ca‐Barrabeig 2011b

Children attending day‐care

and preschool centres

(a) ≥ 15 months (all ages)

(b) 15 to 23 months

(c) 24 to 35 months

(d) ≥ 36 months

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(e) Indirect effectiveness

(e1) 12 to 23 months

(e2) 24 to 35 months

(e3) ≥ 36 months

Confirmed measles

was defined as

laboratory‐confirmed case or met the WHO clinical case definition

and was epidemiologically

linked to laboratory‐confirmed case.

Priorix/Schwarz or
MDS/Enders

dose 1 at 9 to 12 months

dose 2 at 15 months

(a) N = 1027 (any dose)

(a1) N = 830 (1 dose)

(a2) N = 197 (2 doses)

(b) N = 269 (any doses)

(c) N = 384 (any doses)

(d) N = 374 (any doses)

(a) n = 94

(b) n = 57

(c) n = 20

(d) n = 17

unvaccinated

(a) 5/1027 versus 12/94

(a1) 5/830 versus 12/94

(a2) 0/197 versus 12/94

(b) 3/296 versus 6/57

(c) 1/384 versus 4/20

(d) 1/374 versus 2/17

(a) 96.2% (89.4% to 98.6%)

(a1) 95.3% (86.9% to 98.%)

(a2) 100% (‐% to ‐%)

(b) 89.4% (58.9% to 97.3%)

(c) 98.7% (88.9% to 99.8%)

(d) 97.7% (76.1% to 99.8%)

VE = (1 − RR) x 100

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(e1) 71.1% (63.5% to 78.8%)

(e2) 80.0% (56.3% to 94.3%)

(e3) 88.2% (63.6% to 98.5%)

VE = (ARU − ARV)/ARU x 100

Orenstein 1985

ca‐Bhuniya 2013

Children aged 9 to 59 months

(at 30 June 2011)

(a) 9 to 59 months

(b) 9 to 12 months

(c) > 12 months

A clinical case of measles is

defined as fever with maculopapular

rash and either conjunctivitis

or cough or coryza

(catarrhal inflammation of the

mucous membrane in the nose).

A confirmed case of measles is defined

as a clinical case who is positive for

anti‐measles virus nucleoprotein

immunoglobulin M antibodies

in serological tests but has not been

vaccinated against measles

during last 1 month.

MMR vaccine not described

(a) N = 50 (1 dose)

(a) N = 18

(a) 15/50 versus 16/18

(a) 66.3% (46.9% to 78.6%)

(b) 66.6%(*)

(c) 65.4%(*)

(*) no statistical evidence

VE = (1 − RR) x 100

ca‐Choe 2017

Outbreak at a university in 2014

Students born between 1984 and 1993.

N = 14,465

VE > 10 years after vaccination

The definition of suspected measles case was individuals with
following features: fever and rash and at least 1 of cough, coryza,
or conjunctivitis.

All suspected cases were quarantined
and were interviewed using standardised questionnaire,
and physical examinations were performed by trained physicians.
Presence of symptoms (fever, rash, cough, coryza, or conjunctivitis),
travel history, and days of illnesses were assessed.

MMR/not stated

2 doses

N = 11448

N = 3017

52/11448 versus 33/3017

60% (38.2% to 74.1%)

VE = (1 − RR) x 100

ca‐La Torre 2017

N = 11,004

children born

between 2008 and 2010

who underwent vaccination

in 2009 to 2011.

Follow‐up = 24 months

Hospitalisation for

(a) measles

(b) mumps (see also Table 3)

(c) measles and mumps

(d) all infectious diseases

(e) all respiratory diseases

The effectiveness of MMR

vaccine in reducing hospitalisations
for any infection was assessed

by analysing 2 distinct databases

(vaccination record) and

(hospital discharge):
Hospital discharge diagnosis which

contained the following ICD‐9 codes in primary or secondary diagnosis:

001 to 139 for infectious and parasitic diseases;

460 to 519 for respiratory diseases

MMR not described

the vaccination records of the database of the

Roma Local Health Unit from which relevant

data were extracted,

such as date of birth;

MMR vaccination (yes/no);

MMR dose (only for vaccinated);

personal tax code.

The cohort was recomposed

through record linkage of the 2
archives, registration and

vaccination of hospital discharge
records, using personal

tax codes as a common

identification
in both archives.

(1) 1 dose N = 5392

(2) 2 doses N = 3310

(3) any dose

N = 8702

Unvaccinated

N = 2302

(a1) 3/5392 versus 9/2302

(a2) 0/3310 versus 9/2302

(a3) 3/8702 versus 9/2302

(b1) 1/5392 versus 1/2302

(b2) 0/3310 versus 1/2302

(b3) 1/8702 versus 1/2302

(c1) 4/5392 versus 10/2302

(c2) 0/3310 versus 10/2302

(c3) 4/8702 versus 10/2302

(d1) 82/5392 versus 262/2302

(d2) 70/3310 versus 262/2302

(d3) 414/8702 versus 262/2302

(e1) 202/5392 versus 424/2302

(e2) 183/3310 versus 424/2302

(e3) 809/8702 versus 424/2302

Unadjusted estimates

(a1) 85.8% (47.5% to 96.1%)
(a2) 96.3% (37.1% to 99.8%)
(a3) 91.2% (67.5% to 97.6%)
(b1) 57.3% (−582% to 97.3%)*
(b2) 76.8% (−468% to 99.1%)*
(b3) 73.5% (−322% to 98.3%)*
(c1) 82.9% (45.6% to 94.6%)
(c2) 96.7% (43.5% to 99.8%)
(c3) 89.4% (66.3% to 96.7%)
(d1) 86.6% (83% to 89.5%)
(d2) 81.4% (75.9% to 85.6%)
(d3) 84.7% (81.4% to 87.4%)
(e1) 79.7% (76.1% to 82.7%)
(e2) 70% (64.6% to 74.5%)
(e3) 76% (72.6% to 78.9%)

(*) no statistical evidence

VE = (1 − RR) x 100

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Adjusted estimates

any doses

(a) 91% (68% to 99%)

(b) not reported

(c) 90% (66% to 97%)

(d) 71% (66% to 75%)

(e) 82% (52% to 93%)

VE = (1 − HR)*100

ca‐Marolla 1998

Children (19 to 67 months)

whose parent required a

paediatrician visit during

a measles outbreak peak

Clinical diagnosis
patient records and
parent interviews

(a) Pluserix
Schwarz
(b) Morupar
Schwarz

(c) Triviraten
Edmonston‐Zagreb

vaccination records

(a) N = 329 (1 dose)

(b) N = 747 (1 dose)

(c) N = 1023 (1dose)

N = 646

unvaccinated

(a) 0/329 versus 114/646

(b) 2/747 versus 114/646

(c) 8/1023 versus 114/646

‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(a) 0/ 19,836 PT

(b) 2/ 12,906 PT

(c) 8/ 31,329 PT

(control) 114/22,188 PT = person‐time in months

(a) 100% (‐% to ‐%)

(b) 97% (88% to 99%)
(c) 95% (90% to 98%)

VE = (ARU − ARV)/ARU x 100

Orenstein 1985

ca‐Musa 2018

Children aged up to 14 years.

N = 2784

(children aged > 14 years, N = 2300).

Data were presented by age group.

The study included all students in 40

classes with 1 or more registered

measles cases in the period

February 2014 to September 2015.

VE

≤ 5 years since vaccination

6 to 14 years since vaccination

Measles diagnosis was confirmed according to WHO guidelines. The clinical criteria
for measles were fever, maculopapular rash (i.e. non‐vesicular
rash), and cough or coryza (i.e. runny nose) or conjunctivitis
(i.e. red eyes). The laboratory criteria for measles surveillance

case confirmation were measles IgM antibody detection, or
measles virus isolation, or measles viral RNA detection by
RT‐PCR, or a significant rise in measles IgG antibody in
paired sera.
All suspected cases were investigated and classified based on
clinical, laboratory, and epidemiological data, based on the WHO
case definition.

