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Department of Paediatrics, National University of
Singapore, Lower Kent Ridge Road, Singapore 119074
Correspondence to: Dr Lee.
Accepted 6 August 1998
AIM
To evaluate the risk factors for breakthrough
varicella in a follow up study of a cohort of 181 healthy children
immunised when aged 9-24 months with a reformulated Oka strain
varicella vaccine (SmithKline Beecham Biologicals/Oka).
DESIGNThe children were randomised in a double
blind manner into one of four groups to receive one of two production
lot vaccine batches, at two different titres (high titre,
103.9 and 104.0 plaque forming units (pfu); low
titre (heat exposed), 102.7 and 102.8 pfu). The
overall seroconversion rate after immunisation was 99%.
RESULTSOne hundred and sixty eight patients were
available for review after a mean (SD) follow up of 35 (9) months after
vaccination. Multivariate analysis indicated that risk factors for
breakthrough varicella were household contact with varicella (adjusted
odds ratio (OR), 19.89; 95% confidence interval (CI), 18.39 to 21.39), vaccination age of 
14 months (adjusted OR, 2.30; 95% CI, 1.69 to
2.90), and receiving low titre (102.7 pfu) vaccine
(adjusted OR, 2.13; 95% CI, 1.54 to 2.73). All children who developed
breakthrough varicella, had a modified varicella illness, except for
three, all of whom had received low titre vaccine.
CONCLUSIONThe identification of young
immunisation age ( 14 months) and low titre vaccine as risk factors
for breakthrough varicella have important implications for the
implementation of varicella vaccination programmes in healthy children.
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