Varicella vaccine should be introduced into the UK immunisation programme immediately

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Varicella vaccine should be introduced into the UK immunisation programme immediately. Andrew J Pollard. Varicella. The vaccine programme is about improving child health Burden of disease Mortality Complications. Chickenpox Epidemiology. 90% infected by 18 years of age
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Varicella vaccine should be introduced into the UK immunisation programme immediatelyAndrew J PollardVaricella
  • The vaccine programme is about improving child health
  • Burden of disease
  • Mortality
  • Complications
  • Chickenpox Epidemiology
  • 90% infected by 18 years of age
  • 670,000 cases per year in England & Wales
  • 51% of cases <5 years of age
  • 84% of cases <15 (~600,000)
  • 14% in 15-44 year age group = 100,000 cases
  • Extrapolation from German data
  • Varicella-related hospitalization 14.1/100,000 children (95% CI: 9.7–18.6),
  • 27 hospitalizations per 10,000 varicella cases.
  • 1809 children hospitalised per year
  • 6 deaths per year
  • Transmission
  • 90% of non-immune household contacts become infected
  • Any face to face contact
  • 15 minutes in the same room
  • Any ward exposure
  • Options
  • VZIG
  • Active vaccination
  • Anti-virals
  • Complications
  • BPSU Nov 2002-Nov 2003
  • 112 cases
  • 30 pneumonia
  • 30 bacteraemia/septic shock
  • 26 encephalitis
  • 25 ataxia
  • 14 toxic shock
  • 7 necrotising fasciitis
  • 5 purpura fulminans
  • 5 fulminant varicella
  • 3 neonatal varicella
  • 29 admitted to icu
  • 6 deaths
  • Cameron at al 2007Complications
  • Blood
  • 69% Group A Strep
  • 12% Staph aureus
  • Skin
  • 36% Group A Strep
  • 64% Staph aureus
  • Cameron at al 2007Pregnancy
  • 5-10% childbearing age are susceptible
  • Tropical areas may be as high as 20-40%
  • Infection in first 20 weeks = 1-2 % congenital varicella
  • Vaccine Efficacy
  • 5 years = 90%
  • 97% effective against severe and moderately severe disease
  • Breakthrough cases 5-7% over 5 years
  • 2nd dose of VZV
  • 5-107 spots
  • Mixture of maculopapular and vesicles
  • Shinefield 2002, Vazquez 2001, Chaves 2007Adverse events
  • Varicella rash
  • 4-6%
  • Day 2-33
  • Number of spots 1-100
  • Duration of spots 1-16
  • White 1991, Lau 2002ZOSTEROxman 2005Impact of varicella vaccineDecline in mortality in USAVaccine introduced in 1995Nguyen 2005
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