Risks and Benefits of Varicella Vaccine

Seidman, Danielle

doi:10.1001/jama.279.13.993-a

Cited by 4 publications

(3 citation statements)

References 2 publications

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“…4 Although the risk for serious morbidity and mortality from varicella is 10 to 20 fold higher in adults,5 the greatest burden of this disease is borne by children, who account for more than 90% of varicella infections, two thirds of varicella-related hospitalizations, and nearly half of varicella-related fatalities.s.s.6 Despite the varicella vaccine's strong record of safety and efficacy,7 there was significant opposition to recommendations for universal immunization of healthy children. [8][9][10][11][12][13][14][15] Many parents and pediatricians argued that chickenpox is generally a benign childhood illness, requiring no preventive measures.10-12 Other reservations about routine varicella vaccination included concerns about altering the epidemiology of the disease,10,13 the unknown duration of vaccine-induced immunity,11~12,14 and cost.12>15 Anecdotal evidence suggested that some pediatricians who were parents themselves were electing not to vaccinate their own children against chickenpox.11,16 Low initial patient vaccination rates may have been a reflection of the pediatric community's uncertainty regarding this vaccine. [17][18][19] Given the debate surrounding this vaccine, varicella vaccination practices were examined to determine whether pediatricians' recommendations for patients in clinical practice differed from the choices these same pediatricians, as parents, were making for their own children.…”

Section: Introductionmentioning

confidence: 99%

A Look at the Pediatrician as Parent: Experiences with the Introduction of Varicella Vaccine

Katz‐Sidlow

Sidlow

2003

Clin Pediatr (Phila)

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Many physicians voiced reservations about routine use of the varicella vaccine for healthy children after its licensing in 1995. Anecdotal evidence suggested that some pediatricians who were parents themselves were electing not to vaccinate their own children against chickenpox. Little has been written about pediatrician-parents' behaviors in caring for their own children, and how these practices may differ from the behavior that these same pediatricians apply in practice. Pediatricians' tacit attitudes toward medical interventions might be better understood from their behaviors as parents than from their clinical practices, which may be influenced by a sense of responsibility to follow guidelines of professional organizations. Varicella vaccination practices were examined to determine whether pediatricians' behaviors in parenting their own children differed from their recommendations for their patients. A mail survey was sent to 1,762 New York State pediatricians selected randomly from the membership directory of the American Academy of Pediatrics. The response rate was 43% (764/1,762); 63% of responding pediatricians were parents. Eighty-five percent of pediatricians recommended varicella vaccine routinely in practice. Of the pediatricians' own eligible children, 88% (256/291) had been vaccinated against chickenpox. We found a high overall rate of compliance with recommendations for routine use of varicella vaccine. Pediatricians who were parents were just as likely as nonparent pediatricians to recommend the vaccine routinely for their patients. Importantly, pediatrician-parents demonstrated no "double standard"; at the time of the study, 88% of pediatricians' own eligible children had been vaccinated against varicella.

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Section: Introductionmentioning

confidence: 99%

A Look at the Pediatrician as Parent: Experiences with the Introduction of Varicella Vaccine

Katz‐Sidlow

Sidlow

2003

Clin Pediatr (Phila)

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“…As a result, only 43% of children are currently vaccinated [16]. Obstacles to vaccination include (1) the perception that varicella is a mild disease in children, and (2) the concern that the efficacy of the vaccine could potentially wane [12,14,15,17,18] and, ultimately, could lead to an increase in the number of cases of chickenpox in adults, for whom the disease is more severe [19][20][21]. Proponents of universal vaccination have countered these arguments by emphasizing that studies have suggested that (1) vaccine efficacy persists for at least 20 years [22], (2) most hospitalizations and deaths due to varicella occur among children and can be prevented by vaccination [17,23,24], and (3) vaccination may also prevent morbidity associated with herpes zoster [24][25][26].…”

mentioning

confidence: 99%

“…Varicella models published elsewhere have all viewed vaccination in terms of its societal benefit, offering no specific guidance for the individual. Some pediatricians have proposed, as an alternative to universal vaccination, that vaccination be delayed until children are 10 years of age [19,20]. This delay would result in most children acquiring immunity after natural infection, with the remainder receiving vaccination before adulthood.…”

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confidence: 99%

Do the Benefits of Varicella Vaccination Outweigh the Long‐Term Risks? A Decision‐Analytic Model for Policymakers and Pediatricians

Rothberg

Bennish

Kao³

et al. 2002

CLIN INFECT DIS

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Although varicella vaccine is recommended for infants, many physicians and parents have withheld vaccination from infants because of concerns about the vaccine's long-term efficacy. We used a decision-analytic Markov model to examine the effects of decreasing vaccine efficacy on individuals and society. The model incorporated published data on age-specific incidence, morbidity, and mortality rates, as well as data on shifting disease burden from childhood to adulthood as vaccine compliance increases. The effects of 2 vaccination strategies---vaccinating infants at age 12 months and waiting to vaccinate until children are 10 years of age---were compared with the effects of no vaccination. If the efficacy of the vaccine were to decrease by 75%, then 50% compliance with vaccination at age 12 months would save 1800 life-years and 12,800 quality-adjusted life-years annually in the United States. The quality-adjusted life expectancy of individuals vaccinated at age 12 months would be 63 h longer than that of nonvaccinated individuals and would increase to 79 h as vaccination compliance increases and the burden of chickenpox shifts to adulthood. Varicella vaccination of infants at age 12 months appears to be beneficial, even if the efficacy of the vaccine declines substantially.

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Update on varicella vaccine

Kamiya

Ito

1999

Current Opinion in Pediatrics

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A live varicella vaccine has been licensed in Japan, Korea, some European countries, and the United States. Susceptible children can receive varicella vaccine at 12 to 18 months of age, and those who lack a reliable history of chickenpox should be immunized between 11 and 12 years of age. Susceptible children 13 years of age or older should receive two doses at least 1 month apart. Varicella vaccine administered under routine conditions has been proved to be highly effective. Varicella immunization has induced long-term humoral and cellular immunity. The varicella vaccine can be given in immunocompromized children, including children with leukemia and bone marrow transplantation recipients, when immune function recovers. Inactivated varicella vaccine can also reduce morbidity due to varicella zoster virus reactivation in high-risk populations.

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Risks and Benefits of Varicella Vaccine

Cited by 4 publications

References 2 publications

A Look at the Pediatrician as Parent: Experiences with the Introduction of Varicella Vaccine

A Look at the Pediatrician as Parent: Experiences with the Introduction of Varicella Vaccine

Do the Benefits of Varicella Vaccination Outweigh the Long‐Term Risks? A Decision‐Analytic Model for Policymakers and Pediatricians

Update on varicella vaccine

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