MMR/not stated

(a) 1 dose

(b) 2 doses

(c) ≤ 5 years since vaccination

(d) 6 to 14 years since vaccination

(a) N = 100

(b) N = 606

(c) N = 20

(d) N = 76

N = 95

(a) 3/100 versus 35/95

(b) 6/606 versus 35/95

(c) 1/20 versus 35/95

(d) 2/76 versus 35/95

(a) 91.9% (74.4% to 97.4%)
(b) 97.3% (93.8% to 98.8%)
(c) 86.4% (6.6% to 98.0%)
(d) 92.9% (71.2% to 98.2%)

VE = (1 − RR) x 100

ca‐Ong 2007

Children from

primary school in Singapore

(aged 8 to 14 years,

> 5 years since vaccination)

during

a measles outbreak

Clinical with

laboratory confirmation.

Active survey and

serological confirmation

MMR vaccine not described

Vaccination status was ascertained from health booklet.

N = 171 (1 dose)

N = 13

unvaccinated

2/171 versus 7 /13

97.8% (90.6% to 99.5%)

VE = (1 − RR) x 100

ca‐Wichmann 2007

School outbreak 2006.

Students aged

10 to 15 years (N = 875)
16 to 21 years (N = 139)

VE

< 10 years after vaccination

> 10 years after vaccination

Clinical or laboratory

MMR/not stated

(a) 1 dose

(b) 2 doses

(c) unknown
vaccination status

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

All ages

(a) N = 199

(b) N = 561

(c) N = 218

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

10 to 15 years

(a) N =196
(b) N = 502
(c) N = 144

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
16 to 21 years
(a) N = 3

(b) N = 59

(c) N = 74

All ages

N = 36

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

10 to 15 years

N = 33
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
16 to 21 years
N = 3

All ages

(a) 2/199 versus 19/36

(b) 2/5611 versus 19/36

(c) 30/218 versus 19/36

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

10 to 15 years

(a) 2/196 versus 18/33

(b) 2/502 versus 18/33
(c) 25/144 versus 18/33

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
16 to 21 years
(a) 0/3 versus 1/3
(b) 0/59 versus 1/3

(c) 5/74 versus 1/3

All ages
(a) 98.1% (92.2% to 99.5%)
(b) 99.3% (97.2% to 99.8%)

(c) 73.9% (59.0% to 83.4%)

VE = (1 − RR) x 100

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

10 to 15 years
(a) 98.1% (92.3% to 99.5%)
(b) 99.3% (97.0% to 99.8%)
(c) 68.2% (48.9% to 80.2%)

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
16 to 21 years

(a) 66.7% (*)

(b) 97.8% (53.7% to 99.9%)

(c) 79.7% (*)
VE = (1 − RR) x 100

(*) no evidence

ca‐Woudenberg 2017

Infants aged 6 to 14 months

living in municipalities where coverage

with the first dose of MMR vaccine was < 90%.

Infants aged 6 to 11 months were

offered an extra vaccination

(and would thus still be

eligible for their second MMR vaccination

at the age of 14 months).

Infants aged 12 to 14 months were

offered an early MMR vaccination

as an alternative to the regular

time point at 14 months of age.

All infants were eligible for another

dose of MMR scheduled at 9 years of age.

Laboratory‐confirmed measles

N = 1080 infants eligible for analysis laboratory‐confirmed

MMR vaccine:

(M‐M‐RVAXPRO; Sanofi

Pasteur MSD).

This vaccine contains measles

virus Enders’ Edmonston strain.

Vaccination status was checked

in the national vaccination register.

Parents were asked whether their

infant(s) had had measles in the

preceding 3 months.

N = 919

N = 311

3/106,631 (PT‐days) versus

10/23,769 (PT‐days)

HR (95% CI)(*)

0.29 (0.05 to 1.72)

(*) adjusted estimates Cox proportional
hazard model

VE = 1 − HR

ca‐Arenz 2005

Household contacts

55 families, 43 children

(a) 1 dose

(b) 2 doses

(c) any dose

Clinical

MMR/strain
not stated

(a) N = 13

(b) N = 4

N = 26

(a) 1/13 versus 19/26

(b) 0/4 versus 19/26

(c) 1/20 versus 19/26

(a) 96.9% (71.8% to 99.7%)

(b) 95.7% (10.6% to 99.8%)

(c) 97.7% (79.3% to 99.7%)

VE = (1 − RR) x 100

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(a) 90% (35% to 97%)

(b) not reported

(c) 92% (48% to 98%)

VE = (ARU − ARV)/ARU x 100

Orenstein 1985

ca‐Hales 2016

Household contacts

adolescents and young

adults (10 to 29 years)

(a) any dose

(b) 1 dose

(c) 2 doses

(d) 3 doses

Clinical or

laboratory confirmation, or both

MMR vaccine not described

(a) N = 302

(b) N = 27

(c) N = 205

(d) N = 70

(a) N = 16

Pre‐campaign

MMR doses

(a) 16/302 versus 2/16

(b) 3/27 versus 2/16

(c) 13/205 versus 2/16

(d) 0/70 versus 2/16

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Pre‐campaign MMR doses

(a) (No data)

(b) 23.1% (−425.0% to 87.3%)*

(c) 63.4% (−103.0% to 90.6%)*

(d) 95.9% (45% to 100%)

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Campaign MMR doses:

78.7% (10.1% to 97.7%)

for pre‐exposure doses

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

50.4% (*)

for postexposure doses

(*) no statistical evidence

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

VE = (1 − OR) x 100

from logistic regression

ca‐Marin 2006

Household contacts

(6 months to 14 years)

of primary measles cases

Secondary cases

Clinical (WHO definition) or

IgM positive antibody of

secondary cases

Standardised questionnaires

MMR vaccine not described

Vaccination records

(a1) N = 48 (1 dose)

(a2) N = 106 (2 doses)

(b) N = 44 (> 2 doses)

(c) N = 219 any doses

contacts

N = 21

unvaccinated

(a1) 2/48 versus 11/21

(a2) 3/106 versus 11/21

(b) 1/44 versus 11/21

(c) 17/219 versus 11/21

(a1) 92.0% (67.2% to 98.1%)

(a2) 94.6% (82.3% to 98.4%)

(b) 95.7% (68.6% to 99.4%)

(c) 85.2% (72.7% to 92.0%)

VE = (1 − RR) x 100

ca‐Arciuolo 2017

Postexposure prophylaxis

Childrena aged < 19 years

N = 208

All who subsequently

developed measles were

considered as contacts.

MMR not described

MMR PEP administered within

72 hours of initial exposure.

N = 44

N = 164

(a) 2/44 versus 45/164

(a) 83.4% (34.4% to 95.8%)

VE = (1 − RR) x 100

ca‐Barrabeig 2011a

Postexposure prophylaxis

N = 166 children with

median age of 16.5 months

(range 6 to 47 months)

Candidates for the

intervention were

susceptible contacts who had

not received either measles‐containing vaccine or

had not suffered measles.

