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Peer-reviewedCC BY-NCJournal of Korean medical science

Assessing the Age-Specific Seroepidemiology of Varicella-Zoster Virus in Korea in the Post-COVID-19 Era Using an Acetone-Fixed Cell FAMA Assay

  • Kyu-Ri Kang1
  • Gyu-Won Cho1
  • Hye-Sook Jeong2
  • June-Woo Lee2
  • Ah-Ra Kim2
  • Hyunhye Kang3
  • Dongsub Kim4
  • Dong Ho Kim5
  • Dong Hyun Kim6
  • Jimyung Kim7
  • Chung Hyun Nahm8
  • Su Eun Park9
13 more authors
  • Joonhong Park10
  • Sun Min Lee11
  • Eun Lee12
  • Ae-chin Oh13
  • Dae Sun Jo14
  • Eun Young Cho15
  • Ji Yeon Ham16
  • Hyun-Woo Choi17
  • Seung-Jung Kee17
  • Hyun Mi Kang1,18
  • Jin-Han Kang1
  • Ui Yoon Choi1,19
  • Soo-Young Lee1,20
20 affiliations
  1. 1The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea .
  2. 2Division of Clinical Research for Vaccine, Center for Vaccine Research, National Institute of Infectious Diseases, National Institute of Health, Cheongju, Korea .
  3. 3Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea .
  4. 4Department of Pediatrics, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea .
  5. 5Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea .
  6. 6Department of Pediatrics, Inha University College of Medicine, Incheon, Korea .
  7. 7Department of Laboratory Medicine, Chungnam National University Hospital, Daejeon, Korea .
  8. 8Department of Laboratory Medicine, Inha University College of Medicine, Incheon, Korea .
  9. 9Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of Medicine, Yangsan, Korea .
  10. 10Department of Laboratory Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea .
  11. 11Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea .
  12. 12Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea .
  13. 13Department of Laboratory Medicine, Korea Cancer Center Hospital, Seoul, Korea .
  14. 14Department of Pediatrics, Jeonbuk National University Children’s Hospital, Jeonbuk National University Medical School, Jeonju, Korea .
  15. 15Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea .
  16. 16Department of Clinical Pathology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea .
  17. 17Department of Laboratory Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea .
  18. 18Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea .
  19. 19Department of Pediatrics, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea .
  20. 20Department of Pediatrics, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea .
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Abstract

Background: In Korea, the National Immunization Program has recommended a single dose of varicella vaccine at 12–15 months since 2005. Nevertheless, varicella notification continued to rise through 2019, prompting sustained seroprevalence monitoring. This study aimed to assess nationwide varicella-zoster virus (VZV) immunity in Republic of Korea (South Korea) during 2023–2024. A total of 843 serum samples of individuals aged 0 to 88 years from 8 tertiary hospitals over the country were tested using the acetone-fixed cell fluorescent antibody to membrane antigen (FAMA) assay and a commercial glycoprotein enzyme-linked immunosorbent assay (gpELISA) kit.

Methods: To establish basis of the cutoff, the British standard for anti-VZV IgG was subjected to repeated testing by acetone-fixed cell FAMA, live-cell FAMA and gpELISA.

Results: Using the acetone-fixed cell FAMA cutoff of 1:16, which corresponded to a concentration of 50 mIU/mL as determined by repeated testing, the seroprevalence rate was 92.53% (95% confidence interval [CI], 90.55–94.11) by gpELISA and 93.71% (95% CI, 91.87–95.16) by acetone-fixed FAMA. Both assays demonstrated a strong negative correlation with VZV notification during 2023–2024 in Korea. Among all age groups, infants aged 0 years exhibited the lowest seroprevalence. When these infants were excluded, seroprevalence remained lowest in the 5–9- and 10–14-year groups.

Conclusion: This trend appears to partially reflect the current VZV notification in 2024. High VZV notification has shifted from the 0–4-year group to the 10–14-year group, while in 5–9-year-olds remains high. These findings likely reflect the combined effects of post–coronavirus disease 2019 non-pharmaceutical interventions and an age shift related to primary vaccination. The consistent low seroprevalence observed in children aged 5–9 years may provide supportive evidence for considering the potential benefit of an additional varicella vaccine dose beyond the current single-dose schedule at 12–15 months, although further investigation is warranted.

