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 2 nd 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. Oxman 2005 ZOSTER

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