Clinical and laboratory

MMR not stated

(a) at least 1 dose

(b) vaccinated ≤ 3 days

(c) vaccinated 4 to 5 days

(d) vaccinated 6 to 7 days

(e) vaccinated 8 to 9 days

(f) vaccinated 10 to 12 days

(a) N = 54

(b) N = 17

(c) N = 14

(d) N = 14

(e) N = 8

(f) N = 1

N = 21

(a) 12/54 versus 13/21

(b) 1/17 versus 13/21

(c) 4/14 versus 13/21

(d) 5/14 versus 13/21

(e) 1/8 versus 13/21

(f) 1/1 versus 13/21

(a) 64.1% (34.5% to 80.3%)

(b) 90.5% (34.5% to 98.6%)

(c) 53.8% (0.0% to 81.1%)

(d) 42.3% (0.0% to 81.1%)

(e) 79.8% (0.0% to 73.5%)

(f) not reported

VE = (1 − RR) x 100

ba‐Defay 2013

Children aged 5 to 17 years

(a) outside of outbreak school

(b) all participants

(a) N = 61

(b) N = 102

confirmed by laboratory testing

or epidemiologic link

is notifiables

by both physicians and

laboratories in Quebec

(a) N = 305

(b) N = 510

Controls were matched

for date of birth

(± 6 months)

and school attended

in 2010 to 2011.

MMR‐II

(Merck Canada,

Montreal, Quebec)

Cases and controls

received

2 doses of

measles‐containing

vaccine.

No data reported
amongst unvaccinated.

‐

‐

ba‐Hungerford 2014

Participants

(median age 16 years,

upper quartile age 76 years)

living in Merseyside (UK)

N = 42

microbiological confirmation:

oral fluid/blood test

IgM positive or PCR positive

N = 42

Control group participants were

selected at random,

matched 1:1 by general

medical practice and aged

within 1 year.

MMR vaccine not described

(a) vaccinated appropriately for age
(b) under age

for vaccination (< 14 months)

(c) all ‐ vaccinated

Unvaccinated: incompletely or partially vaccinated for age (> 13 months)

(a) 5/27 versus 23/29

(b) 15/37 versus 12/18

(c) 20/42 versus 35/42

Risk factors for

measles infection

(univariate analysis)

age > 13 months and incomplete vaccination

6.3 (1.9 to 33.4)

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(Multivariate analysis)

under age for routine

vaccination

20.4 (2.0 to 300)

incomplete/partial vaccination

for age > 13 months

22.1 (3.8 to 300)

(**) adjusted for confounders

Risk factors for

measles infection

(univariate analysis)

age > 13 months and incomplete vaccination

84.1% (47.4% to 97.0%)

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(Multivariate analysis)

under age for routine

vaccination

95.1% (50.0% to 100%)

incomplete/partial vaccination

for age > 13 months

95.5% (73.7% to 100%)

(**) adjusted for confounders

VE = (1 − OR) x 100

ba‐Jick 2010

Participants

aged 1 to 19 years

N = 1261

clinical definition

N = 4996

randomly selected, matched for year of birth, gender, general practice attended, index date

MMR or MR

not described

(a) 1 dose

(b) > 1 dose

(a) 409/1221 versus 2012/4750

(b) 40/852 versus 246/2984

(a) 0.49 (0.41 to 0.58)*

(b) 0.39 (0.26 to 0.58)*

*adjusted estimates, conditional logistic regression

(a) 51.0% (42.0% to 59.0%)
(b) 61.0% (42.0% to 74.0%)

VE = (1 − OR) x 100

ca‐Chamot 1998

Children aged up to 16 years

from Geneva were

household contacts
of primary confirmed mumps cases
(clinical or with laboratory confirmation
notified by a paediatrician).

Clinical diagnosis of

secondary cases

Phone interview

(a) MMR‐II/Jeryl LynnB

(b) Pluserix or Trimovax/Urabe AM9

(c) Triviraten/Rubini

(d) any strain

Vaccination records

Unspecified

number of doses

(a) N = 30

(b) N = 75

(c) N = 83

(d) N = 193

N = 72

unvaccinated

(a) 4/30 versus 25/72

(b) 7/75 versus 25/72

(c) 27/83 versus 25/72

(d) 38/193 versus 25/72

(a) 61.6 % (−0.9% to 85.4%)

(b) 73.1% (41.8% to 87.6%)

(c) 6.3% (−45.9% to 39.8%)

(d) 43.0% (12.7% to 62.8%)

VE = (1 − RR) x 100

ca‐Compés‐Dea 2014

235 students (in Spain)

(aged 16 to 17 years)

Laboratory confirmed

MMR vaccine:
Jeryl Lynn RIT4385 or Rubini

(a) 1 dose

(b) 2 dose

(c) 3 dose

(d) any dose

(a) N = 5

(b) N = 37

(c) N = 2

(d) N = 44

N = 2

unvaccinated

(a) 2/5 versus 1/2

(b) 9/37 versus 1/2

(b) 2/2 versus 1/2

(d) 13/44 versus 1/2

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Incidence

(a) 33 versus 50 x 100 person‐day

(≥ 2 doses) 16 versus 50 x 100 person‐day

(a) not reported
(b) not reported
(c) not reported
(d) not reported

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

VE = (1 − rr) x 100

(a) 34% (−44% to 70%)*

(≥ 2 doses) 67% (28% to 83%)

*no statistical evidence

ca‐Greenland 2012

Students from the

3 university cities

N = 989

Self‐reported

MMR vaccine: Jeryl Lynn

(a) 1 dose

(b) 2 doses

(a) N = 29

(b) N = 706

N = 16

unvaccinated

(a) 2/29 versus 7/16

(b) 92/706 versus 7/16

(a) not reported

(b) 68% (40.6% to 82.2%)

adjusted estimate

VE = 1 − RR

ca‐La Torre 2017

N = 11,004

children born

between 2008 and 2010,

who underwent vaccination

in 2009 to 2011.

Follow‐up = 24 months

Hospitalisation for

(a) measles (see also Table 1)

(b) mumps

(c) measles and mumps

(d) all infectious diseases

(e) all respiratory diseases

The effectiveness of MMR vaccine in reducing

hospitalisations
for any infection

was assessed

by analysing 2 distinct

databases

(vaccination record) and

(hospital discharge):
hospital discharge

diagnosis contained the

following ICD‐9 codes

in primary or

secondary diagnosis:

• 001 to 139 for infectious and parasitic diseases;

• from 460 to 519 for respiratory diseases.

MMR not described (we assume Jeryl Lynn)

the vaccination records

from the Roma Local Health Unit database

from which relevant

data were extracted,

such as date of birth;

MMR vaccination

(yes/no);

MMR dose (only for vaccinated);

personal tax code.

The cohort was recomposed

through record linkage of the 2
archives, registration and

vaccination of hospital discharge
records, using

personal tax codes as a common

identification
in both archives.

(1) 1 dose N = 5392

(2) 2 doses N = 3310

(3) any dose

N = 8702

Unvaccinated

N = 2302

(a1) 3/5392 versus 9/2302

(a2) 0/3310 versus 9/2302

(a3) 3/8702 versus 9/2302

(b1) 1/5392 versus 1/2302

(b2) 0/3310 versus 1/2302

(b3) 1/8702 versus 1/2302

(c1) 4/5392 versus 10/2302

(c2) 0/3310 versus 10/2302

(c3) 4/8702 versus 10/2302

(d1) 82/5392 versus 262/2302

(d2) 70/3310 versus 262/2302

(d3) 414/8702 versus 262/2302

(e1) 202/5392 versus 424/2302

(e2) 183/3310 versus 424/2302

(e3) 809/8702 versus 424/2302

Unadjusted estimates

(a1) 85.8% (47.5% to 96.1%)
(a2) 96.3% (37.1% to 99.8%)
(a3) 91.2% (67.5% to 97.6%)
(b1) 57.3% (−582% to 97.3%)*
(b2) 76.8% (−468% to 99.1%)*
(b3) 73.5% (−322% to 98.3%)*
(c1) 82.9% (45.6% to 94.6%)
(c2) 96.7% (43.5% to 99.8%)
(c3) 89.4% (66.3% to 96.7%)
(d1) 86.6% (83% to 89.5%)
(d2) 81.4% (75.9% to 85.6%)
(d3) 84.7% (81.4% to 87.4%)
(e1) 79.7% (76.1% to 82.7%)
(e2) 70% (64.6% to 74.5%)
(e3) 76% (72.6% to 78.9%)

