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Congenital and neonatal varicella: impact of the national varicella vaccination programme in Australia
  1. Gulam Khandaker1,
  2. Helen Marshall2,
  3. Elizabeth Peadon3,
  4. Yvonne Zurynski3,
  5. David Burgner4,5,
  6. Jim Buttery5,
  7. Michael Gold6,
  8. Michael Nissen7,
  9. Elizabeth J Elliott3,
  10. Margaret Burgess1,
  11. Robert Booy1
  1. 1National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead and University of Sydney, Sydney, New South Wales, Australia
  2. 2Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital and University of Adelaide, Adelaide, South Australia, Australia
  3. 3University of Sydney, Children's Hospital at Westmead and Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia
  4. 4School of Paediatrics and Child Health, University of Western Australia, Western Australia, Australia
  5. 5Department of Paediatrics, Murdoch Childrens Research Institute, Royal Children's Hospital, Monash University, Melbourne, Victoria, Australia
  6. 6Discipline of Paediatrics, School of Reproductive Medicine and Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
  7. 7Queensland Paediatric Infectious Disease Laboratory, University of Queensland and Royal Children's Hospital, Brisbane, Queensland, Australia
  1. Correspondence to Professor Robert Booy, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead and University of Sydney, Locked Bag 4001, Westmead, NSW 2145, Australia; robertb2{at}


Objective Routine varicella zoster vaccination for children aged 18 months began in Australia from November 2005. The aim of this study was to compare the current incidence and outcomes of congenital and neonatal varicella in Australia with similarly collected data from 1995 to 1997.

Methods Active national prospective surveillance was carried out for congenital and neonatal varicella using the Australian Paediatric Surveillance Unit (APSU) for 3.5 years from June 2006. Around 1300 clinicians reported monthly according to predefined case criteria.

Results During the study period the mean monthly return rate of APSU report cards was 93.7%. Two cases of congenital varicella (0.19 per 100 000 live births per annum) and 16 cases of neonatal varicella (2.0 per 100 000 live births per annum) were identified. During 2008 and 2009 no cases of congenital varicella were reported; neonatal varicella rates declined to 0.7 per 100 000 live births per annum, a significant trend (p=0.005) and a reduction of over 85% compared with rates during 1995–1997 (the prevaccination era) and the first year of the current surveillance study. Eleven of 16 neonatal cases followed prenatal maternal infection; seven of the 11 infections were acquired from children, four of whom were living in the same household. Ten (62.5%) infants with neonatal varicella were admitted to hospital, one of whom developed varicella pneumonitis requiring ventilatory support, but none died. Only one infecting contact had been vaccinated.

Conclusions There has been an apparent reduction of congenital varicella and a significant reduction of neonatal varicella in Australia following the introduction of universal varicella vaccination in 2005.

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  • Funding The activities of the APSU are supported by the Australian Government Department of Health and Ageing; NHMRC Enabling grant no. 402784; NHMRC Practitioner Fellowship no. 457084 (EJE); the Faculty of Medicine, University of Sydney; and the Royal Australasian College of Physicians.

  • Competing interests HM has participated as a board member of Global Advisory Boards for Merck and GlaxoSmithKline and has participated as an Investigator in industry-sponsored clinical vaccine trials. JB has served on advisory and/or data safety monitoring committees for CSL Vaccines and GSK for which the Murdoch Childrens Research Institute (MCRI) receives payments into an educational fund. RB has received financial support by pharma, including CSL, Sanofi, GSK, Novartis, Roche and Wyeth to conduct research and present at scientific meetings; if fees were offered, these were placed in a university research account. The other authors declare that they have no conflict of interest in relation to this work.

  • Ethics approval This study was conducted with the approval of the Royal Alexandra Hospital for Children (The Children's Hospital at Westmead) Human Research Ethics Committee, Westmead, New South Wales, Australia.

  • Provenance and peer review Not commissioned; externally peer reviewed.