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Primary varicella infection (chickenpox) is common in the UK with over three-quarters of parents reporting a history of chickenpox in their children by 5 years of age.1 Following primary infection, the varicella zoster virus (VZV) remains dormant in the dorsal root ganglia and reactivates in later life following a decline in cell-mediated immunity to cause herpes zoster or shingles (HZ). Although chickenpox is generally mild and self-limiting in healthy children, secondary bacterial infections, pneumonia and neurological complications can occur. The risk of severe chickenpox is higher in immunocompromised individuals, pregnant women and neonates, although most hospitalisations for severe complications are in previously healthy children.2 Shingles is a potentially debilitating condition, which results in a greater burden and quality of life loss than chickenpox.3 The incidence of shingles and the risk of post herpetic neuralgia increase with age.
Safe and effective live-attenuated varicella vaccines (Oka VZV strain) have been available for the prevention of chickenpox since the 1980s; two doses have a reported effectiveness between 84% and 98%.4 Countries across Europe, North America and Australia have adopted different approaches to using vaccine for VZV control. While some countries, such as Australia and the USA, have introduced routine childhood varicella programmes using one or two dose schedules, many European countries (including the UK and Belgium) have not. In the UK, a selective vaccination policy has been recommended, offering vaccine to high-risk groups including non-immune healthcare workers and susceptible household contacts of immunosuppressed …