(*) no statistical evidence

VE = (1 − RR) x 100

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Adjusted estimates

any dose

(a) 91% (68% to 99%)

(b) not reported

(c) 90% (66% to 97%)

(d) 71% (66% to 75%)

(e) 82% (52% to 93%)

VE = 1 − HR

ca‐Livingston 2013

From 2176 household residents

from 2009 to 2010

All ages,

(age group 1) age ≤ 17 years

(age group 2) age ≥ 18 years

Clinical or
laboratory confirmed, or both

MMR vaccine: Jeryl Lynn

(a) 1 dose

(b) 2 doses

(c) unknown

(d) any dose

Age ≤ 17 years

(group 1)

(1a) 1 dose N = 342

(1b) 2 doses N = 361

(1c) unknown N = 914

(d) any dose

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Age ≥ 18 years

(2a) 1 dose N = 9

(2b) 2 doses N = 97

(2c) unknown N = 574

(d) any dose

Age ≤ 17 years

(group 1)

N = 126

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Age ≥ 18 years

(group 2)

N = 6

unvaccinated

All ages (group 1 + 2)

(a) 4/117 versus 4/20

(b) 19/691 versus 4/20

(c) 17/520 versus 4/20

(d) 23/808 versus 4/20

Secondary households

contacts age ≥ 5 years N = 1348

All ages

(a) 82.9% (37.1% to 95.4%)

(b) 86.3% (63.3% to 94.9%)

(c) 83.7% (55.9% to 93.9%)

(d) 85.8% (62.7% to 94.6%)

VE = (1 − RR) x 100

assessed amongst 44

secondary cases and

1304 non‐sick household contacts

ca‐Lopez Hernandez 2000

Male children

aged between

3 and 15 years

attending a scholastic

institute in Spain

during a mumps outbreak

(March to November 1997)

Clinical diagnosis. Cases notified by the Andalusian survey system.

MMR strain not reported

N = 685

vaccination record

N = 38

unvaccinated

73/685 versus 8/38

49% (3% to 74%)

VE = (1 − RR) x 100

ca‐Ma 2018

Conducted between

1 December 2014 and

20 September 2015.

N = 2303 students

aged 6 to 15 years.

Of these, 114 were excluded

because they had history of mumps illness; 281 students were excluded

because of unknown immunisation history.

N = 1378 vaccinated and

unvaccinated

N = 530 children included

in the analysis

A mumps case was defined as

a student having unilateral or

bilateral parotid or other salivary

gland swelling and pain, lasting 2 or more days, with onset between

1 December 2014 and 20 September 2015.

All cases were diagnosed by

clinical criteria without laboratory confirmation, and no mumps

virus genotype information was obtained during this outbreak investigation.

MMR:

S79 strain of mumps

vaccine virus,

derived through further attenuation of the Jeryl Lynn strain.

Students’ vaccination

certificates were obtained during the field investigation.

(a) 1 dose

(≤ 5 years since vaccination)

(b) 1 dose

(> 5 years since vaccination)

(c) any time since vaccination

(a) N = 363

(b) N = 301

(c) N = 664

Unvaccinated

N = 530

(a) 28/363 versus 93/530

(b) 21/301 versus 93/530

(c) 49/664 versus 93/530

(a) 56% (34.4% to 70.6%)
(b) 60.2% (37.5% to 74.7%)
(c) 57.9% (41.7% to 69.7%)

VE = (1 − RR) x 100

ca‐Marolla 1998

Children (19 to 67 months)
whose parent required a
paediatrician visit during a
measles outbreak peak

Clinical diagnosis

Patient records and

parent interviews

(a) Pluserix/Urabe

(b) Morupar/Urabe

(c) Triviraten/Rubini

Vaccination records

(a) N = 329 (1 dose)

(b) N = 747 (1 dose)

(c) N = 1023 (1 dose)

N = 646

unvaccinated

(a) 38 cases/19433 (PT)

(b) 28 cases/12785 (PT)

(c) 185 cases/29974 (PT)

Control = 206 cases/25,816

PT=person‐ time in months

(a) 75% (65% to 83%)

(b) 73% (59% to 82%)

(c) 23% (6% to 37%)

VE = (ARU − ARV)/ARU x 100

Orenstein 1985

ca‐Nelson 2013

During 2009 to 2010 mumps outbreak

Children aged 9 to 14 years with a history of 2 MMR vaccine doses,

had not previously received

a third MMR vaccine dose, and

had no history of mumps

Laboratory confirmed

MMR vaccine

not described

third dose

N = 1068

Only 2 doses MMR

N = 2171

1/1068 versus 5/2171

59.3% (−247% to 95.2%)

VE = (1 − RR) x 100

ca‐Ogbuanu 2012

During 2009 to 2010 mumps outbreak

Schoolchildren

(aged 11 to 17 years) from 3 schools. N = 2665.

N = 2178 had validated

history of

receiving 2 previous

doses of MMR.

Laboratory confirmed

MMR vaccine

not described

third dose

(a) all students with validated 2 doses

(b1) postvaccination period 1 to 21 days after third dose

(b2) postvaccination period 22 to 41 days after third dose

Third dose

(a) N = 1755

(b1) N = 1751

(b2) N = 1723

Only 2 doses MMR

(a) N = 432

(b1) N = 420

(b2) N = 413

(a) 35/1755 versus 14/432

(b1) 28/1751 versus 7/420

(b2) 1/1723 versus 2/413

(a) 39.7% (−11.0% to 67.3%)

(b1) 4.1% (−118% to 57.8%)

(b2) 88% (−31.9% to 98.9%)

VE = (1 − RR) x 100

ca‐Ong 2005

Children from childcare centres and
primary schools in Singapore,

aged 5 to 12 years

Clinical diagnosis.

Standard questionnaire

filled by trained public health officer

or physician diagnoses.

(a) Jeryl Lynn

(b) Urabe

(c) Rubini

Health booklet

(a) N = 711

(b) N = 190

(c) N = 1694

1 or 2 MMR doses

N = 614

unvaccinated

(a) 8/711 versus 35/614

(b) 5/190 versus 35/614

(c) 150/1694 versus 35/614

(a) 80.3% (57.8% to 90.8%)

(b) 53.8%*

(c) −55.3% (−121.8% to −8.8%)

VE = (1 − RR) x 100

*no statistical evidence

ca‐Schlegel 1999

Children aged 5 to 13 years
from a small village in Switzerland

Clinical confirmation

after virus isolation

or clinical picture observed

in sibling of confirmed cases.

Parents interview and

evaluation by study investigators

(a) Jeryl Lynn

(b) Urabe

(c) Rubini

Vaccination records

(a) N = 36

(b) N = 40

(c) N = 79

at least 1 dose

N = 8

unvaccinated

(a) 5/36 versus 5/8

(b) 3/40 versus 5/8

(c) 53/79 versus 5/8

(a) 78% (64% to 82%)

(b) 87% (76% to 94%)

(c) −4%

VE = (ARU − ARV)/ARU x 100

Orenstein 1985

ca‐Snijders 2012

Children (aged < 19 years)

attending

(a) primary schools

and

(b) their household contacts.

