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Varicella vaccine should be introduced into the UK immunisation programme immediately

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 immediately

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  1. Varicella vaccine should be introduced into the UK immunisation programme immediately Andrew J Pollard

  2. Varicella • The vaccine programme is about improving child health • Burden of disease • Mortality • Complications

  3. 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

  4. 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

  5. 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

  6. 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 2007

  7. Complications • Blood • 69% Group A Strep • 12% Staph aureus • Skin • 36% Group A Strep • 64% Staph aureus Cameron at al 2007

  8. Pregnancy • 5-10% childbearing age are susceptible • Tropical areas may be as high as 20-40% • Infection in first 20 weeks = 1-2 % congenital varicella

  9. 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 2007

  10. Adverse events • Varicella rash • 4-6% • Day 2-33 • Number of spots 1-100 • Duration of spots 1-16 White 1991, Lau 2002

  11. ZOSTER Oxman 2005

  12. Impact of varicella vaccineDecline in mortality in USA Vaccine introduced in 1995 Nguyen 2005

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