Changes in epidemiological characteristics and sero-prevalence against the varicella zoster virus in school-age children after the introduction of a national immunization program in Japan

A national immunization program using two doses of live attenuated varicella vaccine was introduced for children aged one to two years in Japan in October 2014. Varicella cases declined after 2014, and immunological status against varicella among vaccinated children changed in post-vaccination era. A retrospective observational study of anti-varicella antibody seroprevalence, varicella vaccination status, and history of varicella among 528 students in the first grade of elementary school was conducted. The percentage of students who received at least a single dose of varicella vaccination increased from 67% (187 of 279 students) in 2007–2008 to 91% (226 of 249 students) in 2017. Students with a history of varicella decreased from 114 of 279 (41%) in 2007–2008 to 48 of 249 (19%, P < .01) in 2017. Among them, the rate of breakthrough varicella after a single dose of vaccine in students with a history of varicella significantly increased from 38% (43 of 114 students) in 2007–2008 to 58% (28 of 48 students) in 2017 (P < .05). The antibody-positive rate significantly decreased from 50% among subjects without varicella zoster who received a single dose (95%CI: 41–58%) in 2007–2008 to 29% (95%CI: 21–38%) in 2017 (P < .01). The antibody-positive rate among students without varicella history who received two doses of vaccine was only 43% (95%CI: 32–55%) in 2017. The number of varicella infections and antibody-positive rate among students without history of varicella who received varicella vaccination decreased after the introduction of a national immunization program.