4. Discussion
In this study, we investigated the epidemiological characteristics of varicella and the protective efficacy of Changchun Baike in Yanji from 2018 to 2024. In total, 2,452 cases were reported from 2018 to 2024, with an average annual incidence rate of 62.71 per 100,000 population. Notably, the incidence rate declined from 142.37 per 100,000 in 2018 to 55.25 per 100,000 population by 2024. This decline is closely linked to the widespread use of Changchun Baike varicella vaccine, which reduces the risk of VZV transmission through humoral and cellular immunity (7). Additionally, cases were concentrated among preschool and school-aged children, with a slightly higher incidence in males than in females. Moreover, the decline in the incidence rate was faster in males than in females during the period under consideration. Among the areas surveyed, the densely populated Jin Xue and Beishan streets had relatively high incidence rates. Additionally, the economically underdeveloped Sandaowan town had a higher transmission risk due to low vaccination coverage (10,11). Vaccine efficacy analysis showed an adjusted efficacy of 98.0–99.0% (95% CI: 97.0–100.0%) for the one-dose schedule and 99.0% (95% CI: 98.0–100.0%) for the two-dose schedule, with latter schedule significantly outperforming the former schedule in preventing breakthrough infections (12,13). However, breakthrough infections and inadequate vaccination coverage suggest the need for optimized vaccination strategies to further reduce the disease burden (14,15).
Consistent with findings in Qingyang, Gansu, and Shenyang (2,16), varicella incidence exhibited a distinct seasonal pattern, with peaks from April to July (31.83%) and October to January (51.71%). Winter peaks are associated with increased indoor gatherings and higher respiratory droplet transmission risk in cold conditions, whereas late spring to early summer peaks are correlated with increased school-related contact and social activities (7,8). Despite the declining incidence, the seasonal pattern remained unchanged, indicating that VZV transmission is driven by climate and behavioral factors (17). Enhanced surveillance in schools and childcare facilities during peak seasons is crucial for identifying and controlling outbreaks.
Spatially, all six streets and four towns reported cases with significant variations in incidence rates. Jin Xue and Beishan streets, with high population density and frequent mobility, were high-risk areas, reflecting the role of social contact in transmission chains (18–20). Economically disadvantaged areas, such as Sandaowan town, had a higher transmission risk due to poor sanitation and low vaccination coverage (21). Targeted interventions, including increased vaccination coverage, improved public health infrastructure, and health education, are necessary to reduce transmission in high-risk areas.
Regarding population distribution, cases were concentrated among children aged 0–14 years, with the 10–14 years age group having the highest incidence, followed by the 5–9 years age group. Preschool- and school-aged children are more susceptible to the disease than adults because of their underdeveloped immune systems and frequent contact in crowded settings (22,23). Notably, the incidence rate increased in the ≥ 40 years age group, possibly due to waning single-dose vaccine efficacy or lack of vaccination in some adults (24). Additionally, the higher incidence rate in males than in females may be due to more active social interactions, poorer hygiene, and lower parental acceptance of vaccination among males (25–27). Male patients are more prone to complications, such as skin infections and pneumonia, which may increase the healthcare burden (28). Moreover, occupational distribution highlighted students, preschool children, and unemployed/household workers as primary case groups, driven by school and childcare environments, low vaccination coverage, and limited parental awareness of vaccine safety (29,30).
Importantly, Changchun Baike varicella vaccine demonstrated excellent protective efficacy. One-dose aVE was 99.0% (95% CI: 98.0–99.0%) and two-dose was 99.0% (95% CI: 98.0–99.0%) from 2018 to 2022; both were 99.0% (95% CI: 97.0–100.0%) from 2019 to 2023; and one-dose was 98.0% (95% CI: 97.0–99.0%) and two-dose was 99.0% (95% CI: 98.0–100.0%) from 2020 to 2024. Cox regression confirmed that two-dose vaccination had a lower hazard ratio, offering significant advantages in preventing breakthrough infections (31). Our results align with international findings, such as the > 90% incidence reduction in the U.S. after implementing a two-dose strategy (32). However, the incidence of breakthrough infections suggests that vaccine efficacy is influenced by individual immune responses, age at vaccination, and storage conditions (33). Children vaccinated at ≤ 15 months had a higher infection risk, and single-dose antibody titers wane over time, whereas two doses significantly extend protection (31). Economic barriers and insufficient health education limit second-dose uptake (17). For example, the free two-dose policies in Shanghai and Tianjin significantly reduced the incidence of the disease (34,35). Additionally, schools and childcare facilities should implement vaccination verification and routine VZV surveillance to curb varicella outbreaks (36). Future research should focus on the long-term efficacy of two-dose vaccination schedule and the pathogenesis of breakthrough infections to optimize strategies and strengthen control measures.
Table 4.
Distribution characteristics of vaccinated and unvaccinated groups before and after PSM, 2018–2022.
Table 4.