(c) index case

Clinical diagnosis

MMR Jeryl Lynn

or RIT 4385

(a1) (1 dose) N = 484

(a2) (2 doses) N = 301

(b) (unspecified number of doses) N = 19

(c) (any dose) N = 16

(a) N = 351

(b) N = 87

(c) N = 90

unvaccinated

(a1) 13/484 versus 183/351

(a2) 7/301 versus 183/351

(b) 3/19 versus 44/87

(c) 3/16 versus 44/90

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

adjusted data

(a1) 9/484 versus 65/351

(a2) 7/301 versus 86/351

(a1) 92% (83% to 96%)

(a2) 93% (85% to 97%)

(b) 67% (65% to 95%)

(c) 11% (−4% to 88%)

Adjusted for confounders

from Poisson regression

VE = 1 − incidence rate

In order to include "adjusted data", Di Pietrantonj 2006 method is used to convert adjusted estimates and its 95% CI in "adjusted data".

ca‐Takla 2014

Primary school: 108 students of 5 classes with at least 1 mumps case

Clinical or
laboratory confirmed, or both

MMR vaccine: RIT 4385 or
Jeryl Lynn strain

(a) (1 dose) N = 4

(b) (2 doses) N = 89

N = 6

(a) 3/4 versus 5/6

(b) 6/89 versus 5/6

(a) 10% (−75% to 53%)

(b) 91.9% (81.0% to 96.5%)

VE = (1 − RR) x 100

ba‐Castilla 2009

Children aged between 15 months and 10 years from Navarre region

(Northern Spain)

at the time a mumps outbreak occurred (between August 2006 and June 2008)

(a) N = 181

(b) N = 72

(c) N = 241

Laboratory or epidemiological
confirmation of clinical cases:

swelling of 1 of more salivary glands
for at least 2 days with either laboratory
(PCR or IgM positive) or
epidemiological confirmation
(i.e. epidemiological relation with
other laboratory confirmed or
clinical mumps cases).

Obtained from cases notified
to the regional health authority

(a) N = 875

(b) N = 353

(c) N = 1205

matched for sex,
municipality,
district of residence, and paediatrician

(a) 1 dose

(b) 2 doses

(c) any dose

MMR/Jeryl Lynn

doses received

at least 30 days

before symptom

disease onset.

Blinded review of

primary care vaccination

registry

(a) 169/181 versus 852/875

(b) 59/72 versus 330/353

(c) 228/241 versus 1182/1205

‐

(a) 66% (25% to 85%)

(b) 83% (54% to 94%)

(c) 72% (39% to 87%)

adjusted for confounders

ba‐Fu 2013

Children in Guangzhou

aged 8 months to 12 years

during 2006 to 2012

N = 1983

randomly selected clinical definition

N = 1983

matched 1:1

by birth date,

gender,

residence

not reported

breakdown

by type of vaccine administrated

(a) MMR/Jeryl Lynn RIT4385

(b) measles‐mumps

(c) missing (vaccine type)

(d) any vaccine

1 dose

(a) 112 versus 145

(b) 242 versus 261

(c) 620 versus 837

(d) 974/1983 versus 1243/1983

(a) OR extracted from

VE reported

0.49 (0.26 to 0.93)

(a) 51.3% (7.2% to 95.0%)

ba‐Giovanetti 2002

Children and adolescents aged 14 months to

15 years from urban area of Alba and Bra and 10 rural towns (n = 12,800 residents from 0 to 15 years)

during 2000 to 2001 epidemic

Clinical diagnosis

(cases notified by

national infectious diseases surveillance system)

N = 139

notified mumps cases

N = 139 randomly selected from immunisation registry,

matched for birth year and address.

(controls received
at least 1 MMR dose)

MMR vaccine not specified.

Vaccination registry and phone interviews, immunisation

should have been received

at least 30 days before disease onset.

90/139 versus 111/139

0.46 (0.27 to 0.80)

53.7% (20.4% to 73.0%)

ba‐Goncalves 1998

Children and adolescents

(15 months to 16 years)

from Oporto (Portugal)

Clinical diagnosis

Cases reported by GPs or hospital

doctors, occurred during the 1995 to 1996 mumps outbreak

(a) N = 73

(b) N = 133

(c) N = 189

2 consecutive
vaccination records
of the same sex, month and birth year as the case
were selected.

(a) N = 169

(b) N = 236

(c) N = 378

Controls received at least 1 MMR dose.

Assuming that before 1 November 1992 MMR mumps Urabe strain

was administered,

subsequently

the Rubini strain

(a) Urabe

(b) Rubini

(c) all

at least 1 MMR dose

(a) 56/73 versus 142/169

(b) 116/133 versus 209/236

(c) 172/189 versus 351/378

‐

(a) 70% (25% to 88%)

(b) 1% (−108% to 53%)

adjusted for confounders

ba‐Harling 2005

Children and adolescents
aged between 1 and 18 years
from religious community
in Northeast London.
Mumps outbreak

Clinical diagnosis

N = 156 (GP notification to the local CCDC, mumps diagnoses from electronic practice list, verbal reports by community members)

‐‐‐‐‐‐‐‐‐‐‐‐

Laboratory confirmation

of clinical diagnosis

N = 43

GP notification to the local CCDC

of notified cases,

IgM and mumps RNA

testing was offered

N = 175
randomly selected
and stratified for
age and sex
from practice list

Jeryl Lynn 1 or 2

MMR doses

received

at least 1 month

before index date

(a) at least 1 dose

(b) 1 dose

(c) 2 doses

79/156 versus 134/175

(a) 0.31 (0.20 to 0.50)

(a) 69% (50% to 80%) (crude)

(a) 69% (41% to 84%)

adjusted for age, sex, practice

‐‐‐‐‐‐‐‐‐‐

Laboratory‐confirmed cases

(a) 65% (25% to 84%)

(b) 64% (40% to 78%)

(c) 88% (62% to 96%)

All adjusted for age, sex, practice. Proportion of vaccinated in cases and controls not provided.

ba‐Kim 2012

Children

(a) prospective

case‐control study

from March 2010
to October 2011

(b) retrospective

case‐control study

2008 to 2009 in western Seoul, Incheon, and Goyang

(c) total

(a) N = 55

(a1) 1 dose

(a2) 2 doses

(a3) any dose

‐‐‐‐‐‐‐‐‐‐‐‐

(b) N = 122

(b1) 1 dose

(b2) 2 doses

(b3) any dose

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(c) N = 177

(c1) 1 dose

(c2) 2 doses

(c3) any dose

(a) N = 165

(a1) 1 dose

(a2) 2 doses

(a3) any dose

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(b) N = 449

(b1) 1 dose

(b2) 2 doses

(b3) any dose

‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(c) N = 614

(c1) 1 dose

(c2) 2 doses

(c3) any dose

MMR vaccine not described (assumed to be Jeryl Lynn following Park 2015)

For (a) and (b):

data about demographic characteristics and MMR vaccination status were collected from cases

and controls.

‐‐‐‐‐‐‐‐‐‐(a)‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(a1) 0.58 (0.05 to 6.90)

(a2) 1.1 (0.09 to 13.3)

(a3) 0.67 (0.06 to 7.35)

‐‐‐‐‐‐‐‐‐‐(b)‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(b1) 0.33 (0.02 to 5.33)

(b2) 0.11 (0.01 to 2.12)

(b3) 0.33 (0.02 to 5.33)

‐‐‐‐‐‐‐‐‐(c)‐‐‐‐‐‐‐‐‐‐‐

(c1) 0.58 (0.10 to 3.56)

(c2) 0.42 (0.06 to 2.81)

(c3) 0.50 (0.08 to 2.99)

‐‐‐‐‐‐‐‐(a)‐‐‐‐‐‐‐‐‐

(a1) 42.0%*
(a2) −10.0%*
(a3) 33.0%*
‐‐‐‐‐‐‐‐‐(b)‐‐‐‐‐‐‐‐‐‐‐

(b1) 67.0%*
(b2) 89.0%*
(b3) 67.0%*

‐‐‐‐‐‐‐‐‐(c)‐‐‐‐‐‐‐‐‐‐‐
(c1) 42.0%*
(c2) 58.0%*
(c3) 50.0%*

*no statistical evidence

ba‐Mackenzie 2006

About 600 pupils attending

a boarding school in Scotland

during a mumps outbreak that

peaked between October and

November 2004

Virological confirmation
of clinical diagnosis

N = 20 (aged 13 to 17 years).

