{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T05:58:05Z","timestamp":1784095085403,"version":"3.55.0"},"reference-count":32,"publisher":"American Society for Clinical Investigation","issue":"20","license":[{"start":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T00:00:00Z","timestamp":1729555200000},"content-version":"vor","delay-in-days":49,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"na","award":["na"],"award-info":[{"award-number":["na"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,22]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Immune processes are influenced by circadian rhythms. We evaluate the association between varicella vaccine administration time of day and vaccine effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A national cohort, children younger than 6 years, were enrolled between January 2002 and December 2023. We compared children vaccinated during morning (7:00\u201310:59), late morning to afternoon (11:00\u201315:59), or evening hours (16:00\u201319:59). A Cox proportional hazards regression model was used to adjust for ethnicity, sex, and comorbidities. The first varicella infection occurring at least 14 days after vaccination and a second dose administration were treated as terminal events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Of 251,141 vaccinated children, 4,501 (1.8%) experienced breakthrough infections. Infection rates differed based on vaccination time, with the lowest rates associated with late morning to afternoon (11:00\u201315:59), HR 0.88, 95% CI 0.82\u20130.95,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001, and the highest rates with evening vaccination (16:00\u201319:59), HR 1.41, 95% CI 1.32\u20131.52,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001. Vaccination timing remained significant after adjustment for ethnicity, sex, and comorbidities. The association between immunization time and infection risk followed a sinusoidal pattern, consistent with a diurnal rhythm in vaccine effectiveness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>We report a significant association between the time of varicella vaccination and its clinical effectiveness. Similar association was observed with the COVID-19 vaccine, providing proof of concept consistent with a diurnal rhythm in vaccine effectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1172\/jci.insight.184452","type":"journal-article","created":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T12:48:27Z","timestamp":1725367707000},"source":"Crossref","is-referenced-by-count":9,"title":["Diurnal rhythms in varicella vaccine effectiveness"],"prefix":"10.1172","volume":"9","author":[{"given":"Dana","family":"Danino","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel."},{"name":"Pediatric Infectious Diseases Unit, Saban Children Hospital, Soroka University Medical Center, Beer Sheva, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Kalron","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Haspel","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Hazan","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel."},{"name":"Pediatric Pulmonary Unit, Saban Children Hospital, Soroka University Medical Center, Beer Sheva, 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