Effectiveness of post-exposure prophylaxis during varicella outbreaks among primary and middle school students in Shanghai: An analysis of three-year surveillance data.

Highlights • First 3-year large data emergency vaccination post-exposure prophylaxis study. • Varicella outbreaks in one-dose regime areas more likely in schools. • Emergency vaccinations effective within 3 days of exposure in prior vaccinated. • Emergency vaccinations control school outbreaks in one-dose varicella regime areas. Abstract Objectives To evaluate the effectiveness of post-exposure prophylaxis conducted during varicella outbreaks among students in Shanghai. Methods Surveillance data were collected from September 1, 2013 to December 31, 2016 involving 3524 susceptible students in 109 primary and middle school classes where emergency vaccinations (EVs) had been administered. Students were divided into two groups according to their prior vaccination (PV) varicella vaccine status. A secondary attack rate was used to compare EV and non-EV groups using a chi-squared test. Stratification analyses were performed, adjusting for the EV administration date, the vaccination coverage rate, and the number of cases prior to the EV. Results The effectiveness rate was 92.2% (95% confidence interval (CI): 37.1–99.0%) when EV was applied within 3 days following the outbreak onset date, and 95.2% (95% CI: 79.9–98.8%) when vaccination coverage was ≥80% among students with PV. When students with PV received an EV for varicella within 3 days, the effectiveness rate was 100%. Conclusions EV showed high protective effectiveness for varicella during outbreaks, especially if administered within 3 days of an outbreak and in conjunction with a high coverage rate. [ABSTRACT FROM AUTHOR]