{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:27:22Z","timestamp":1777418842797,"version":"3.51.4"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Although universal varicella vaccination (UVV) significantly reduces morbidity and mortality, it has not been implemented in Belgium. We evaluated the clinical and economic outcomes of two-dose UVV in Belgium. A previously published dynamic transmission model with dynamic population age structure was adapted to Belgium. The base case UVV strategy (Strategy 0) consisted of routine two-dose varicella vaccination at ages 1 year (vaccine coverage rate [VCR] = 95%) and 8 years (VCR\u2009=\u200990%), catch-up one-dose varicella vaccination at 8 years (VCR\u2009=\u200970%, 1-year duration), and routine two-dose herpes zoster (HZ) vaccination at 60 years (VCR\u2009=\u200950%). Alternative vaccination strategies were evaluated and reported. The reference strategy consisted of routine two-dose HZ vaccination only. Outcomes were estimated for a 50-year time-horizon. Annual discounting of 3% and 1.5% were applied to costs (in 2023 Euros) and quality-adjusted life-year outcomes, respectively. Under Strategy 0, cumulative varicella incidence, hospitalizations, and deaths decreased by approximately 91%, 89%, and 61% respectively. A transient increase in HZ incidence (that peaked in 2032 at +3% versus the reference strategy) was observed, however, cumulative HZ cases decreased by 3% over 50 years. Under the payer perspective, Strategy 0 had an incremental cost-effectiveness ratio of \u20ac11,260. Under the societal perspective, Strategy 0 resulted in cost savings, with total costs decreasing by \u20ac17,524,487. UVV can significantly reduce the burden of varicella with marginal impact on HZ cases and be cost-effective in Belgium versus routine HZ vaccination only.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005636","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T18:37:19Z","timestamp":1767983839000},"page":"e0005636","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Modeling the clinical and economic impact of universal varicella vaccination in Belgium with dynamic population"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1770-2995","authenticated-orcid":true,"given":"John C.","family":"Lang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8093-8893","authenticated-orcid":true,"given":"Robert B.","family":"Nachbar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Xausa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9","family":"Bento-Abreu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Merckx","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manjiri","family":"Pawaskar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"issue":"9544","key":"pgph.0005636.ref001","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1016\/S0140-6736(06)69561-5","article-title":"Varicella","volume":"368","author":"U Heininger","year":"2006","journal-title":"Lancet"},{"issue":"6","key":"pgph.0005636.ref002","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1080\/21645515.2020.1847582","article-title":"A systematic literature review of herpes zoster incidence worldwide","volume":"17","author":"D van Oorschot","year":"2021","journal-title":"Hum Vaccin Immunother"},{"issue":"25","key":"pgph.0005636.ref003","first-page":"265","article-title":"Varicella and herpes zoster vaccines: WHO position paper","volume":"89","author":"World Health Organization","year":"2014","journal-title":"Wkly Epidemiol Rec"},{"issue":"3","key":"pgph.0005636.ref004","doi-asserted-by":"crossref","first-page":"645","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":"11","key":"pgph.0005636.ref005","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1017\/S0950268811002640","article-title":"The health and economic burden of chickenpox and herpes zoster in Belgium","volume":"140","author":"J Bilcke","year":"2012","journal-title":"Epidemiol Infect"},{"issue":"12","key":"pgph.0005636.ref006","doi-asserted-by":"crossref","first-page":"555","DOI":"10.3345\/cep.2021.01564","article-title":"Global varicella vaccination programs","volume":"65","author":"YH Lee","year":"2022","journal-title":"Clin Exp Pediatr"},{"issue":"3","key":"pgph.0005636.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":"2","key":"pgph.0005636.ref008","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/INF.0000000000002233","article-title":"Implementing universal varicella vaccination in Europe: the path forward","volume":"38","author":"V Spoulou","year":"2019","journal-title":"Pediatr Infect Dis J"},{"issue":"8","key":"pgph.0005636.ref009","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1080\/14760584.2017.1343669","article-title":"Varicella vaccination - the global experience","volume":"16","author":"P Wutzler","year":"2017","journal-title":"Expert Rev Vaccines"},{"key":"pgph.0005636.ref010","doi-asserted-by":"crossref","DOI":"10.1093\/infdis\/jiac242","article-title":"Decline in severe varicella disease during the United States varicella vaccination program: hospitalizations and deaths, 1990-2019","volume":"226","author":"M Marin","year":"2022","journal-title":"J Infect Dis"},{"key":"pgph.0005636.ref011","unstructured":"Health Belgium. 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