{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T01:42:44Z","timestamp":1782783764192,"version":"3.54.5"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Merck Sharp & Dohme LLC"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>We modeled the long-term clinical and economic impact of two-dose universal varicella vaccination (UVV) strategies in Denmark using a dynamic transmission model. The cost-effectiveness of UVV was evaluated along with the impact on varicella (including age-shift) and herpes zoster burden. Six two-dose UVV strategies were compared to no vaccination, at either short (12\/15 months) or medium (15\/48 months) intervals. Monovalent vaccines (V-MSD or V-GSK) for the 1<jats:sup>st<\/jats:sup> dose, and either monovalent or quadrivalent vaccines (MMRV-MSD or MMRV-GSK) for the 2<jats:sup>nd<\/jats:sup> dose were considered. Compared to no vaccination, all two-dose UVV strategies reduced varicella cases by 94%-96%, hospitalizations by 93%-94%, and deaths by 91%-92% over 50 years; herpes zoster cases were also reduced by 9%. There was a decline in the total number of annual varicella cases in all age groups including adolescents and adults. All UVV strategies were cost-effective compared to no vaccination, with ICER values ranging from \u20ac18,228-\u20ac20,263\/QALY (payer perspective) and \u20ac3,746-\u20ac5,937\/QALY (societal perspective). The frontier analysis showed that a two-dose strategy with V-MSD (15 months) and MMRV-MSD (48 months) dominated all other strategies and was the most cost-effective. In conclusion, all modeled two-dose UVV strategies were projected to substantially reduce the clinical and economic burden of varicella disease in Denmark compared to the current no vaccination strategy, with declines in both varicella and zoster incidence for all age groups over a 50-year time horizon.<\/jats:p>","DOI":"10.1371\/journal.pgph.0001743","type":"journal-article","created":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T17:28:22Z","timestamp":1680715702000},"page":"e0001743","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Universal varicella vaccination in Denmark: Modeling public health impact, age-shift, and cost-effectiveness"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0393-0767","authenticated-orcid":true,"given":"Colleen","family":"Burgess","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salome","family":"Samant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0260-2147","authenticated-orcid":true,"given":"Thomas","family":"leFevre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Schade Larsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjiri","family":"Pawaskar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,4,5]]},"reference":[{"key":"pgph.0001743.ref001","volume-title":"Varicella vaccination in the European Union","author":"European Centre for Disease Prevention and Control","year":"2015"},{"issue":"8","key":"pgph.0001743.ref002","doi-asserted-by":"crossref","DOI":"10.1080\/14760584.2017.1343669","article-title":"Varicella vaccination\u2014the global experience.","volume":"16","author":"P Wutzler","year":"2017","journal-title":"Expert Rev Vaccines."},{"issue":"25","key":"pgph.0001743.ref003","article-title":"Varicella and herpes zoster vaccines: WHO position paper, June 2014.","volume":"89","year":"2014","journal-title":"Wkly Epidemiol Rec."},{"key":"pgph.0001743.ref004","unstructured":"European Centre for Disease Prevention and Control. Vaccine Scheduler 2020 updated December 16, 2020. Available from: https:\/\/vaccine-schedule.ecdc.europa.eu\/Scheduler\/ByCountry?SelectedCountryId=58&IncludeChildAgeGroup=true&IncludeChildAgeGroup=false&IncludeAdultAgeGroup=true&IncludeAdultAgeGroup=false."},{"issue":"1","key":"pgph.0001743.ref005","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-12343-x","article-title":"Economic burden of varicella in Europe in the absence of universal varicella vaccination.","volume":"21","author":"M Pawaskar","year":"2021","journal-title":"BMC public health."},{"key":"pgph.0001743.ref006","article-title":"A national register-based study of paediatric varicella hospitalizations in Denmark 2010\u20132016.","author":"IG Helmuth","year":"2017","journal-title":"Epidemiology and infection"},{"issue":"3","key":"pgph.0001743.ref007","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2015-3741","article-title":"Global Varicella Vaccine Effectiveness: A Meta-analysis","volume":"137","author":"M Marin","year":"2016","journal-title":"Pediatrics"},{"issue":"7","key":"pgph.0001743.ref008","doi-asserted-by":"crossref","DOI":"10.1001\/jama.294.7.797","article-title":"Impact of varicella vaccination on health care utilization","volume":"294","author":"F Zhou","year":"2005","journal-title":"JAMA"},{"key":"pgph.0001743.ref009","unstructured":"Centers for Disease Control and Prevention. Chickenpox Vaccine Saves Lives and Prevents Serious Illness Infographic. Available from: https:\/\/www.cdc.gov\/chickenpox\/vaccine-infographic.html."