{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:31:51Z","timestamp":1792024311161,"version":"4.4.0"},"reference-count":38,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Varicella zoster virus (VZV) remains a significant cause of pediatric morbidity in populations in Lebanon, yet comprehensive data on population immunity and vaccination uptake are limited. This study aimed to estimate VZV seroprevalence and identify factors associated with immunity and vaccine uptake among children and adolescents in Northern Lebanon. Methods: A cross-sectional study was conducted among 180 participants aged 1\u201318 years recruited from urban and rural settings in North Lebanon. After receiving informed parental consent, sociodemographic and clinical information were collected via structured questionnaires. Anti-VZV IgG and IgM antibodies were measured using validated Enzyme-Linked Immunosorbent Assays (ELISA). Associations with seropositivity and vaccination uptake were analyzed using multivariable logistic regression. Results: IgG seroprevalence was 79.4% (95% CI: 72.7\u201385.1), indicating prior exposure or immunization, while IgM antibodies, reflecting recent infection, were detected in 5.0% (95% CI: 2.3\u20139.4) of participants. Among vaccinated participants, IgG seropositivity was 63.6% (95% CI: 43.5\u201383.7) in the one-dose group and 89.5% (95% CI: 83.0\u201396.0) in the two-dose group. Completing the two-dose regimen was significantly associated with a higher IgG seropositivity (OR = 0.110, 95% CI: 3.2\u201352.4, p = 0.002). Parental reporting of history of varicella showed high sensitivity (99.0%) and overall accuracy (90.8%) in predicting seropositivity. Primary vaccination barriers included preference for natural infection (67%), perceived non-necessity (19%), and cost (10%). Regular pediatric follow-up strongly predicted vaccination (OR = 15.239, p &lt; 0.001), whereas low parental awareness was associated with decreased vaccine uptake (OR = 0.027, p = 0.015). Conclusions: Suboptimal VZV vaccination coverage and persistent susceptibility underscore the need to integrate varicella vaccination into Lebanon\u2019s national immunization schedule. Targeted educational efforts and enhanced pediatric healthcare engagement are critical to increasing vaccine uptake and reducing disease burden.<\/jats:p>","DOI":"10.3390\/vaccines13111166","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T10:24:58Z","timestamp":1763375098000},"page":"1166","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Seroprevalence and Vaccination Determinants of Varicella Zoster Virus Among Pediatric and Adolescent Populations in Northern Lebanon"],"prefix":"10.3390","volume":"13","author":[{"given":"Nourhan","family":"Farhat","sequence":"first","affiliation":[{"name":"Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Tripoli 11-5020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dima","family":"El Safadi","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L7 8XZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Massoud","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Tripoli 11-5020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Khalife","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Tripoli 11-5020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.ncl.2008.03.011","article-title":"Varicella Zoster Virus Infection: Clinical Features, Molecular Pathogenesis of Disease, and Latency","volume":"26","author":"Mueller","year":"2008","journal-title":"Neurol. Clin."},{"key":"ref_2","first-page":"1","article-title":"Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"56","author":"Marin","year":"2007","journal-title":"MMWR Recomm. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/B978-0-444-53488-0.00012-2","article-title":"Varicella-Zoster","volume":"123","author":"Gilden","year":"2014","journal-title":"Handb. Clin. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1128\/CMR.9.3.361","article-title":"Varicella-zoster Virus","volume":"9","author":"Arvin","year":"1996","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Abendroth, A., Arvin, A.M., and Moffat, J.F. (2010). Overview of Varicella-Zoster Virus Glycoproteins gC, gH and gL. Varicella-Zoster Virus, Springer.","DOI":"10.1007\/978-3-642-12728-1"},{"key":"ref_6","unstructured":"CDC (2025, January 01). Chickenpox (Varicella), Available online: https:\/\/www.cdc.gov\/chickenpox\/index.html."