{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:14:54Z","timestamp":1787022894301,"version":"build-2736575974"},"reference-count":36,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,9,1]]},"abstract":"<jats:p>Objective. Universal childhood immunization against varicella in the United States, first recommended in 1995, was predicted to lead to significant decreases in varicella-related hospitalization rates and corresponding charges. Previous studies have not found such effects. We studied trends in varicella-related hospitalization rates and associated charges before and after introduction of varicella vaccine.<\/jats:p>\n                  <jats:p>Methods. We examined hospitalization and charge data from the Nationwide Inpatient Sample for the years 1993\u20132001, representative of national hospitalization patterns for children and adults. We derived weighted estimates of population-adjusted, varicella-related hospitalization rates and inflation-adjusted, varicella-related hospital charges.<\/jats:p>\n                  <jats:p>Results. The annual varicella-related hospitalization rate exceeded 0.5 hospitalizations per 10 000 US population from 1993 to 1995, declined to 0.26 per 10 000 by 1999, and again halved to 0.13 per 10 000 by 2001. Hospitalization rates declined most substantially among individuals primarily targeted for vaccination (0- to 4-year-old children) but decreased among youths aged 5 to 19 years and among adults as well. Concomitantly, varicella-related hospital charges declined from $161.1 million (95% confidence interval: $130.5 million\u2013$191.8 million) in 1993 to $66.3 million (95% confidence interval: $50.9 million\u2013$81.7 million) in 2001 (all 2001 $US). Among expected primary payers, inflation-adjusted declines in varicella-related hospital discharges\u2013related charges accrued to Medicaid, private insurance, and \u201cother\u201d payers (including uninsured and self-pay) but not to Medicare.<\/jats:p>\n                  <jats:p>Conclusions. This national analysis indicates a clinically and statistically significant reduction in varicella-related hospitalizations for children and adults associated with childhood varicella immunization in the United States and a corresponding significant decrease in hospital charges.<\/jats:p>","DOI":"10.1542\/peds.2004-0012","type":"journal-article","created":{"date-parts":[[2004,11,5]],"date-time":"2004-11-05T12:23:17Z","timestamp":1099657397000},"page":"786-792","source":"Crossref","is-referenced-by-count":161,"title":["Decline in Varicella-Related Hospitalizations and Expenditures for Children and Adults After Introduction of Varicella Vaccine in the United States"],"prefix":"10.1542","volume":"114","author":[{"given":"Matthew M.","family":"Davis","sequence":"first","affiliation":[{"name":"Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan"},{"name":"Division of General Internal Medicine and the Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitesh S.","family":"Patel","sequence":"additional","affiliation":[{"name":"Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achamyeleh","family":"Gebremariam","sequence":"additional","affiliation":[{"name":"Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2004,9,1]]},"reference":[{"key":"2021121021570702200_R1","unstructured":"American Academy of Pediatrics. Recommendations for the use of live attenuated varicella vaccine. Pediatrics.\u20081995;95:791\u2013796"},{"key":"2021121021570702200_R2","doi-asserted-by":"crossref","unstructured":"Halloran ME, Cochi SL, Lieu TA, Wharton M, Fehrs L. Theoretical epidemiologic and morbidity effects of routine varicella immunization of preschool children in the United States. Am J Epidemiol.\u20081994;140:81\u2013104","DOI":"10.1093\/oxfordjournals.aje.a117238"},{"key":"2021121021570702200_R3","doi-asserted-by":"crossref","unstructured":"Lieu TA, Cochi SL, Black SB, et al. Cost-effectiveness of a routine varicella vaccination program for US children. JAMA.\u20081994;271:375\u2013381","DOI":"10.1001\/jama.271.5.375"},{"key":"2021121021570702200_R4","doi-asserted-by":"crossref","unstructured":"Rhein L, Fleisher GR, Harper MB. Lack of reduction in hospitalizations and emergency department visits for varicella in the first 2 years post-vaccine licensure. Pediatr Emerg Care.