},{"issue":"3","key":"pgph.0001743.ref010","doi-asserted-by":"crossref","DOI":"10.1080\/21645515.2018.1546525","article-title":"Global impact of varicella vaccination programs.","volume":"15","author":"FH Varela","year":"2019","journal-title":"Hum Vaccin Immunother."},{"issue":"Suppl 4","key":"pgph.0001743.ref011","article-title":"Decline in Severe Varicella Disease During the United States Varicella Vaccination Program: Hospitalizations and Deaths, 1990\u20132019","volume":"226","author":"M Marin","year":"2022","journal-title":"J Infect Dis"},{"key":"pgph.0001743.ref012","unstructured":"European Centre for Disease Prevention and Control. Vaccine Scheduler. Available from: https:\/\/vaccine-schedule.ecdc.europa.eu\/Scheduler\/ByDisease?SelectedDiseaseId=11&SelectedCountryIdByDisease=-1."},{"key":"pgph.0001743.ref013","article-title":"The nature of herpes zoster: A long-term study and a new hypothesis","volume":"58","author":"RE Hope-Simpson","year":"1965","journal-title":"Proceedings of the Royal Society of Medicine"},{"issue":"3","key":"pgph.0001743.ref014","doi-asserted-by":"crossref","DOI":"10.1017\/S0950268800004714","article-title":"Modelling the impact of immunization on the epidemiology of varicella zoster virus","volume":"125","author":"M Brisson","year":"2000","journal-title":"Epidemiology and infection"},{"issue":"1","key":"pgph.0001743.ref015","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2013-4251","article-title":"Impact of vaccination on the epidemiology of varicella: 1995\u20132009","volume":"134","author":"R Baxter","year":"2014","journal-title":"Pediatrics"},{"issue":"Suppl 4","key":"pgph.0001743.ref016","article-title":"Monitoring Varicella Vaccine Impact on Varicella Incidence in the United States: Surveillance Challenges and Changing Epidemiology, 1995\u20132019","volume":"226","author":"M Marin","year":"2022","journal-title":"J Infect Dis"},{"issue":"Suppl 4","key":"pgph.0001743.ref017","article-title":"25 Years of Varicella Vaccination in the United States","volume":"226","author":"M Marin","year":"2022","journal-title":"J Infect Dis"},{"issue":"8","key":"pgph.0001743.ref018","doi-asserted-by":"crossref","DOI":"10.1080\/14760584.2019.1646129","article-title":"Do varicella vaccination programs change the epidemiology of herpes zoster? A comprehensive review, with focus on the United States.","volume":"18","author":"R. Harpaz","year":"2019","journal-title":"Expert Rev Vaccines."},{"key":"pgph.0001743.ref019","article-title":"Risk of herpes zoster after exposure to varicella to explore the exogenous boosting hypothesis: self controlled case series study using UK electronic healthcare data","volume":"36810","author":"H Forbes","year":"2020","journal-title":"BMJ"},{"issue":"8","key":"pgph.0001743.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0220921","article-title":"Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model.","volume":"14","author":"LJ Wolfson","year":"2019","journal-title":"PLoS One."},{"issue":"6","key":"pgph.0001743.ref021","doi-asserted-by":"crossref","DOI":"10.1006\/bulm.1999.0126","article-title":"Modeling the effects of varicella vaccination programs on the incidence of chickenpox and shingles","volume":"61","author":"MC Schuette","year":"1999","journal-title":"Bulletin of mathematical biology"},{"key":"pgph.0001743.ref022","article-title":"Comparison of performance of varicella vaccines via infectious disease modeling","author":"M Pillsbury","year":"2022","journal-title":"Vaccine"},{"key":"pgph.0001743.ref023","unstructured":"Sundhedsstryelsen. Bornevaccinations-programmet, 2018. Available from: https:\/\/www.sst.dk\/da\/nyheder\/2019\/~\/media\/02CBB557937E4218AE5F742CA642FA9B.ashx."},{"key":"pgph.0001743.ref024","unstructured":"Finansministeriet. Dokumentationsnotat\u2013den samfunds\u00f8konomiske diskonteringsrente 2021. Available from: https:\/\/fm.dk\/media\/18371\/dokumentationsnotat-for-den-samfundsoekonomiske-diskonteringsrente_7-januar-2021.pdf"},{"key":"pgph.0001743.ref025","unstructured":"The World Bank. GDP per capita (current US$)\u2014Denmark, 1996\u20132020. Available from: https:\/\/data.worldbank.org\/indicator\/NY.GDP.PCAP.CD?locations=DK."},{"key":"pgph.0001743.ref026","unstructured":"Internal Revenue Service. Yearly Average Exchange Rates for Converting Foreign Currencies into US Dollars 2021. Available from: https:\/\/www.irs.gov\/individuals\/international-taxpayers\/yearly-average-currency-exchange-rates."