},{"key":"ref_7","unstructured":"Ayoade, F., and Kumar, S. (2025, January 01). Varicella-Zoster Virus (Chickenpox), StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK448191\/."},{"key":"ref_8","first-page":"95","article-title":"Varicella-zoster Virus Infection: Natural History, Clinical Manifestations, Immunity and Current and Future Vaccination Strategies","volume":"41","author":"Freer","year":"2018","journal-title":"New Microbiol."},{"key":"ref_9","unstructured":"WHO (2025, January 01). Varicella and Herpes Zoster Vaccines: WHO Position Paper. Available online: https:\/\/www.who.int\/publications\/i\/item\/who-wer-8925-265-288."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"15016","DOI":"10.1038\/nrdp.2015.16","article-title":"Varicella-Zoster Virus Infection","volume":"1","author":"Gershon","year":"2015","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"19530","DOI":"10.2807\/ese.15.13.19530-en","article-title":"Impact of the Routine Varicella Vaccination Programme on Varicella Epidemiology in Germany","volume":"15","author":"Siedler","year":"2010","journal-title":"Eurosurveillance"},{"key":"ref_12","first-page":"21","article-title":"The Clinical and Economic Burden of Varicella in the Middle East: A Systematic Literature Review","volume":"16","author":"Dinleyici","year":"2019","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.tmaid.2013.06.002","article-title":"Epidemiology and Impact of Varicella Vaccination: A Longitudinal Study 1994\u20132011","volume":"11","author":"AbuKhamsin","year":"2013","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_14","first-page":"686","article-title":"Seroepidemiology of Varicella Zoster Virus in Healthcare Workers in Babol, Northern Iran","volume":"4","author":"Bayani","year":"2013","journal-title":"Casp. J. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1111\/j.1651-2227.2007.00289.x","article-title":"Varicella Seroprevalence in Turkish Population in Cyprus","volume":"96","author":"Kurugol","year":"2007","journal-title":"Acta Paediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"106","DOI":"10.33762\/mjbu.2012.75807","article-title":"Immunological Responses to Varicella-Zoster Virus (VZV) in Basrah with Special Emphasis on the Pattern of Exposure","volume":"30","author":"Hasony","year":"2012","journal-title":"Med. J. Basrah Univ."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"19","DOI":"10.4103\/jrms.JRMS_979_17","article-title":"Varicella Infection in the Middle East: Prevalence, Complications, and Vaccination","volume":"23","author":"Chehadeh","year":"2018","journal-title":"J. Res. Med. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1093\/inthealth\/ihz023","article-title":"Vaccine Coverage for Lebanese Citizens and Syrian Refugees in Lebanon","volume":"11","author":"Kmeid","year":"2019","journal-title":"Int. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.jiph.2011.02.003","article-title":"Protection of Medical and Paramedical University Students in Lebanon Against Measles, Mumps, Rubella and Varicella: Active Measures Are Needed","volume":"4","author":"Chamat","year":"2011","journal-title":"J. Infect. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1017\/S0950268802007938","article-title":"Immunity to Chickenpox Among School Adolescents in Lebanon and Options for Vaccination","volume":"129","author":"Musharrafieh","year":"2002","journal-title":"Epidemiol. Infect."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S147","DOI":"10.1086\/529448","article-title":"Use and Limitations of Varicella-Zoster Virus-Specific Serological Testing to Evaluate Breakthrough Disease in Vaccinees and to Screen for Susceptibility to Varicella","volume":"197","author":"Breuer","year":"2008","journal-title":"J. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1093\/tropej\/35.4.171","article-title":"Herpes Simplex Virus Type 1 (HSV-1) and Varicella-Zoster Virus (VZV) Infections in Saudi Arabia","volume":"35","author":"Hossain","year":"1989","journal-title":"J. Trop. Pediatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S375","DOI":"10.1093\/infdis\/jiac251","article-title":"25 Years of Varicella Vaccination in the United States","volume":"226","author":"Marin","year":"2022","journal-title":"J. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.4161\/hv.23451","article-title":"Effectiveness of One and Two Doses of Varicella Vaccine in Preventing Laboratory-Confirmed Cases in Children in Navarre, Spain","volume":"9","author":"Cenoz","year":"2013","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_25","unstructured":"Public Health Agency of Canada (2025, January 01). Varicella (Chickenpox) Vaccines: Canadian Immunization Guide. Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/healthy-living\/canadian-immunization-guide-part-4-active-vaccines\/page-24-varicella-chickenpox-vaccine.html."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e820","DOI":"10.1542\/peds.2008-3310","article-title":"Validity of Reported Varicella History as a Marker for Varicella Zoster Virus Immunity Among Unvaccinated Children, Adolescents, and Young Adults in the Post-Vaccine Licensure Era","volume":"123","author":"Perella","year":"2009","journal-title":"Pediatrics"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Vezzosi, L., Santagati, G., and Angelillo, I.F. (2017). Knowledge, Attitudes, and Behaviors of Parents Towards Varicella and Its Vaccination. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2247-6"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2150","DOI":"10.1016\/j.vaccine.2014.01.081","article-title":"Understanding Vaccine Hesitancy Around Vaccines and Vaccination from a Global Perspective: A Systematic Review of Published Literature, 2007\u20132012","volume":"32","author":"Larson","year":"2014","journal-title":"Vaccine"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Abenova, M., Shaltynov, A., Jamedinova, U., and Semenova, Y. (2024). Worldwide Child Routine Vaccination Hesitancy Rate among Parents of Children Aged 0\u20136 Years: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. Vaccines, 12.","DOI":"10.3390\/vaccines12010031"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2773","DOI":"10.1016\/j.vaccine.2023.03.025","article-title":"Geographic Proximity to Immunization Providers and Vaccine Series Completion Among Children Ages 0\u201324 Months","volume":"41","author":"Freeman","year":"2023","journal-title":"Vaccine"},{"key":"ref_31","unstructured":"The American Academy for Oral Medicine (2025, January 01). Varicella-Zoster Disease (Shingles). Available online: https:\/\/maaom.memberclicks.net\/index.php?Itemid=120&catid=22%3Apatient-condition-information&id=139%3Avaricella-zoster-disease--shingles-&option=com_content&view=article."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2503","DOI":"10.1080\/21645515.2017.1367069","article-title":"Interventions to Increase Pediatric Vaccine Uptake: An Overview of Recent Findings","volume":"13","author":"Frew","year":"2017","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1007\/s15010-006-6604-4","article-title":"Seroepidemiology of Varicella Zoster in Israel Prior to Large-Scale Use of Varicella Vaccines","volume":"34","author":"Cohen","year":"2006","journal-title":"Infection"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1093\/jpids\/piae032","article-title":"School-Based Mobile Clinics to Improve Vaccine Access: A Cross-Sectional Study of COVID-19 Vaccination","volume":"13","author":"Mohareb","year":"2024","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Perman, S., Turner, S., Ramsay, A.I.G., Baim-Lance, A., Utley, M., and Fulop, N.J. (2017). School-Based Vaccination Programmes: A Systematic Review of the Evidence on Organisation and Delivery in High-Income Countries. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4168-0"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e2411938","DOI":"10.1001\/jamanetworkopen.2024.11938","article-title":"Effectiveness of a School- and Primary Care\u2013Based HPV Vaccination Intervention: The PrevHPV Cluster Randomized Trial","volume":"7","author":"Thilly","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_37","unstructured":"WHO (2025, January 01). WHO Immunization Data Portal\u2014Eastern Mediterranean Region. Available online: https:\/\/immunizationdata.who.int\/dashboard\/regions\/eastern-mediterranean-region\/LBN."},{"key":"ref_38","unstructured":"Abu Dhabi\u2014The Health Authority (2025, January 01). Health Authority\u2014Varicella Vaccine Added to School, Available online: https:\/\/www.doh.gov.ae\/en\/news\/varicella-vaccine-added-to-school-immunization."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/11\/1166\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T10:51:19Z","timestamp":1763376679000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/11\/1166"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,15]]},"references-count":38,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["vaccines13111166"],"URL":"https:\/\/doi.org\/10.3390\/vaccines13111166","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,15]]}}}