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Cite

BibTeXRIS
BibTeX
@article{kang2026assessing,
  title = {{Assessing the Age-Specific Seroepidemiology of Varicella-Zoster Virus in Korea in the Post-COVID-19 Era Using an Acetone-Fixed Cell FAMA Assay}},
  author = {Kyu-Ri Kang and Gyu-Won Cho and Hye-Sook Jeong and June-Woo Lee and Ah-Ra Kim and Hyunhye Kang and Dongsub Kim and Dong Ho Kim and Dong Hyun Kim and Jimyung Kim and Chung Hyun Nahm and Su Eun Park and Joonhong Park and Sun Min Lee and Eun Lee and Ae-chin Oh and Dae Sun Jo and Eun Young Cho and Ji Yeon Ham and Hyun-Woo Choi and Seung-Jung Kee and Hyun Mi Kang and Jin-Han Kang and Ui Yoon Choi and Soo-Young Lee},
  journal = {Journal of Korean medical science},
  year = {2026},
  month = jul,
  doi = {10.3346/jkms.2026.41.e271},
  url = {https://europepmc.org/article/PMC/PMC13730650},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Assessing the Age-Specific Seroepidemiology of Varicella-Zoster Virus in Korea in the Post-COVID-19 Era Using an Acetone-Fixed Cell FAMA Assay
AU  - Kyu-Ri Kang
AU  - Gyu-Won Cho
AU  - Hye-Sook Jeong
AU  - June-Woo Lee
AU  - Ah-Ra Kim
AU  - Hyunhye Kang
AU  - Dongsub Kim
AU  - Dong Ho Kim
AU  - Dong Hyun Kim
AU  - Jimyung Kim
AU  - Chung Hyun Nahm
AU  - Su Eun Park
AU  - Joonhong Park
AU  - Sun Min Lee
AU  - Eun Lee
AU  - Ae-chin Oh
AU  - Dae Sun Jo
AU  - Eun Young Cho
AU  - Ji Yeon Ham
AU  - Hyun-Woo Choi
AU  - Seung-Jung Kee
AU  - Hyun Mi Kang
AU  - Jin-Han Kang
AU  - Ui Yoon Choi
AU  - Soo-Young Lee
PY  - 2026
DA  - 2026/07/07
JO  - Journal of Korean medical science
DO  - 10.3346/jkms.2026.41.e271
UR  - https://europepmc.org/article/PMC/PMC13730650
AB  - Background: In Korea, the National Immunization Program has recommended a single dose of varicella vaccine at 12–15 months since 2005. Nevertheless, varicella notification continued to rise through 2019, prompting sustained seroprevalence monitoring. This study aimed to assess nationwide varicella-zoster virus (VZV) immunity in Republic of Korea (South Korea) during 2023–2024. A total of 843 serum samples of individuals aged 0 to 88 years from 8 tertiary hospitals over the country were tested using the acetone-fixed cell fluorescent antibody to membrane antigen (FAMA) assay and a commercial glycoprotein enzyme-linked immunosorbent assay (gpELISA) kit.  Methods: To establish basis of the cutoff, the British standard for anti-VZV IgG was subjected to repeated testing by acetone-fixed cell FAMA, live-cell FAMA and gpELISA.  Results: Using the acetone-fixed cell FAMA cutoff of 1:16, which corresponded to a concentration of 50 mIU/mL as determined by repeated testing, the seroprevalence rate was 92.53% (95% confidence interval [CI], 90.55–94.11) by gpELISA and 93.71% (95% CI, 91.87–95.16) by acetone-fixed FAMA. Both assays demonstrated a strong negative correlation with VZV notification during 2023–2024 in Korea. Among all age groups, infants aged 0 years exhibited the lowest seroprevalence. When these infants were excluded, seroprevalence remained lowest in the 5–9- and 10–14-year groups.  Conclusion: This trend appears to partially reflect the current VZV notification in 2024. High VZV notification has shifted from the 0–4-year group to the 10–14-year group, while in 5–9-year-olds remains high. These findings likely reflect the combined effects of post–coronavirus disease 2019 non-pharmaceutical interventions and an age shift related to primary vaccination. The consistent low seroprevalence observed in children aged 5–9 years may provide supportive evidence for considering the potential benefit of an additional varicella vaccine dose beyond the current single-dose schedule at 12–15 months, although further investigation is warranted.
SN  - 1598-6357
SN  - 1011-8934
ER  -