Cases notified to consultant
in public health medicine.
Acute cases with virological
positive test

N = 40
matched for
age, sex,
residential status,
UK or international
students

MMR vaccine not described

(a) 1 dose

(b) 2 doses

(c) any dose

Not specified. Pre‐outbreak
vaccination status obtained by medical notes held in the school,

communication

with parents, and

from Scottish

Immunisation

Recall System.

(a) 9/18 versus 20/34

(b) 2/11 versus 6/20

(c) 11/20 versus 26/40

(a) 0.7 (0.22 to 2.21)

(b) 0.52 (0.09 to 3.16)

(c) 0.66 (0.22 to 1.97)

(a) 30.0%*

(b) 48.1%*

(c) 32.4%*

*no statistical evidence

ca‐Chang 2015

Cohort study

Secondary attack rate

Middle school with

a total of 1621 students

enrolled in the 7th,

8th, and 9th grades,

with a total of 37 classes (ages 11 to 13)

Probable rubella case: defined as a

suspected rubella case with fever > 37.5 °C

and at least 1 of the following symptoms:

arthralgia, arthritis, lymphadenopathy, or conjunctivitis.

Laboratory‐confirmed case: required

a positive serologic test for rubella IgM antibody.

Epidemiologically linked case: confirmed case

was defined as a suspected case or

a probable case that was not

laboratory confirmed, but that was

geographically and temporally

related to a laboratory‐confirmed case.

MMR (BRD‐II or RA27/3)

A BRD‐II rubella strain vaccine was

developed in the 1980s in China,

and has been available in the

Chinese private market since1993.

All monovalent rubella and measles

and rubella combined (MR) vaccines

in use in China are based on the BRD‐II rubella

strain. A domestic measles, mumps, and rubella

combined vaccine (MMR) based on

BRD‐II strain has been available in China’s

private market since 2003. There is also an imported RA27/3 strain‐based

vaccine available in China.

‐

‐

Secondary cases = 2

Exposed person = 47

RR 0.11 (95% CI 0.03 to 0.44)

89% (56% to 97%)

VE = (1 − RR) x 100

aa‐Prymula 2014

RCT

This study is the first phase

(1 September 2005 to 29 June 2009)

of an RCT.

The study was done in 111

study centres in Europe:

Czech Republic (22), Greece (11),

Italy (9), Lithuania (9), Norway (5),

Poland (10), Romania (9), Russia (14),

Slovakia (17), and Sweden (5).

An eligible participant was a healthy

child aged 12 to 22 months at the time of the first vaccination; had a
negative history of varicella, mumps,

measles, and rubella diseases and vaccinations; and was one of the following:

(1) at home with at least 1 sibling

(with negative history

of varicella disease and vaccination),

(2) attending a child minder

(where at least 1 child was without

a known positive
history of varicella disease and vaccination),

(3) playing for more than 5 min weekly with

children without a known positive history of

varicella disease and vaccination,
(4) registered to attend

a day‐care centre from 24 months of age.

An eligible participant’s

parents or guardians had direct access

to a telephone and were deemed by the
investigator of being capable of

complying with the requirements of the trial protocol.

The primary efficacy endpoint was

the occurrence of confirmed varicella

from 42 days after the second vaccine

dose to the end of the first phase of the trial.

The secondary efficacy

endpoint was

the occurrence of confirmed varicella graded by severity

over the same time period.

Varicella cases

(a) All

(b) Moderate/severe

Follow‐up = 3 years

MMRV group:

2 doses of MMRV (Priorix‐Tetra, GSK)

N = 2279

MMR+V group: 1 dose MMR (Priorix, GSK) and

monovalent varicella vaccine

(Varilrix, GSK) at dose 2

N = 2263

MMR group (control):

2 doses of MMR (Priorix, GSK)

N = 743

MMRV

(a) 37/2279

(b) 2/2279

MMR+V

(a) 243/2263

(b) 37/2263

MMR

(a) 201/743

(b) 117/743

MMRV

(a) 94.9% (92.4% to 96.6%)

(b) 99.5% (97.5% to 99.9%)

MMR+V

(a) 65.4% (57.2% to 72.1%)

(b) 90.7% (85.9% to 93.9%)

VE = (1 − HR) x 100

aa‐Henry 2018

RCT

linked to

aa‐Prymula 2014

Healthy children aged

12 to 22 months.

n = 5803

children enrolled and

vaccinated (TVC) in phase A,

n = 4580

in the TVC in phase B,

n = 3829

completed the study up to Year 6;

n = 5289

ATP cohort for efficacy in phase A + B,

n = 3791

in the ATP cohort for efficacy

in phase B

Varicella cases

(a) All

(b) Moderate/severe

(c) Severe

Follow‐up = 6 years

ATP
cohort for efficacy

phase A + B

MMRV n = 2279

MMR+V n = 2266

Phase B

MMRV n = 1802

MMR+V n = 1593

MMRV group

2 doses of MMRV

(Priorix‐Tetra, GSK) at Day 0 and Day 42

MMR+V group

1 dose of MMR

(Priorix, GSK)

at Day 0 and

1 dose of monovalent varicella vaccine

(Varilrix, GSK)

at Day 42

ATP
cohort for efficacy

phase A + B
MMR n = 744

Phase B

MMR n = 396

MMR group

2 doses of the MMR

(Priorix, GSK) vaccine at Day 0 and Day 42

Phase A + B

MMRV

(a) 71/2279

(b) 6/2279

(c) 0/2270

MMR+V

(a) 419/2266

(b) 58/2266

(c) 1/2266

Phase B

MMRV

(a) 33/1800

(b) 4/1800

(c) 0/1800

MMR+V

(a) 176/1592

(b) 18/1592

(c) 0/1592

Phase A + B

MMR

(a) 325 /744

(b) not reported

Phase B

(a) 125/396

(b) not reported

Phase A + B

MMRV

(a) 95.0% (93.6% to 96.2%)

(b) 99.0% (97.7% to 99.6%)

(c) undefined

MMR+V

(a) 67.0% (61.8% to 71.4%)

(b) 90.3% (86.9% to 92.8%)

(c) 94.6% (55.3% to 99.4%)

Phase B

MMRV

(a) 95.3% (93.1% to 96.8%)

(b) 98.4% (95.5% to 99.4%)

(c) undefined

MMR+V

(a) 69.5% (61.5% to 75.8%)

(b) 91.8% (85.9% to 95.2%)

(c) undefined

VE = (1 − HR) x 100

aa‐Povey 2019

RCT

linked to

aa‐Prymula 2014

Children aged 12 to 22

months were eligible

for inclusion if: had not received MMR

or varicella vaccines, or both, or had measles‐mumps‐rubella

or varicella zoster or

herpes zoster diseases,

or both, and were at home

with at least 1 sibling with

negative history of varicella

disease and vaccination,

at a child‐minders where

at least 1 child was without

a known positive history of

varicella disease and vaccination,

playing for more than 5 min/week

with children without a known positive

history of varicella disease

and vaccination, or registered

to attend day care from 24 months.

