Long -term persistence of antibodies against varicella in fully immunized healthcare workers: an Italian retrospective cohort study

BMC Infect Dis. 2021 May 25;21(1):475. doi: 10.1186/s12879-021-06180-x.


Background: Chickenpox is a highly contagious disease caused by the varicella zoster virus (VZV), and in infants, adolescents, adults, pregnant women, and the immunocompromised it can be serious. The best way to prevent chickenpox is immunization with the varicella vaccine. Protective levels of antibodies induced by the varicella vaccine decline over time, but there is currently no formal recommendation for testing anti-varicella zoster virus (VZV) IgG levels in immunized healthcare workers (HCWs).

Methods: The aims of this study were to evaluate the seroprevalence of circulating anti-VZV IgG in a sample a sample of students and residents of the medical school of the University of Bari, the long-term immunogenicity of the varicella vaccine, and the effectiveness of a strategy consisting of a third vaccine booster dose. The study population was screened as part of a biological risk assessment conducted between April 2014 and October 2020. A strategy for the management of non-responders was also examined.

Results: The 182 students and residents included in the study had a documented history of immunization (two doses of varicella vaccine). The absence of anti-VZV IgG was determined in 34% (62/182; 95%CI = 27.2-41.4%), with serosusceptibility more common among males than females (p < 0.05). After a third varicella dose, seroconversion was achieved in 100% of this previously seronegative group. No serious adverse events were recorded.

Conclusions: One-third of the study population immunized against VZV lacked a protective antibody titer, but a third dose of vaccine restored protection. Since it is highly unlikely that VZV will be eliminated in the immediate future, the loss of immunity in a substantial portion of the population implies a risk of varicella outbreaks in the coming years. Screening for varicella immunity in routine assessments of the biological risk of medical students and HCWs may help to prevent nosocomial VZV infections.

Keywords: Chickenpox; Duration of immunization; Healthcare workers; Long-term immunogenicity; Third varicella dose; Varicella zoster virus.

MeSH terms

  • Adolescent
  • Adult
  • Antibodies, Viral / blood*
  • Antibodies, Viral / immunology
  • Chickenpox / blood
  • Chickenpox / epidemiology*
  • Chickenpox / prevention & control*
  • Chickenpox / virology
  • Chickenpox Vaccine / administration & dosage
  • Chickenpox Vaccine / immunology*
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control
  • Disease Outbreaks / prevention & control*
  • Female
  • Health Personnel*
  • Herpesvirus 3, Human / immunology*
  • Humans
  • Immunization, Secondary / methods*
  • Immunogenicity, Vaccine
  • Immunoglobulin G / blood
  • Italy / epidemiology
  • Male
  • Retrospective Studies
  • Seroepidemiologic Studies
  • Treatment Outcome
  • Vaccination / methods*
  • Young Adult


  • Antibodies, Viral
  • Chickenpox Vaccine
  • Immunoglobulin G