Should the UK introduce a universal childhood varicella vaccination programme? | Archives of Disease in Childhood

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Should the UK introduce a universal childhood varicella vaccination programme?

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Varicella vaccination in the UK: reduced risk of stroke might be another advantage
Andrew L. Lux
Published on: 19 May 2016
Herpes Zoster possibly unreported in childhood
Justin Daniels
Published on: 19 May 2016

Published on: 19 May 2016
Varicella vaccination in the UK: reduced risk of stroke might be another advantage
- Andrew L. Lux, Consultant Paediatric Neurologist
- Other Contributors:
  Sam Amin, Andrew A. Mallick, Andrew L. Lux
We read with interest the review by Amirthalingam[1] and colleagues of the potential value of a UK varicella vaccination programme. They cite Blumental[2] and colleagues' article in the same issue which assessed the burden of varicella and outlined some of the known complications, such as bacterial skin and soft tissue infections, pneumonia, and neurological complications including meningitis and encephalitis. The Blumen...
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We read with interest the review by Amirthalingam[1] and colleagues of the potential value of a UK varicella vaccination programme. They cite Blumental[2] and colleagues' article in the same issue which assessed the burden of varicella and outlined some of the known complications, such as bacterial skin and soft tissue infections, pneumonia, and neurological complications including meningitis and encephalitis. The Blumental study included complications occurring up to 21 days after onset of the chickenpox rash. We wish to highlight further potential complications that are possibly excluded from that definition but may be a significant benefit of vaccination.
There is evidence that varicella infection is associated with an increased risk of focal cerebral arteriopathy and arterial ischemic stroke (AIS). In a UK study of incidence, Thomas[3] and colleagues identified 49 children with AIS following chickenpox and found that, in children, the incidence of AIS during the following 6 months was four times that of controls (summary incidence ratio = 4.07; 95% CI 1.96-8.45). The estimated incidence ratio in adults was 2.13 (95% CI 1.05-4.36). Considering varicella vaccination in a cohort of more than 3 million children, Donahue and colleagues found no association with ischemic stroke.[4]
We believe that neurological complications of AIS, which can occur many weeks after infection, were not considered in the review by Amirthalingam and colleagues. Most of the complications that they reported are transient or readily treatable, although meningoencephalitis can leave long-term neurodevelopmental sequelae. There is a high risk of long-term disability from childhood AIS and this places significant financial burden on healthcare systems. We believe that this relatively uncommon but important complication should be considered when determining the cost- effectiveness of a varicella vaccination programme for the UK.
References
1- Amirthalingam G, Ramsay M. Should the UK introduce a universal childhood varicella vaccination programme? Arch Dis Child. 2016 Jan;101(1):2-3.
2- Blumental S, Sabbe M, Lepage P; Belgian Group for Varicella. Varicella paediatric hospitalisations in Belgium: a 1-year national survey. Arch Dis Child. 2016 Jan;101(1):16-22
3- Thomas SL, Minassian C, Ganesan V, Langan SM, Smeeth L. Chickenpox and risk of stroke: a self-controlled case series analysis. Clin Infect Dis. 2014 Jan;58(1):61-8.
4- Donahue JG, Kieke BA, Yih WK, Berger NR, McCauley JS, Baggs J, Zangwill KM, Baxter R, Eriksen EM, Glanz JM, Hambidge SJ, Klein NP, Lewis EM, Marcy SM, Naleway AL, Nordin JD, Ray P, Belongia EA; Vaccine Safety DataLink Team. Varicella vaccination and ischemic stroke in children: is there an association? Pediatrics. 2009 Feb;123(2):e228-34.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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Published on: 19 May 2016
Herpes Zoster possibly unreported in childhood
- Justin Daniels, consultant paediatrician
This editorial is a very helpful review of the current state of the debate.
I am concerned that zoster is under diagnosed in childhood because of lack of familiarity in both primary and secondary care. Anecdotally it is not uncommon in a paediatric unit, in otherwise well children, but does cause significant concern and use of resources. This needs to be accurately captured as it may shift the economic modelling...
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This editorial is a very helpful review of the current state of the debate.
I am concerned that zoster is under diagnosed in childhood because of lack of familiarity in both primary and secondary care. Anecdotally it is not uncommon in a paediatric unit, in otherwise well children, but does cause significant concern and use of resources. This needs to be accurately captured as it may shift the economic modelling used to decide whether to go ahead with varicella vaccination.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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