Distribution characteristics of vaccinated and unvaccinated groups before and after PSM, 2018–2022.
| Before matching |
After matching |
| Variable |
Unvaccinated group |
Vaccinated group |
X2 |
p |
Unvaccinated group |
Vaccinated group |
X2 |
p |
| |
Cases |
Proportion (%) |
Cases |
Proportion (%) |
|
|
Cases |
Proportion (%) |
Cases |
Proportion (%) |
|
|
| 1 Dose |
|
|
|
|
|
|
|
|
|
|
|
|
| < 15 |
70882 |
12.74 |
1904 |
98.81 |
12543.498 |
<.001 |
1904 |
98.81 |
1904 |
98.81 |
0.000 |
1.000 |
| ≥ 15 |
485363 |
87.26 |
23 |
1.19 |
23 |
1.19 |
23 |
1.19 |
| 2 Doses |
|
|
|
|
|
|
|
|
|
|
|
|
| < 15 |
71241 |
12.80 |
1559 |
99.43 |
10345.675 |
<.001 |
1559 |
99.43 |
1559 |
99.43 |
0.000 |
1.000 |
| ≥ 15 |
485363 |
87.20 |
9 |
0.57 |
9 |
0.57 |
9 |
0.57 |
| 1 or 2 Doses |
|
|
|
|
|
|
|
|
|
|
|
|
| < 15 |
69386 |
12.55 |
3463 |
99.08 |
19121.808 |
<.001 |
3463 |
99.08 |
3463 |
99.08 |
0.000 |
1.000 |
| ≥ 15 |
485091 |
87.45 |
32 |
0.92 |
32 |
0.92 |
32 |
0.92 |
Table 6.
Distribution characteristics of vaccinated and unvaccinated groups before and after PSM, 2019–2023.
Table 6.
Distribution characteristics of vaccinated and unvaccinated groups before and after PSM, 2019–2023.
| Before matching |
After matching |
| Variable |
Unvaccinated group |
Vaccinated group |
X2 |
p |
Unvaccinated group |
Vaccinated group |
X2 |
p |
| |
Cases |
Proportion (%) |
Cases |
Proportion (%) |
|
|
Cases |
Proportion (%) |
Cases |
Proportion (%) |
|
|
| 1 Dose |
|
|
|
|
|
|
|
|
|
|
|
|
| < 15 |
72273 |
12.90 |
321 |
93.59 |
1660.372 |
<.001 |
321 |
93.59 |
321 |
93.59 |
0.000 |
1.000 |
| ≥ 15 |
488127 |
87.10 |
22 |
6.41 |
22 |
6.41 |
22 |
6.41 |
| 2 Dose |
|
|
|
|
|
|
|
|
|
|
|
|
| < 15 |
72273 |
12.90 |
321 |
93.59 |
1660.372 |
<.001 |
321 |
93.59 |
321 |
93.59 |
0.000 |
1.000 |
| ≥ 15 |
488127 |
87.10 |
22 |
6.41 |
22 |
6.41 |
22 |
6.41 |
| 1 or 2 Doses |
|
|
|
|
|
|
|
|
|
|
|
|
| < 15 |
72139 |
12.79 |
642 |
93.59 |
6371.477 |
<.001 |
642 |
93.59 |
642 |
93.59 |
0.000 |
1.000 |
| ≥ 15 |
488677 |
87.21 |
44 |
6.41 |
44 |
6.41 |
44 |
6.41 |
Table 8.
Distribution characteristics of vaccinated and unvaccinated groups before and after PSM, 2020–2024.
Table 8.
Distribution characteristics of vaccinated and unvaccinated groups before and after PSM, 2020–2024.
| Before matching |
After matching |
| Variable |
Unvaccinated group |
Vaccinated group |
X2 |
p |
Unvaccinated group |
Vaccinated group |
X2 |
p |
| |
Cases |
Proportion (%) |
Cases |
Proportion (%) |
|
|
Cases |
Proportion (%) |
Cases |
Proportion (%) |
|
|
| 1 Dose |
|
|
|
|
|
|
|
|
|
|
|
|
| < 15 |
72273 |
12.90 |
325 |
93.66 |
1660.372 |
<.001 |
321 |
93.59 |
321 |
93.59 |
0.000 |
1.000 |
| ≥ 15 |
488127 |
87.10 |
22 |
6.34 |
22 |
6.41 |
22 |
6.41 |
| 2 Dose |
|
|
|
|
|
|
|
|
|
|
|
|
| < 15 |
72130 |
12.85 |
606 |
99.02 |
3686.416 |
<.001 |
321 |
93.59 |
321 |
93.59 |
0.000 |
1.000 |
| ≥ 15 |
489084 |
87.15 |
6 |
0.97 |
22 |
6.41 |
22 |
6.41 |
| 1 or 2 Doses |
|
|
|
|
|
|
|
|
|
|
|
|
| < 15 |
71857 |
12.79 |
931 |
97.08 |
6371.477 |
<.001 |
931 |
97.08 |
931 |
97.08 |
0.000 |
1.000 |
| ≥ 15 |
489062 |
87.21 |
28 |
2.92 |
28 |
2.92 |
28 |
2.92 |