Varicella cases

(a) All

(b) Moderate/Severe

Follow‐up = 10 years

Phase A + B

MMRV n = 2279

MMR+V n = 2266

Phase B

MMRV n = 1800

MMR+V n = 1591

MMRV group

2 doses of MMRV

(Priorix‐Tetra, GSK)

at Day 0 and Day 42

MMR+V group

1 dose of MMR

(Priorix, GSK)

at Day 0 and

1 dose of monovalent

varicella vaccine

(Varilrix, GSK)

at Day 42

Phase A + B
MMR n = 744

Phase B

MMR n = 396

MMR group

2 doses of the MMR

(Priorix, GSK) vaccine at Day 0 and Day 42

Phase A + B

MMRV

(a) 71/2279

(b) 6/2279

MMR+V

(a) 469/2266

(b) 67/2266

Phase B

MMRV

(a) 33/1800

(b) 4/1800

MMR+V

(a) 176/1592

(b) 18/1592

Phase A + B

MMR

(a) 352/744

(b) 176/744

Phase B

(a) 149/396

(b) 59/396

Phase A + B

MMRV

(a) 95.4% (94.0% to 96.4%)

(b) 99.1% (97.7% to 99.6%)

MMR+V

(a) 67.2% (62.3% to 71.5%)

(b) 89.5% (86.1% to 92.1%)

Phase B

MMRV

(a) 95.9% (94.1% to 97.1%)

(b) 98.7% (96.4% to 99.5%)

MMR+V

(a) 69.8% (62.8% to 75.5%)

(b) 90.0% (84.2% to 93.7%)

VE = (1 − HR) x 100

ca‐Giaquinto 2018

Children aged 0 to 14 registered with

35 Pedianet database physicians

across Italy between

1 October 1997 and 30 September 1998

Varicella cases recorded in the

Pedianet databases are based

on physician confirmation only

(no laboratory tests were performed).

MMRV: vaccine ProQuad

n = 2357

n = 912 unvaccinated

43/2357 versus 287/912

unadjusted estimate

94% (92% to 96%)

adjusted estimate

94% (91% to 95%)

VE = (1 −RR) x 100

ca‐Rieck 2017

Between January 2006

and October 2013,

n = 1,449,411 children

4‐step algorithm to only select confirmed
and incident varicella cases.

Step 1: excluded incompatible or

implausible coding combinations for

varicella diagnosis reliability;

step 2: excluded observations with

diagnosis reliability other than confirmed

(i.e. suspected, excluded, recovered);

step 3: excluded observations

with diagnosis

type other than incident

(i.e. previous state, unknown,

not provided);
step 4: limited the data selection

to the earliest

ICD‐10 code per patient whilst also keeping the information

about the most severe

ICD‐10 code (within up to one‐quarter

following the initial diagnosis) using the

following ranking

(in descending order of severity):

varicella with encephalitis, meningitis,

pneumonia, other complications,

no complications, no further
details, with the last equalling

‘no complications’.

Since 2004, single‐dose

varicella vaccination has
been recommended for

all children aged 11 to 14 months.

2 single‐compound varicella vaccines (VAR; Varivax,
Sanofi Pasteur MSD; Varilrix, GSK)

were initially available. In 2006, a combined

(MMR)‐varicella vaccine (MMRV;
Priorix‐Tetra, GlaxoSmithKline)

was licenced with a 2‐dose schedule.

A 2‐dose schedule has been recommended

since 2009 targeting children

with the second dose at age 15 to 23 months.

Since 2011, the first immunisation has been given preferably as 2 separate injections of

VAR and MMR due to higher rates of febrile seizures following immunisation with MMRV.

(a) 1 dose MMRV

(b) 2 doses MMRV

‐

‐

‐

VE = (1 − HR) x 100

adjusted estimate

(a) 81.7% (81.0% to 82.4%)

(b) 94.4% (94.2% to 94.6%)

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
VE = (1 −RR) x 100
RR obtained from HR and attack rate
of varicella in unvaccinated
children, Risk in unvaccinated children = 9%

(a) 61.8% (60.6% to 63.0%)
(b) 86.6% (86.1% to 87.0%)

ca‐Spackova 2010

1084 children attended day‐care centres in Germany

Varicella was classified clinically as

mild (< 50 skin lesions),

moderate (≥ 50 skin lesions),

severe (any hospitalised case).

MMRV Priorix‐Tetra

(a) All‐brand doses

(b1) All‐brand 1 dose

(b2) All‐brand 2 dose

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(c) Varivax 1 dose

(d) Varilrix 1 dose

(e1) Priorix‐Tetra 1 dose

(e2) Priorix‐Tetra 2 doses

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(f1) Mild disease

(f2) Moderate disease

(a) n = 244

(b1) n = 167

(b2) n = 77

(c) n = 48

(d) n = 77

(e1) n = 38

(e2) n = 56

(f1) n = 233

(f2) n = 221

n = 108

(f1) n = 71

(f2) n = 93

(a) 33/244 versus 52/108

(b1) 31/167 versus 52/108

(b2) 2/77 versus 52/108

(c) 4/48 versus 52/108

(d) 19/77 versus 52/108

(e1) 7/38 versus 52/108

(e2) 2/56 versus 52/108

(f1) 22/233 versus 15/71

(f2) 10/221 versus 37/93

(a) 71% (57% to 81%)

(b1) 62% (43% to 75%)

(b2) 94% (75% to 98%)

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(c) 86% (56% to 96%)

(d) 56% (29% to 72%)

(e1) 55% (8% to 78%)

(e2) 91% (65% to 98%)

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(f1) 53% (14% to 75%)

(f2) 89% (78% to 95%)

adjusted for confounders

VE = (ARU − ARV)/ARU x 100

Orenstein 1985

VE = (1 − RR) x 100

ca‐Tafuri 2013

Children at

(a) preschool

(b) elementary school

(c) all ages

Reported by
parents

MMRV

(Priorix‐Tetra)

Varicella OKA;

1 dose

(a) n = 170

(b) n = 71

(c) n = 241

(a) n = 40

(b) n = 287

(c) n = 327

(a) 2/170 versus 14/40

(b) 2/71 versus 223/287

(c) 4/241 versus 237/327

(a) Not reported

(b) 69.2% (50.5% to 88.1%)

(c) 59.9% (48.3% to 69.8%)

VE = (ARU − ARV)/ARU x 100

Orenstein 1985

VE = (1 − RR) x 100

ba‐Andrade 2018

From November 2013 to December 2015,
children aged 15 to 32 months

Cases were defined as

children aged 15 to 32 months with rash and either suspected

as having varicella by an attending physician or being a contact to a confirmed varicella case. Cases were confirmed by either clinical or laboratory criteria.

Cases: n = 168

Cases were further classified by

severity of disease based on number of skin lesions, being:

(1) mild – fewer than 50 lesions;

(2) mild/moderate – between 50 and 249 lesions;

(3) moderate – between 250 and 499 lesions; or

(4) severe – 500 lesions or more, having been hospitalised, or having any complication.

Controls matched 1:2 by:

age (15 to 32 months).
Controls were defined as
children residing in the

neighbourhood of the case,

in which no history of varicella or outpatient clinics visits

due to skin lesion was reported. To identify controls,

houses nearby the cases

were visited following a systematic sampling procedure.

Controls: n = 301

MMRV

A combined tetravalent vaccine containing measles, mumps, rubella,

and varicella antigens (MMRV), manufactured by GlaxoSmithKline

(a) Any severity
(b) Moderate severe cases > 50 lesions

Adjusted‐estimates

(a) 0.14 (0.07 to 0.28)

(b) 0.07 (0.03 to 0.18)

adjusted for confounders:
age in months, day‐care attendance, and pulmonary diseases

(a) 86% (72% to 92%)

(b) 93% (82% to 97%)

VE = 1 − OR

ba‐Cenoz 2013

Children between 15 months and 10 years of age

PCR‐confirmed varicella

Cases n = 54

Matched 1:8 by paediatric practice, district of residence, and date of birth (± 1 year)

Controls n = 432

MMR+V (Varivax OKA/Merck)

not described

(a) any doses and age

(a1) 1 dose

(a2) 2 doses

(b) age < 3 years

(b1) 1 dose

(c) age ≥ 3 years

(c1) 1 dose

(c2) 2 doses

(a) 6/54 versus 175/432

(a1) 5/54 versus 112/432

(a2) 1/54 versus 63/432

(b1) 1/6 versus 36/48

(c1) 4/48 versus 76/384

(c2) 1/48 versus 63/384

‐

Adjusted estimates

(a) 92% (77% to 97%)