\u20082001;17:101\u2013103","DOI":"10.1097\/00006565-200104000-00005"},{"key":"2021121021570702200_R5","doi-asserted-by":"crossref","unstructured":"Galil K, Brown C, Lin F, et al. Hospitalizations for varicella in the United States, 1988 to 1999. Pediatr Infect Dis J.\u20082002;21:931\u2013934","DOI":"10.1097\/00006454-200210000-00009"},{"key":"2021121021570702200_R6","doi-asserted-by":"crossref","unstructured":"Ratner AJ. Varicella-related hospitalizations in the vaccine era. Pediatr Infect Dis J.\u20082002;21:927\u2013930","DOI":"10.1097\/00006454-200210000-00008"},{"key":"2021121021570702200_R7","doi-asserted-by":"crossref","unstructured":"Seward JF, Watson BM, Peterson CL, et al. Varicella disease after introduction of varicella vaccine in the United States, 1995\u20132000. JAMA.\u20082002;287:606\u2013611","DOI":"10.1001\/jama.287.5.606"},{"key":"2021121021570702200_R8","unstructured":"Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization in Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; July 2003. Available at: www.ahrq.gov\/data\/hcup\/hcupnis.htm. Accessed January 2, 2004"},{"key":"2021121021570702200_R9","unstructured":"US Census Bureau, Administrative and Customer Services Division, Statistical Compendia Branch. Statistical abstract of the United States. Available at: www.census.gov\/statab\/www\/. Accessed January 2, 2004"},{"key":"2021121021570702200_R10","unstructured":"US Department of Labor, Bureau of Labor Statistics. Consumer price index. Available at: ftp:\/\/ftp.bls.gov\/pub\/special.requests\/cpi\/cpiai.txt. Accessed January 2, 2004"},{"key":"2021121021570702200_R11","doi-asserted-by":"crossref","unstructured":"Meyer PA, Seward JF, Jumaan AO, Wharton M. Varicella mortality: trends before vaccine licensure in the United States, 1970\u20131994. J Infect Dis.\u20082000;182:383\u2013390","DOI":"10.1086\/315714"},{"key":"2021121021570702200_R12","unstructured":"Brunell PA. Chickenpox. In: Wehrle PF, Top FH, eds. Communicable and Infectious Diseases. 9th ed. St. Louis, MO: The CV Mosby Company; 1981;155\u2013160"},{"key":"2021121021570702200_R13","unstructured":"Englund JA, Balfour HH Jr. Varicella and zoster infections. In: Hoeprich PD, Jordan MC, Ronald AR, eds. Infectious Diseases. 5th ed. Philadelphia, PA: JB Lippincott Company; 1994;952\u2013962"},{"key":"2021121021570702200_R14","unstructured":"Zaia JA, Grose C. Varicella and herpes zoster. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious Diseases. 2nd ed. Philadelphia, PA: WB Saunders Company; 1994;1311\u20131323"},{"key":"2021121021570702200_R15","unstructured":"Centers for Disease Control and Prevention. Estimated vaccination coverage with individual vaccines and selected vaccination series among children 19\u201335 months of age by state\u2014Q1\/1996\u2013Q4\/1996. Available at: www.cdc.gov\/nip\/coverage\/NIS\/96\/toc-96.htm. Accessed January 2, 2004"},{"key":"2021121021570702200_R16","unstructured":"Centers for Disease Control and Prevention. Estimated vaccination coverage with individual vaccines and selected vaccination series among children 19\u201335 months of age by state\u2014Q1\/1997\u2013Q4\/1997. Available at: www.cdc.gov\/nip\/coverage\/NIS\/97\/toc-97.htm. Accessed January 2, 2004"},{"key":"2021121021570702200_R17","unstructured":"Centers for Disease Control and Prevention. Estimated vaccination coverage with individual vaccines and selected vaccination series among children 19\u201335 months of age by state\u2014Q1\/1998\u2013Q4\/1998. Available at: www.cdc.gov\/nip\/coverage\/NIS\/98\/toc-98.htm. Accessed January 2, 2004"},{"key":"2021121021570702200_R18","unstructured":"Centers for Disease Control and Prevention. Estimated vaccination coverage with individual vaccines and selected vaccination series among children 19\u201335 months of age by state\u2014Q1\/1999\u2013Q4\/1999. Available at: www.cdc.gov\/nip\/coverage\/NIS\/99\/toc-99.htm. Accessed January 2, 2004"},{"key":"2021121021570702200_R19","unstructured":"Centers for Disease Control and Prevention. Estimated vaccination coverage with individual vaccines and selected vaccination series among children 19\u201335 months of age by state\u2014Q1\/2000\u2013Q4\/2000. Available at: www.cdc.gov\/nip\/coverage\/NIS\/00\/toc-00.htm. Accessed January 2, 2004"},{"key":"2021121021570702200_R20","unstructured":"Centers for Disease Control and Prevention. Estimated vaccination coverage with individual vaccines and selected vaccination series among children 19\u201335 months of age by state\u2014Q1\/2001\u2013Q4\/2001. Available at: www.cdc.gov\/nip\/coverage\/NIS\/01\/toc-01.htm. Accessed January 2, 2004"},{"key":"2021121021570702200_R21","doi-asserted-by":"crossref","unstructured":"Schaffer SJ, Bruno S. Varicella immunization practices and the factors that influence them. Arch Pediatr Adolesc Med.