Epidemiological impact of universal varicella vaccination on consecutive emergency department visits for varicella and its economic impact among children in Kobe City, Japan

Abstract Varicella is highly contagious and endemic worldwide. Previous studies reported a dramatic decline in varicella incidence and varicella-related deaths after implementing universal varicella vaccination (VarV). However, its impact and cost-effectiveness remain unknown in single emergency department (ED). We retrospectively reviewed the clinical database of consecutive patients younger than 16 years presenting to our primary ED between January 1, 2011, and December 31, 2019. Of the 265,191 children presenting to our ED, 3,092 were clinically diagnosed with varicella. The annual number of varicella patients was approximately 500 before introduction of the universal two-dose VarV in October 2014, and it decreased to approximately 200 in 2019. The number of varicella patients younger than 1 year (not eligible for vaccination) also decreased. Regarding the cost-effectiveness of VarV, approximately JPY1.5 million (US$14,300) were saved annually by our center. However, our study showed a relatively large percentage of infected unvaccinated children presenting to our ED (59.0%). After implementation of the universal VarV, infection was mainly observed in older children (i.e., the unvaccinated generation). In conclusion, our data showed excellent universal VarV effectiveness and cost-effectiveness in the ED. Additionally, our data suggest that the VarV should be administered to all eligible older patients.

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Multivariate analysis of the impact of weather and air pollution on emergency department visits for night-time headaches among children: retrospective, clinical observational study

BMJ Open ◽

10.1136/bmjopen-2020-046520 ◽

2021 ◽

Vol 11 (4) ◽

pp. e046520

Author(s):

Hiroshi Yamaguchi ◽

Kandai Nozu ◽

Shinya Ishiko ◽

Hiroaki Nagase ◽

Takeshi Ninchoji ◽

...

Keyword(s):

Emergency Department ◽

Air Pollution ◽

Multivariate Analysis ◽

Poisson Regression ◽

Positive Relationship ◽

Emergency Department Visits ◽

Night Time ◽

Mean Temperature ◽

Number Of Patients ◽

Kobe City

ObjectivesTo examine the association between the number of visits to the emergency department (ED) by children for night-time headaches and exposure to multifaceted factors, such as meteorological conditions and air pollution.DesignWe conducted a clinical observational time-series analysis study.SettingWe reviewed consecutive patients younger than 16 years of age at the primary ED centre in Kobe city, Japan, during the night shift (19:30–7:00 hours) between 1 January 2011 and 31 December 2019.ParticipantsIn total, 265 191 children visited the ED; 822 presented with headache during the study period.Primary outcome measuresWe investigated the effects of meteorological factors and air pollutants by multivariate analysis of Poisson regression estimates. A subanalysis included the relationship between the number of patients with night-time headaches and the above factors by sex. Furthermore, the effect of typhoon landing on patient visits for headache was also analysed. Headache was not classified because examinations were performed by general paediatricians (non-specialists).ResultsThe number of patients with night-time headaches displayed distinct seasonal changes, with peaks during the summer. Multivariate analysis of Poisson regression estimates revealed a significant positive relationship between the number of patients for headache and mean temperature. Subanalysis by sex indicated a positive relationship between the number of patients with headache and mean temperature in both sexes; however, it was significant only for females. No relationship was found between the number of patients with headache and air pollution. There was no change in the number of patients for night-time headaches 3 days before and after typhoon landing.ConclusionsHigh temperature is the main factor for visiting ED for night-time headaches among children in Kobe city. Our results suggest that preventive measures against night-time headaches may be possible by reducing time spent outside during summer.

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