Fwd: Universal Vaccination against Varicella

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Just another article-FYI

>The New England Journal of Medicine -- March 5, 1998 -- Volume 338,

>Number 10

>Universal Vaccination against Varicella

>

>Historically, chickenpox has been largely a benign disease affecting

>predominantly preschool and school-aged children. Times are changing:

in

>Massachusetts, children enrolled in day-care programs will soon be

>required to be vaccinated against varicella (or have evidence of having

>had the disease). (1) Although it is generally held that immunizing

>children is axiomatic for public health, vaccinating all children

>against chickenpox is a bad idea.

>

>It is unknown whether long-term immunity to varicella arises from an

>attack of the disease in childhood or from the virus's repeatedly (and

>naturally) boosting immunity because it is maintained in our

>communities. Furthermore, it is unknown how long immunity will last

>after vaccination. Yet policies of universal vaccination of children

>will serve, over time, to eradicate most, but not all, naturally

>occurring varicella and its immeasurable booster effect.

>

>In most children, varicella is a self-limited illness lasting five to

>seven days. Only rarely does a child die from its complications. In

>fact, most deaths attributed to varicella occur among adults. (2) To

>prevent deaths and severe illness, the proponents of vaccination argue

>that universal vaccination of children should be instituted to

eliminate

>the presence of contagious children. (3) Universal vaccination means

>that many, but not all, children will be inoculated. If the protective

>immunity of the immunized children wanes as they age or if

noninoculated

>children escape disease because contagion becomes rarer, outbreaks of

>life-threatening varicella may occur as these children become older.

>Since the morbidity and mortality associated with chickenpox are

>increased in fetuses and after childhood, (4) a considerable problem

may

>develop even if the rates of childhood immunization against varicella

>are high: an ever-expanding population of adults, including pregnant

>women, with nonboosted (even waning) immunity may inadvertently be

>created.

>

>Proponents of universal immunization argue that waning immunity will be

>countered by providing adults with booster immunizations. Yet adults

are

>notoriously underimmunized in the United States, as illustrated by the

>large number of pregnant women who lack immunity to rubella. Similarly,

>although there were 36 cases of tetanus reported in 1996, none occurred

>in children. (5) Relying on adults to obtain booster vaccinations

should

>their immunity to chickenpox wane is folly. Hence, it makes good sense

>to immunize only vulnerable adults, susceptible children as they become

>young adults, and younger children at high risk for complications

should

>they acquire the disease. A dialogue about universal vaccination of

>toddlers against varicella might make sense only if it could clearly be

>demonstrated that susceptible adults could be successfully immunized.

>

> W. Spingarn, M.D., M.P.H.

> A. , M.D.

>1400 Centre St.

>Newton Centre, MA 02159

>

>References

>1. Immunization guidelines. Boston: Massachusetts Department of Public

>Health, Aug 1997.

>2. Varicella-related deaths among adults --US, 1997. MMWR

>1997;46:409-12.

>3. Plotkin SA. Varicella vaccine. Pediatrics 1996;97:251-3.

>4. Wharton M. Epidemiology of varicella-zoster virus infections. Infect

>Dis Clin North Am 1996;10:571-81.

>5. Status report on the Childhood Immunization Initiative: reported

>cases of selected vaccine-preventable diseases --US,1996. MMWR

>1997;46:665-71.

>