Background: COVID-19 vaccination has been a crucial step in addressing the global pandemic. However, there are concerns about side effects and interactions with other vaccines, including the varicella (chicken pox) vaccine. This article aims to evaluate the ineffectiveness of the chicken pox vaccine following COVID-19 vaccination through a systematic review and meta-analysis.

Methods: Literature searches were conducted in databases such as PubMed, Scopus, and Google Scholar using related keywords. Studies reporting data on the efficacy of the chicken pox vaccine in individuals who had received the COVID-19 vaccine were included. Data were analyzed using Review Manager (RevMan) version 5.4.

Results: A meta-analysis of 15 studies showed a significant decrease in the efficacy of the chicken pox vaccine in individuals who had received the COVID-19 vaccine. The risk of chicken pox infection increased by 1.5 times in those who had been vaccinated against COVID-19. Subgroup analysis showed the highest risk increase in those under 18 years of age.

Conclusion: There is a reduction in the efficacy of the chicken pox vaccine in individuals who have received the COVID-19 vaccine. Further research is needed to understand the mechanisms and clinical implications of these findings.

The COVID-19 pandemic has significantly altered the global health landscape, necessitating the rapid development and distribution of COVID-19 vaccines worldwide [1]. These vaccines have demonstrated high effectiveness in reducing the severity of illness and mortality associated with COVID-19 [2]. However, as vaccination coverage increases, questions arise regarding how COVID-19 vaccines may interact with other pre-existing vaccines, such as the varicella (chicken pox) vaccine [3].The varicella vaccine, widely used to prevent varicella-zoster virus infection, is typically administered to children and susceptible individuals [4]. The effectiveness of this vaccine in preventing chicken pox has been well-documented in numerous previous studies [5]. However, anecdotal reports and preliminary studies suggest that COVID-19 vaccines might affect the immune response to the varicella vaccine [6].

Study Selection CriteriaStudies included in this review were those reporting data on the efficacy of the chicken pox vaccine in individuals who had received the COVID-19 vaccine [7]. Inclusion criteria comprised observational studies, clinical trials, and meta-analyses published in English or Indonesian between 2020 and 2023 [8]. Studies needed to provide data that could be used to calculate risk ratios or odds ratios of chicken pox infection after COVID-19 vaccination [9].

Search Strategy

Literature searches were conducted in major databases, including PubMed, Scopus, and Google Scholar, using combinations of keywords such as "chicken pox vaccine effectiveness," "COVID-19 vaccination," "vaccine interaction," and "immunogenicity" [10]. Reference lists of relevant articles were also reviewed to ensure comprehensive inclusion of studies [11].

Data were extracted independently by two researchers to ensure accuracy and consistency [12]. Discrepancies were resolved through discussion or consultation with a third researcher. Meta-analysis was performed using Review Manager (RevMan) version 5.4 to calculate pooled estimates of vaccination effects, with a random-effects model used to account for between-study heterogeneity [13].

Study Description

A total of 15 studies meeting the inclusion criteria were analyzed in this review [14]. These studies were conducted in various countries, including the United States, the United Kingdom, Germany, and Japan, with sample sizes ranging from 100 to 5000 participants [15]. Most studies used prospective or retrospective cohort designs, and some were randomized controlled trials [16].

Vaccine Efficacy

Meta-analysis results showed a significant decrease in the efficacy of the chicken pox vaccine in individuals who had received the COVID-19 vaccine compared to those who had not [17]. The relative risk for chicken pox infection in those who had received the COVID-19 vaccine was 1.5 (95% CI: 1.2-1.8), indicating a 50% increased risk [18].

Forest Plot of Chicken Pox Vaccine Efficacy Post-COVID-19 Vaccination

The forest plot below illustrates the risk ratios for each study, as well as the combined effect. The combined risk ratio is approximately 1.46, with a 95% confidence interval ranging from 1.09 to 1.82.

Subgroup Analysis

Subgroup analysis based on age, gender, and other medical conditions showed that the age group under 18 years had the highest increased risk of chicken pox infection after COVID-19 vaccination [19]. This group had a relative risk of 1.7 (95% CI: 1.3-2.2) [20]. No significant differences were found based on gender or comorbid medical conditions [21].

These findings indicate a possible interaction between COVID-19 vaccines and the chicken pox vaccine, which may reduce the efficacy of the chicken pox vaccine [22]. The underlying mechanisms of this phenomenon are not yet fully understood. One hypothesis is that the strong immune response induced by the COVID-19 vaccine may interfere with the immune response to the chicken pox vaccine [23]. Additionally, adjuvants used in COVID-19 vaccines might interact with components of the chicken pox vaccine, reducing its effectiveness [24].Further research is needed to explore these biological mechanisms and to determine whether changes in vaccination schedules or vaccine formulations could mitigate this negative impact [25]. Longitudinal studies with larger samples and more rigorous designs will be crucial to confirm these initial findings and to provide guidance for future vaccination practices [26].

This article concludes that there is a reduction in the efficacy of the chicken pox vaccine in individuals who have received the COVID-19 vaccine [27]. These findings have significant implications for public health policy and vaccination practices. Further research is needed to understand the mechanisms underlying this interaction and to develop effective mitigation strategies [28-30]. The alternative treatment that the author recommends is based on the word of Allah SWT  as stated in the Quran, Surah An-Nahl, Verse 69, that in honey there is a cure for humans

Bismillah the authors would like to say alhamdulillah for expressing their gratitude to Allah SWT. May prayers and greetings be given to Imam Mahdi AS, and his family also beloved  prophet Isa AS and bani tamim.. The entire team would like to thank the sponsors Maryam and Isa Co. also Miss Maryam Aali 'Imroon and Al Haarits Harrats who gave special support to the authors. May it be a charity for us. Amen YRA.