Increasing Varicella Incidence Rates Among Children in the Republic of Korea: An Age-Period-Cohort Analysis

Epidemiol Infect. 2019 Jan;147:e245. doi: 10.1017/S0950268819001389.


In the Republic of Korea, despite the introduction of one-dose universal varicella vaccination in 2005 and achieving a high coverage rate of 98.9% in 2012, the incidence rate has been increased sevenfold. This study aimed to investigate time trends of varicella incidence rate, assessing the age, period and birth cohort effects. We used national data on the annual number of reported cases from 2006 to 2017. A log-linear Poisson regression model was used to estimate age-period-cohort effects on varicella incidence rate. From 2006 to 2017, the incidence of varicella increased from 22.5 cases to more than 154.8 cases per 100 000. Peak incidence has shifted from 4 to 6 years old. The estimated period and cohort effects showed significant upward patterns, with a linear increasing trend by net drift. There has been an increase in the incidence among the Korean population regarding period and cohort despite the universal vaccination of varicella vaccine. Our data suggest the need for additional studies to address the current gap in herd immunity.

Keywords: Age–period–cohort; chickenpox; incidence; varicella.

MeSH terms

  • Adolescent
  • Age Factors
  • Chickenpox / epidemiology*
  • Chickenpox / prevention & control*
  • Chickenpox Vaccine / administration & dosage*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Humans
  • Immunity, Herd
  • Incidence
  • Infant
  • Linear Models
  • Male
  • Registries*
  • Republic of Korea / epidemiology
  • Risk Assessment
  • Vaccination / statistics & numerical data*


  • Chickenpox Vaccine