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To: ADC Fetal and Neonatal Edition Letters and ADC Education and Practice Letters

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Perspectives: Marion Roderick, Athimalaipet V Ramanan, and Adam Finn Should the UK introduce varicella vaccine? Arch Dis Child 2007; 92: 1051-1052 [Full text] [PDF]

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Caution over long term immunity

Dylan M Wilson   (30 November 2007)

Caution over long term immunity 30 November 2007
Dylan M Wilson, Paediatric Registrar Gold Coast, Australia Send letter to journal: Re: Caution over long term immunity dylanwilson1{at}hotmail.com Dylan M Wilson	The argument by Roderick et al as to whether varicella vaccine should be introduced has particular relevance to Australia. Here, a single dose only is offered at 18 months, with a further opportunity in the teenage years for those without prior history of disease or vaccination. My concern lies in the provisional evidence of waning vaccine-induced immunity over time, as this will only result in chicken pox shifting from being a predominantly preschool illness to being an adult illness. Far from protecting those at higher risk of disease (like pregnant women and their unborn children), a childhood vaccine could create increased numbers of such an at-risk population. This potential long term implication of childhood vaccination needs to be addressed by answering the question whether two doses will provide lifelong immunity - or at least, from a paediatric point of view, through the child-bearing years. It may be that with increased herd immunity these adults and pregnant women wil be at less risk, but overall I would still urge caution, and I would not be surprised if Australia sees an increase in congenital varicella or neonatal chicken pox in twenty to thirty years time, unless that 2nd dose is added in soon.