\u20081999;153:357\u2013362","DOI":"10.1001\/archpedi.153.4.357"},{"key":"2021121021570702200_R22","doi-asserted-by":"crossref","unstructured":"Gold MR, Siegel JE, Russel LB, Weinstein MC. Cost-Effectiveness in Health and Medicine. New York, NY: Oxford University Press; 1996","DOI":"10.1093\/oso\/9780195108248.001.0001"},{"key":"2021121021570702200_R23","unstructured":"Institute of Medicine. Calling the Shots: Immunization Finance Policies and Practices. Washington, DC: The National Academies Press; 2000"},{"key":"2021121021570702200_R24","unstructured":"Institute of Medicine. Financing Vaccines in the 21st Century: Assuring Access and Availability. Washington, DC: The National Academies Press; 2003"},{"key":"2021121021570702200_R25","unstructured":"Immunization Action Coalition. Varicella prevention mandates. Available at: www.immunize.org\/laws\/varicel.htm. Accessed January 2, 2004"},{"key":"2021121021570702200_R26","doi-asserted-by":"crossref","unstructured":"Spingarn RW, Benjamin JA. Universal vaccination against varicella. N Engl J Med.\u20081998;338:683","DOI":"10.1056\/NEJM199803053381011"},{"key":"2021121021570702200_R27","doi-asserted-by":"crossref","unstructured":"Meissner HC. Universal vaccination against varicella. N Engl J Med.\u20081998;338:684","DOI":"10.1056\/NEJM199803053381011"},{"key":"2021121021570702200_R28","doi-asserted-by":"crossref","unstructured":"Wack RP. More on varicella immunization. N Engl J Med.\u20081998;338:1927","DOI":"10.1056\/NEJM199806253382620"},{"key":"2021121021570702200_R29","doi-asserted-by":"crossref","unstructured":"Galil K, Lee B, Strine T, et al. Outbreak of varicella at a day-care center despite vaccination. N Engl J Med.\u20082002;347:1909\u20131915","DOI":"10.1056\/NEJMoa021662"},{"key":"2021121021570702200_R30","doi-asserted-by":"crossref","unstructured":"Gershon AA. Varicella vaccine\u2014are two doses better than one?N Engl J Med.\u20082002;347:1962\u20131963","DOI":"10.1056\/NEJMe020138"},{"key":"2021121021570702200_R31","unstructured":"Centers for Disease Control and Prevention. Recommended adult immunization schedule, 2003\u20132004. Available at: www.cdc.gov\/nip\/recs\/adult-schedule.htm#print. Accessed January 2, 2004"},{"key":"2021121021570702200_R32","doi-asserted-by":"crossref","unstructured":"Coplan P, Black S, Rojas C, et al. Incidence and hospitalization rates of varicella and herpes zoster before varicella vaccine introduction: a baseline assessment of the shifting epidemiology of varicella disease. Pediatr Infect Dis J.\u20082001;20:641\u2013645","DOI":"10.1097\/00006454-200107000-00002"},{"key":"2021121021570702200_R33","doi-asserted-by":"crossref","unstructured":"Gordon JE. Chickenpox: an epidemiologic review. Am J Med Sci.\u20081962;224:362\u2013389","DOI":"10.1097\/00000441-196209000-00013"},{"key":"2021121021570702200_R34","doi-asserted-by":"crossref","unstructured":"Joseph CA, Noah ND. Epidemiology of chickenpox in England and Wales, 1967\u20131985. BMJ.\u20081988;296:673\u2013676","DOI":"10.1136\/bmj.296.6623.673"},{"key":"2021121021570702200_R35","unstructured":"Degeun S, Chau NP, Flahault A. Epidemiology of chickenpox in France (1991\u20131995). J Epidemiol Community Health.\u20081998;52:46S\u201398S"},{"key":"2021121021570702200_R36","doi-asserted-by":"crossref","unstructured":"Arvin AM. Antiviral therapy for varicella and herpes zoster. Semi Pediatr Infect Dis.\u20082002;13:12\u201321","DOI":"10.1053\/spid.2002.29753"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/114\/3\/786\/1027690\/zpe00904000786.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/114\/3\/786\/1027690\/zpe00904000786.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,14]],"date-time":"2024-01-14T19:38:12Z","timestamp":1705261092000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/114\/3\/786\/67191\/Decline-in-Varicella-Related-Hospitalizations-and"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,9,1]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2004,9,1]]},"published-print":{"date-parts":[[2004,9,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2004-0012","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,9,1]]}}}