USA - Before 1995 Each year 4 million people would get the chicken pox About 10,500 – 13,000 were hospitalized Majority : healthy children and 100 to 150 died adultshttp://www.cdc.gov 4Walter A., Orenstein M.D., National Immunization Program. Overview of the US Vaccination Program
Why a VZV vaccine? Varicella develops in nearly all persons living in the US • > 90% of adults immune to VZV Complications rate higher for persons ≥ 15 and < 1 years of age • Bacterial infection of skins lesions, pneumonia, dehydratation, encephalitis, hepatitis VZV vaccine licensed in several European countries (1984), Japan (1986), Korea (1988) • No safety concerns after the administration of > 2 million doses in these countries Varicella is less severe among vaccinated persons than unvaccinated persons • Afebrile, fewer vesicular lesions, shorter duration of illness Difference of incidence of herpes zoster • 18 per 100000 persons/year for vaccinated people • 77 per 100000 persons/year after natural Varicella 5MMWR, Advisory Committee on Immunization Practices (ACIP). Prevention of Varicella. July 12, 1996, Vol 45, No RR-11
Cost-effectiveness of a Routine Varicella Vaccination program for US children One dose/child under 6 30-year period following introduction $35/dose At school entry, vaccination coverage level = 97% by the 6th year Medical costs Work-loss costs • Varicella treatment : Acyclovir • Parents missing work when their children • Vaccinated people : no Acyclovir have the chickenpox ($201) • Complications • Adults contracting chickenpox Taking into account • Evidence about vaccine efficacy • Effects of expected changes in the age distribution of the disease • Empirical data on the costs of medical utilization and work loss from varicella 6Lieu, Tracy A et al. Cost-effectiveness of a Routine Varicella Vaccination program for US Children. JAMA; 1994; 271 (5), 375-381
Cost-effectiveness of a Routine Varicella Vaccination program for US children 7Lieu, Tracy A et al. Cost-effectiveness of a Routine Varicella Vaccination program for US Children. JAMA; 1994; 271 (5), 375-381
Cost-effectiveness of a Routine Varicella Vaccination program for US children Savings from Varicella disease prevention : $1.3 billion for the 1-dose program, $1.4 billion for the 2-dose program. 8Lieu, Tracy A et al. Cost-effectiveness of a Routine Varicella Vaccination program for US Children. JAMA; 1994; 271 (5), 375-381
Recommendation map Kg: Kindergarten Gr: School Grade
Effects of vaccination Hospitalization rate: 2.2 to 3.3/100.000 (1995-1998) to 0.5/100.000 (2004)Death rate: 0.41 deaths/1,000,000 (1990-1994) to 0.14 (1999-2001) (decrease of 78%)
The other hand FEAR Not natural Side effects•Mild : fever (≤1/10), rash (1/25)•Moderate: Seizure (jerking/staring) caused by fever (very rare)•Severe: pneumonia
The French point of view Same incidence, same complications, same risks… BUT vaccine only recommended in certain cases, if no varicella history: •Vaccination within 3 days following exposure (adults & immunocompetent) •Health care workers •Contact with young children & immunodeficient people •Children organ recipient Considering that: 15 years of vaccine coverage of children of 11 years-old is necessary to save: •1 death •30 severe complications •30.000 cases/year (nowadays incidence is about 600.000 cases/year) Plus: •increasing of the disease in the teenage and adult population •Increasing of zoster outcomes in the senior population.HAS: AVIS DU CONSEIL SUPÉRIEUR DHYGIÈNE PUBLIQUE DE FRANCESECTION MALADIES TRANSMISSIBLESRelatif à la vaccination contre la varicelle
“ils sont fous ces américains” New drifts :Mailing/selling infected clothes, saliva samples, infected lollipops... Risk of 20 years of imprisonment: under biohazard regulation (like anthrax) Danger for workers of mailing companiesLooking for more dangerous diseases: Measles, mumps…
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