(a1) 87% (60% to 97%)

(a2) 97% (79.5% to 99.6%)

(b1) 84% (−58% to 100%)(*)

(c1) 80% (37% to 95%)

(c2) 97% (79% to 100%)

VE = (1 −OR) x 100

(*) no statistical evidence

ba‐Liese 2013

Children at least 1 year of age, born on or after 1 July 2003, who resided in Germany

PCR‐confirmed varicella

n = 432

Children matched by

age and paediatric practice,

fulfilling the same criteria

as cases but without

history or present clinical

diagnosis of varicella

n = 432

Any varicella vaccine

(a1) 1 dose

(a2) 2 doses

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

OKA/GSK

(b1) 1 dose

(b2) 2 doses

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Other than OKA/GSK*

(c1) 1 dose

(c2) 2 doses

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Unknown vaccine

(d1) 1 dose

(d2) 2 doses

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Any varicella vaccine

(after vaccination)

(y1) up to 1 year

(y2) 1 to 2 year

(y3) 4 to 5 year

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(*) includes OKA/Merck
and MMR‐OKA/GSK

(a) 57/432 versus 195/432

(a1) 55/430 versus 153/390

(a2) 2/377 versus 42/279

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(b1) 35/410 versus 63/300

(b2) 0/375 versus 6/243

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(c1) 19/394 versus 87/324

(c2) 2/377 versus 25/262

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(d1) 1/376 versus 3/240

(d2) 0/375 versus 11/248

‐

Adjusted estimates

(a1) 86.4% (77.3% to 91.8%)

(a2) 94.3% (76.4% to 98.6%)

(b1) 71.5% (49.1% to 84.0%)

(b2) not reported

(c1) not reported

(c2) not reported

(d1) not reported

(d2) not reported

(y1) 94.5% (76.9% to 98.7%)

(y2) 81.5% (56.8% to 92.1%)

(y3) 73.2% (9.1% to 92.1%)

VE = (1 − OR) x 100

ba‐Vazquez 2001

Children between 13 months and 16 years of age.

(a) < 5 years old

(b) 5 to 10 years old

(c) > 10 years old

(d) all ages

PCR‐confirmed varicella

n = 202

Matched 1:2 according to date of birth (within 1 month) and paediatric practice

n = 389

MMR+V

Vaccine type and
number of doses not described

46/202 versus 238/389

‐

Adjusted estimates

(a) 79% (61% to 89%)

(b) 89% (80% to 94%)

(c) 92% (45% to 99%)

(d) 87% (78% to 90%)

VE = (1 − OR) x 100

ga‐Boccalini 2015

Case‐only ecological method

Hospitalisation between 2004 to 2012 in the Tuscan region.

Aged 0 to 14 years

(a) age < 1 year

(b) age 1 to 4 years

(c) age 5 to 14 years

Hospitalised cases for varicella

or its complications, as a primary or secondary discharge diagnosis, with the following ICD‐9‐CM

codes (2002 and 2007) were examined:
052.0 (post‐varicella encephalitis),
052.1 (varicella (haemorrhagic) pneumonitis),
052.2 (post‐varicella myelitis),
052.7 (varicella with other specified complications),
052.8 (varicella with unspecified complication),
052.9 (varicella without complication).

MMRV vaccine: not described

and monovalent varicella vaccine

Reference period

2004 to 2007

Exposed period

2009 to 2012

Data from 2008, the transition year
between the 2 periods, were excluded from our analysis in this study.

Reference period

(a) 73/122,483

(b) 189/478,481

(c) 105/1,141,304

Exposed period

(a) 42/128,440

(b) 99/523,810

(c) 55/1,222,222

RR (95% CI) (*)

(a) 0.55 (0.38 to 0.80)

(b) 0.48 (0.38 to 0.61)

(c) 0.48 (0.35 to 0.67)

(*) Relative risk

between exposed and reference period

VE = 1 − RR

(a) 45.1% (19.8% to 62.5%)
(b) 52.2% (39% to 62.5%)
(c) 51.1% (32.2% to 64.7%)

ga‐Pozza 2011
Case‐only ecological method

Hospitalisation between 2000 to 2008 in the Veneto region.

Aged 0 to 14 years

Varicella cases incidence:

(a) from surveillance data retrieved

from the RDP

(b) sentinel surveillance system

based on a sample of paediatricians

(SPES).

Hospitalised cases for varicella

hospital discharges that reported
in the primary and secondary

diagnoses codes 052.X.

Admissions

with coexistent codes

for herpes zoster, i.e. 053.X, were excluded.

(c) hospitalisations

MMRV vaccine: not described

and monovalent varicella vaccine

Reference period

2000 to 2006

Exposed period

2007 to 2008

Cases/person time

(RDP) incidence

reference period

(a) 81,276/438,3097

Exposed period

(a) 14,749/1,345,351

(SPES) incidence

reference period

(b) 13,543/196,949

Exposed period

(b) 1344/26,861

Hospitalised

reference period

(c) 770/4,383,497

Exposed period

(c) 126/1,348,474

rr (95% CI)

(a) 0.59 (0.58 to 0.6)
(b) 0.73 (0.69 to 0.77)
(c) 0.53 (0.44 to 0.64)

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(a1) 0.44 (0.43 to 0.45)
(b1) 0.58 (0.53 to 0.64)
(c1) 0.48 (0.37 to 0.63)

Sensitivity analysis

Data from 2007,
the transition year
between the 2 periods,
were excluded from analysis.

VE = (1 − rr) x 100

(a) 40.9% (39.8% to 41.9%)
(b) 27.2% (23% to 31.2%)
(c) 46.8% (35.8% to 55.9%)

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

(a1) 56.2% (54.9% to 57.3%)
(b1) 41.8% (36.2% to 46.8%)
(c1) 52.2% (37.4% to 63.5%)

ga‐Tafuri 2015
Case‐only ecological method

Hospitalisation between 2003 to 2012 in the Puglia region.

Aged 0 to 14 years

(a) age < 1 year

(b) age 1 to 4 years

(c) age 5 to 14 years

Hospitalised cases for varicella

Hospitalisation rates, overall and specific by
age, were calculated on data extracted

from the regional HDR, selecting

all hospital admissions with
a main diagnosis of chickenpox

or its complications (ICD9‐CM
codes: 052.x) in the same period.

Incidence rates, overall and specific by age,

between 2003
and 2012 were calculated by using data

collected in the Apulian
computerised surveillance system

for communicable diseases.

MMRV vaccine: not described

and monovalent varicella vaccine

Reference period

2003 to 2005

Exposed period

2009 to 2012

Hospitalised

reference period

(a) 245/39,618

(b) 2148/163,321

(c) 2201/451,858

Exposed period

(a) 39/37,356

(b) 161/152,607

(c) 289/420,058

Incidence

reference period

(a) 14/39,548

(b) 57/1,623,931

(c) 42/446,809

Exposed period

(a) 5/39,063

(b) 9/160,714

(c) 10/434,783

rr (95% CI)(*)

Hospitalised

(a) 0.17 (0.12 to 0.24)

(b) 0.08 (0.07 to 0.09)

(c) 0.14 (0.12 to 0.16)

Incidence

(a) 0.36 (0.13 to 1.03)

(b) 0.16 (0.08 to 0.33)

(c) 0.25 (0.12 to.050)

(*) Relative risk

between exposed and reference period

VE = (1 − rr) x 100

Hospitalised

(a) 63.8% (−0.4% to 87%)
(b) 84% (67.8% to 92.1%)
(c) 75.5% (51.2% to 87.7%)

Incidence

(a) 83.1% (76.3% to 88%)
(b) 92% (90.6% to 93.2%)
(c) 85.9% (84% to 87.5%)