Burden of varicella in the Asia-Pacific region: a systematic literature review

Expert Rev Vaccines. 2019 May;18(5):475-493. doi: 10.1080/14760584.2019.1594781. Epub 2019 Apr 14.


Varicella is a highly contagious infection that can lead to serious complications, particularly in high-risk groups; however, it is vaccine preventable. Disease awareness and understanding of the disease burden can strongly influence vaccine coverage. This review provides insight into the current epidemiology and the importance of varicella from both public health and economic perspectives across the Asia-Pacific (APAC) region. Areas covered: A systematic literature review was conducted to identify studies on the incidence, seroprevalence, fatality rate and complication rate of varicella. Economic burden studies were also captured. Altogether, 125 studies were identified across the region; these were supplemented by government reports (gray data). Reported vaccine coverage varied from 2.8% to 97%; a key influencing factor was inclusion of the varicella vaccine in national immunization programs. In general, varicella incidence in the unvaccinated population was highest in children ≤5 years old and seroprevalence increased with age. Economic analyses highlighted the cost-saving potential of vaccination programs, especially from a societal perspective. Expert opinion: Varicella-related data varied greatly across the APAC region, highlighting the need to better understand the burden of varicella in this area, and particularly identified the need for better surveillance and reporting.

Keywords: Disease burden; Varicella; epidemiology; national immunization program; vaccine.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Asia / epidemiology
  • Chickenpox / economics
  • Chickenpox / epidemiology*
  • Chickenpox / mortality
  • Cost of Illness*
  • Humans
  • Incidence
  • Pacific Islands / epidemiology
  • Seroepidemiologic Studies
  • Survival Analysis