{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T01:00:07Z","timestamp":1781830807318,"version":"3.54.5"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2018,12,24]],"date-time":"2018-12-24T00:00:00Z","timestamp":1545609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,27]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The \u201cexogenous boosting hypothesis\u201d postulates that reexposure to circulating varicella zoster virus (VZV) over the life span inhibits reactivation of VZV. Consequently, if circulation of VZV is suppressed by introduction of chickenpox vaccination, incidences of herpes zoster may rise.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a systematic review and metaanalysis on impact of chickenpox vaccination on herpes zoster incidence and time trend, focusing on population-level effects by analyzing interrupted time-series (ITS) studies. We searched Medline and Embase for ITS reporting incidences of chickenpox and herpes zoster before and after implementation of chickenpox vaccination. Autoregressive integrated moving average models were calculated. Change in trend and incidence from studies were pooled.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twelve studies were included, of which 6 were eligible for metaanalysis. Metaanalysis revealed a significant increase in chickenpox cases prior to implementation of chickenpox vaccination and a reversed trend thereafter, particularly in individuals aged 1\u20134 years. The increase in age-adjusted herpes zoster incidence before implementation of chickenpox vaccination did not change thereafter. However, separate analysis of age groups revealed a net increase of hospitalized herpes zoster cases in individuals aged 10\u201349 years after implementation of chickenpox vaccination. This very small effect (fewer than 2 additional cases per 100 000 persons) did not occur in other age groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>To date, no conclusive evidence exists that chickenpox vaccination has a substantial population-level impact on herpes zoster in nonvaccinated age groups. While exogenous boosting may exist, the effect size generated by chickenpox vaccination might be rather small on the population level.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciy1099","type":"journal-article","created":{"date-parts":[[2018,12,21]],"date-time":"2018-12-21T13:50:25Z","timestamp":1545400225000},"page":"1329-1338","source":"Crossref","is-referenced-by-count":35,"title":["Systematic Review and Meta-analysis of Chickenpox Vaccination and Risk of Herpes Zoster: A Quantitative View on the \u201cExogenous Boosting Hypothesis\u201d"],"prefix":"10.1093","volume":"69","author":[{"given":"Thomas","family":"Harder","sequence":"first","affiliation":[{"name":"Immunization Unit, Robert Koch Institute, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anette","family":"Siedler","sequence":"additional","affiliation":[{"name":"Immunization Unit, Robert Koch Institute, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,12,24]]},"reference":[{"key":"2019092701015498700_CIT0001","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1128\/IAI.32.1.24-27.1981","article-title":"Decrease of the lymphoproliferative response to varicella-zoster virus antigen in the aged","volume":"32","author":"Berger","year":"1981","journal-title":"Infect Immun"},{"key":"2019092701015498700_CIT0002","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1086\/379048","article-title":"Decline in varicella-zoster virus (VZV)-specific cell-mediated immunity with increasing age and boosting with a high-dose VZV vaccine","volume":"188","author":"Levin","year":"2003","journal-title":"J Infect Dis"},{"key":"2019092701015498700_CIT0003","first-page":"9","article-title":"The nature of herpes zoster: a long-term study and a new hypothesis","volume":"58","author":"Hope-Simpson","year":"1965","journal-title":"Proc R Soc Med"},{"key":"2019092701015498700_CIT0004","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1017\/S0950268800050019","article-title":"The epidemiology of varicella-zoster virus infections: the influence of varicella on the prevalence of herpes zoster","volume":"108","author":"Garnett","year":"1992","journal-title":"Epidemiol Infect"},{"key":"2019092701015498700_CIT0005","doi-asserted-by":"crossref","first-page":"e66485","DOI":"10.1371\/journal.pone.0066485","article-title":"Herpes zoster risk reduction through exposure to chickenpox patients: a systematic multidisciplinary review","volume":"8","author":"Ogunjimi","year":"2013","journal-title":"PLoS One"},{"key":"2019092701015498700_CIT0006","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/S0140-6736(02)09837-9","article-title":"Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study","volume":"360","author":"Thomas","year":"2002","journal-title":"Lancet"},{"key":"2019092701015498700_CIT0007","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.2105\/AJPH.2009.160002","article-title":"Herpes zoster and exposure to the varicella zoster virus in an era of varicella vaccination","volume":"100","author":"Donahue","year":"2010","journal-title":"Am J Public Health"},{"key":"2019092701015498700_CIT0008","doi-asserted-by":"crossref","first-page":"h2750","DOI":"10.1136\/bmj.h2750","article-title":"Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis","volume":"350","author":"Kontopantelis","year":"2015","journal-title":"BMJ"},{"key":"2019092701015498700_CIT0009","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann Intern Med"},{"key":"2019092701015498700_CIT0010","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1002\/jrsm.1232","article-title":"Estimating data from figures with a web-based program: considerations for a systematic review","volume":"8","author":"Burda","year":"2017","journal-title":"Res Synth Methods"},{"key":"2019092701015498700_CIT0011","unstructured":"(EPOC) CEPaOoC. 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