},{"issue":"3","key":"pgph.0001743.ref027","doi-asserted-by":"crossref","DOI":"10.1016\/j.vaccine.2009.10.086","article-title":"Comparative varicella vaccine effectiveness during outbreaks in day-care centres","volume":"28","author":"M Spackova","year":"2010","journal-title":"Vaccine"},{"issue":"5","key":"pgph.0001743.ref028","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2012-3303","article-title":"Long-term effectiveness of varicella vaccine: a 14-Year, prospective cohort study","volume":"131","author":"R Baxter","year":"2013","journal-title":"Pediatrics"},{"key":"pgph.0001743.ref029","article-title":"Relative efficacy of varicella vaccines: Network meta-analysis of randomized controlled trials","author":"M Pawaskar","year":"2022","journal-title":"Curr Med Res Opin"},{"issue":"2","key":"pgph.0001743.ref030","doi-asserted-by":"crossref","DOI":"10.1097\/01.inf.0000109287.97518.67","article-title":"Ten year follow-up of healthy children who received one or two injections of varicella vaccine","volume":"23","author":"B Kuter","year":"2004","journal-title":"The Pediatric infectious disease journal"},{"issue":"3","key":"pgph.0001743.ref031","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(18)30716-3","article-title":"Protection against varicella with two doses of combined measles-mumps-rubella-varicella vaccine or one dose of monovalent varicella vaccine: 10-year follow-up of a phase 3 multicentre, observer-blind, randomised, controlled trial.","volume":"19","author":"M Povey","year":"2019","journal-title":"Lancet Infect Dis."},{"issue":"13","key":"pgph.0001743.ref032","doi-asserted-by":"crossref","DOI":"10.1016\/j.vaccine.2011.01.037","article-title":"Modelling the impact of a combined varicella and zoster vaccination programme on the epidemiology of varicella zoster virus in England","volume":"29","author":"AJ van Hoek","year":"2011","journal-title":"Vaccine"},{"issue":"19\u201320","key":"pgph.0001743.ref033","article-title":"Exposure to varicella boosts immunity to herpes-zoster: implications for mass vaccination against chickenpox","volume":"20","author":"M Brisson","year":"2002","journal-title":"Vaccine"},{"issue":"4","key":"pgph.0001743.ref034","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0060732","article-title":"Perspectives on the impact of varicella immunization on herpes zoster. A model-based evaluation from three European countries.","volume":"8","author":"P Poletti","year":"2013","journal-title":"PLoS One."},{"issue":"Suppl 4","key":"pgph.0001743.ref035","article-title":"The Impact of Universal Varicella Vaccination on Herpes Zoster Incidence in the United States: Comparison of Birth Cohorts Preceding and Following Varicella Vaccination Program Launch","volume":"226","author":"J Leung","year":"2022","journal-title":"J Infect Dis"},{"key":"pgph.0001743.ref036","article-title":"The Cost-Effectiveness of Universal Varicella Vaccination in Italy: A Model-Based Assessment of Vaccination Strategies.","author":"C Azzari","year":"2020","journal-title":"ClinicoEconomics and outcomes research: CEOR."},{"issue":"6","key":"pgph.0001743.ref037","doi-asserted-by":"crossref","DOI":"10.1097\/INF.0000000000003136","article-title":"Health Impact and Cost-effectiveness Assessment for the Introduction of Universal Varicella Vaccination in Switzerland.","volume":"40","author":"U Heininger","year":"2021","journal-title":"The Pediatric infectious disease journal"},{"issue":"7","key":"pgph.0001743.ref038","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0254080","article-title":"Clinical and economic impact of universal varicella vaccination in Norway: A modeling study.","volume":"16","author":"M Pawaskar","year":"2021","journal-title":"PLoS One."},{"issue":"9","key":"pgph.0001743.ref039","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines10091416","article-title":"Modeling the Impact of Exogenous Boosting and Universal Varicella Vaccination on the Clinical and Economic Burden of Varicella and Herpes Zoster in a Dynamic Population for England and Wales.","volume":"10","author":"O Sharomi","year":"2022","journal-title":"Vaccines"},{"key":"pgph.0001743.ref040","author":"D. Erhverv","year":"2020","journal-title":"Samfunds\u00f8konomisk potentiale ved vaccination"},{"issue":"12","key":"pgph.0001743.ref041","doi-asserted-by":"crossref","DOI":"10.2471\/BLT.15.164418","article-title":"Cost-effectiveness thresholds: pros and cons","volume":"94","author":"MY Bertram","year":"2016","journal-title":"Bulletin of the World Health Organization"},{"key":"pgph.0001743.ref042","unstructured":"Agreement of price reductions and a cap on the prices of hospital-only medicinal products for the period April 1, 2019 \u2013March 31, 2023. Available from: https:\/\/www.lif.dk\/wp-content\/uploads\/2020\/10\/Price-cap-agreement-on-hospital-medicin-2019-2023.pdf."}],"updated-by":[{"DOI":"10.1371\/journal.pgph.0002407","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T00:00:00Z","timestamp":1694649600000}}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0001743","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T17:29:01Z","timestamp":1680715741000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0001743"}},"subtitle":[],"editor":[{"given":"Edina","family":"Amponsah-Dacosta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,4,5]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0001743","relation":{"correction":[{"id-type":"doi","id":"10.1371\/journal.pgph.0002407","asserted-by":"object"}]},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,5]]}}}