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Viral Infections
the coverage could be expected to be high, while it is considered US and in some but not all European countries. The combined vaccine
unrealistic in developing countries with many other more important has in several studies been shown to be equally immunogenic to all
public health priorities.
30
The European Working Group on Varicella, components as MMR and varicella vaccines given separately. The
sponsored by the non-profitable New York-based VZV Research general availability of this MMRV vaccine would hasten the introduction
Foundation, came to the same conclusion in 2004.
31
Sicily was the first of varicella vaccination.
region in Europe to incorporate varicella vaccine in the general
vaccination programme during the second year of life in 2002. Germany Another obstacle to be addressed by proponents of varicella vaccines is
followed in 2004, and Greece in 2007 (for more information see the almost concurrent marketing of the important vaccines against
www.euvac.net). Some countries are expected to follow within the next pneumococcal infections, human papillomavirus and rotavirus. In my
few years. A few countries recommend vaccination of young adolescents home country, Sweden, the authorities will handle these separately, and
with no history of varicella or with non-detectable serum antibodies. it is not realistic that a new vaccine will be introduced every or every
other year. In my opinion, it would be more effective to introduce
Questions for the Future varicella vaccines and the three other vaccines concurrently and at the
Not surprisingly, it is now commonly acknowledged that at least one same time run an extensive information campaign to physicians, nurses
booster dose of varicella vaccine should be adminsitered. Despite the and parents.
promising results of many immunogenicity studies demonstrating long-
lasting protective serum antibodies, breakthrough cases and school A further obstacle to be overcome is the constant threat from vaccine
outbreaks – including cases among vaccinated children – have been opponents, who often receive widespread media attention. If parents
increasingly commonly reported.
32–34
In these outbreaks, the perceive a hesitation about varicella vaccine, and if it is offered as
effectiveness of one dose given during the second year of life has varied MMRV, there is a risk that the coverage of the even more beneficial
between 70 and 85% in six- to 10-year-olds, but this in combination vaccines against measles, mumps and rubella might decrease – this must
with a moderate vaccine coverage has not been enough to prevent the not be allowed to happen.
outbreaks. The US now recommends that a second dose is given to
children when they are four to six years old.
35
It is quite possible that the Finally, the four questions raised at the beginning of this review cannot
future will reveal the need for a third booster dose. be answered until at least one generation has been vaccinated against
varicella with high coverage. Continued surveillance of varicella, herpes
The success of a general varicella vaccination programme in Europe will zoster and VZV-associated neurological disease will have to be
to a large extent depend on ease of administration. A combined vaccine strengthened and continue for generations to come, because it is not
against measles, mumps, rubella and varicella (MMRV) is available in the realistic to believe that VZV will be eradicated. ■
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78 EUROPEAN INFECTIOUS DISEASE
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