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Varicella vaccination in Europe – taking the practical approach

Paolo Bonanni1, Judith Breuer2, Anne Gershon3, Michael Gershon4, Waleria Hryniewicz5, Vana Papaevangelou6, Bernard Rentier7, Hans Rümke8, Catherine Sadzot-Delvaux7*, Jacques Senterre9, Catherine Weil-Olivier10 and Peter Wutzler11

Author Affiliations

1 Department of Public Health, University of Florence, Florence, Italy

2 Skin Virus Laboratory, Centre for Cutaneous Research, St Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary College, London, UK

3 Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, USA

4 Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, USA

5 National Medicines Institute, Chelmska Street, 00-725 Warsaw, Poland

6 Second Department of Pediatrics, University of Athens Medical School, "P & A Kyriakou" Children's Hospital, Athens, Greece

7 Unit of Fundamental Virology and Immunology, GIGA-Research, B34 University of Liége, 4000 Liège, Belgium

8 Vaxinostics, University Vaccine Center Rotterdam Nijmegen, Rotterdam, the Netherlands

9 Department of Pediatrics, University of Liège, Liège, Belgium

10 University Paris VII, Paris 75005, France

11 Institute of Virology and Antiviral Therapy, Friedrich-Schiller University, Jena, Germany

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BMC Medicine 2009, 7:26  doi:10.1186/1741-7015-7-26

Published: 28 May 2009


Varicella is a common viral disease affecting almost the entire birth cohort. Although usually self-limiting, some cases of varicella can be serious, with 2 to 6% of cases attending a general practice resulting in complications. The hospitalisation rate for varicella in Europe ranges from 1.3 to 4.5 per 100,000 population/year and up to 10.1% of hospitalised patients report permanent or possible permanent sequelae (for example, scarring or ataxia). However, in many countries the epidemiology of varicella remains largely unknown or incomplete.

In countries where routine childhood vaccination against varicella has been implemented, it has had a positive effect on disease prevention and control. Furthermore, mathematical models indicate that this intervention strategy may provide economic benefits for the individual and society. Despite this evidence and recommendations for varicella vaccination by official bodies such as the World Health Organization, and scientific experts in the field, the majority of European countries (with the exception of Germany and Greece) have delayed decisions on implementation of routine childhood varicella vaccination, choosing instead to vaccinate high-risk groups or not to vaccinate at all.

In this paper, members of the Working Against Varicella in Europe group consider the practicalities of introducing routine childhood varicella vaccination in Europe, discussing the benefits and challenges of different vaccination options (vaccination vs. no vaccination, routine vaccination of infants vs. vaccination of susceptible adolescents or adults, two doses vs. one dose of varicella vaccine, monovalent varicella vaccines vs. tetravalent measles, mumps, rubella and varicella vaccines, as well as the optimal interval between two doses of measles, mumps, rubella and varicella vaccines).

Assessment of the epidemiology of varicella in Europe and evidence for the effectiveness of varicella vaccination provides support for routine childhood programmes in Europe. Although European countries are faced with challenges or uncertainties that may have delayed implementation of a childhood vaccination programme, many of these concerns remain hypothetical and with new opportunities offered by combined measles, mumps, rubella and varicella vaccines, reassessment may be timely.