROM AUTHOR]

Varicella remains a dangerous viral pathogen for pediatric cancer patients. The incidence of primary varicella infection in Eastern of Turkiye is still high because of low vaccination rate. Medical records of 27 pediatric patients with hematological malignancies that developed varicella/herpes zoster were retrospectively reviewed. All were treated at a single medical center in Eastern Turkiye between 1997 and 2006. Varicella (n=22) or herpes zoster (n=5) were diagnosed in 27 cases, of whom 14 had acute lymphoblastic leukemia (ALL), five had acute myeloblastic leukemia (AML), and eight had non-Hodgkin lymphoma (NHL). The mean age of the children was 5.7 ± 3.2 years. None of these children had evidence of disseminated disease. The mean total leukocyte count was 2600 ± 1500/mm^{3} in ALL group, 2300 ± 1800/mm^{3} in AML group, and 3100 ± 1700/mm^{3} in NHL group. While intravenous acyclovir was administered to 21 patients, remaining six patients were received oral acyclovir. Fever was reduced in mean 5.6 ± 2.1, 5.2±1.7 and 4.4 ± 1.8 days in ALL, AML, and NHL groups, respectively. None of the 27 children worsened or developed features of visceral dissemination. Outcome of the patients were not different in terms of oral and intravenous acyclovir use. These results suggest that in our institution varicella is not associated with a high incidence of mortality in cancer patients. Early administration of acyclovir can prevent the visceral dissemination of varicella-zoster virus. Prednisolone usage during the incubation period of varicella did not result in increased severe varicella infection. [ABSTRACT FROM AUTHOR]

Varicella is a vaccine-preventable disease, and the incidence of varicella has declined since the introduction of varicella vaccine campaigns. A wild type of varicella zoster virus (VZV) was isolated from a 33-month-old child with varicella in Korea in 1989, a different strain (MAV/06). A live-attenuated varicella vaccine containing strain (MAV/06), Suduvax®, was developed in South Korea in 1994. Turkey introduced the varicella vaccine containing the MAV/06 strain (Varicella Vaccine-GCC, Green Cross, South Korea) in January 2019. Therefore, we aimed to compare the seroconversion rates among MAV/06 vaccine- and vOka-administered children. We prospectively collected blood samples from 98 received vOKA and 98 received MAV/06 children 6 weeks after administration, and seroconversion rates were determined by an indirect fluorescence assay (Anti-VZV IIFT IgG, Euroimmun, Germany). Seroconversion rate was significantly higher in vOka group than MAV/06 group (82.7% vs. 64.3%; p = .004 ). Of the children vaccinated with vOka strain, 17 children did not develop antibodies, 12 were weakly positive, and the remaining 69 children were strongly positive. Of the children who were administered MAV/06 strain, 35 were negative, 20 were weakly positive, and 43 were strongly positive. In conclusion, this study demonstrated that MAV/06 varicella vaccine had lower seroconversion rates and the strong seropositive cases were less common than vOka-administered children. Larger and prospective studies are needed.

Objective: To explore what factors influence Turkish parents' decision whether to have their children immunised or not and compare them with other internationally published studies. Method: Data from 300 parents were gathered via a survey completed by the parents during their policlinic visit between January 2009 and March 2010 in Kocaeli, Turkey. The survey content was based on 10 Health Belief Model, each question being based on a 5-point Likert scale together with additional 19 questions in order to discover other demographic factors. Results: One of the differences in our study when compared to other published studies is mothers'' jobs as employed mothers were significantly willing to have their children vaccinated whereas studies elsewhere have generally shown that demographic background variables do not affect parents'' perceptions. The parents who took part in this study were not overly concerned about the side effects in contrast to other published studies. Another major finding is the positive influence of parents being informed by a consultant paediatrician rather than their family general practitioner. Conclusions: The acceptance of varicella vaccine depends on a complex interaction of factors but parents'' perceptions may change dramatically by being well informed as well as having financial support from the government. [Copyright &y& Elsevier]

Background: In Turkey, varicella vaccine was introduced into routine childhood immunization in 2013, with a single dose administered to children aged 12 months. However, there is limited information on the morbidity (incidence and seroprevalence), mortality and burden of disease of varicella in the overall Turkish population., Aim: To determine varicella seroprevalence and its social determinants in Manisa Province, Turkey in children aged > 2 years before single-dose varicella vaccination was introduced in 2013., Methods: The presence of anti varicella-zoster virus IgG antibodies was determined using enzyme-linked immunosorbent assay in serum samples collected from 1250 participants., Results: The overall seroprevalence was 92.8% and the seroprevalence was > 90% among all age groups except 2-9 years (55.7%). Seroprevalence was significantly associated with family size, annual per capita equivalent income, number of people per room and education level. After adjusting by age, only education level remained significantly associated with seroprevalence, reflecting the early age effect., Conclusion: High seroprevalance depends on natural exposure to the infectious agent itself and is not associated with social determinants. High vaccine coverage should be maintained for effective varicella control and switching to a 2-dose schedule may also be considered to reduce the number and size of outbreaks in the Turkish population., (Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Summary: Objectives: We aimed to determine the rate of breakthrough varicella in Turkey, a country with low varicella vaccination coverage. Methods: This study was conducted between April 2008 and March 2009 at the Well-Child Clinic at Ege University and pediatricians’ offices. We collected information on vaccination status and varicella infection using a questionnaire. In order to elicit more details about the severity of illness, we interviewed all parents and reviewed the clinician records. Vaccination status was verified from the medical records or vaccination cards with dates. Results: A total of 2802 children were evaluated. Of these, 1683 had been vaccinated with a single dose of varicella vaccine and 1119 were unvaccinated. Among vaccinated children, 466 (27.7%) had breakthrough varicella. Vaccinated children tended to have mild varicella. However, about 25% of breakthrough cases had moderate or severe disease. Children who were vaccinated ≥5 years previously had a 3.7-fold higher risk of breakthrough disease than those who were vaccinated <5 years before. Vaccination at younger than 15 months of age was not significantly associated with an increased risk of breakthrough infection. Conclusions: Breakthrough varicella is not rare in Turkey where varicella infections are common. A longer interval since vaccination may be a risk factor for developing breakthrough varicella. Children who had been vaccinated >5 years previously were at risk for breakthrough disease. A two-dose varicella vaccine policy may be needed to provide improved protection. [ABSTRACT FROM AUTHOR]