Burden of Varicella in Asia-Pacific Countries: A Systematic Review and Critical Analysis


      Varicella is a common, vaccine-preventable illness but its impact on public health in Asia-Pacific countries has received little attention. This study aimed to review the epidemiology and economic burden of varicella in Asia-Pacific countries.


      A systematic literature review was conducted using PubMed and government web sites. Outcomes included epidemiology of varicella (incidence, mortality, and complication), vaccination policy and coverage, and varicella-related health care resource utilization and costs. Critical analyses of study quality and data gaps were performed.


      Published data were identified from thirteen countries including Australia, China, India, Japan, Korea, Malaysia, New Zealand, Pakistan, Philippines, Singapore, Sri Lanka, Taiwan, and Thailand. No studies were identified for Indonesia and Vietnam. Publicly funded universal childhood vaccination against varicella has been implemented in Australia, Korea, and Taiwan, while the remaining countries either recommend vaccination for only high-risk individuals or have no recommendations. The annual incidence of varicella in the general populations ranged from 13.7 to 76 per 100,000 in Asia-Pacific countries with universal vaccination, and from 100 to 512 per 100,000 in Asia-Pacific countries without universal vaccination. Studies in China, Japan, and South Korea showed varicella incidence peaking in spring and winter. Limited publication has reported varicella-related mortality in the Asia-Pacific region. Majority of the studies assessing health care resource utilization focused on inpatient care. The most frequent complications among hospitalized patients were skin and respiratory complications. Hospitalization rates associated with varicella reported in Australia and Taiwan were 0.11 and 60 per 1,000 cases, respectively. Medical costs associated with varicella were estimated in China, Japan, Singapore, Taiwan, and Australia.


      Epidemiology and economic burden of varicella in Asia-Pacific countries have not been extensively studied. Given limited varicella vaccination policy in this region, gaps in evidence need to be addressed to inform policy makers about the public health impact of varicella.