Chloe Ramirez
The United States has been criticised for heading in the direction of anti-vaccination, with the Department of Health and Human Services stripping away support for vaccine development, promotion, and distribution. However, the US does vaccinate against varicella (chickenpox), with routine vaccination against the varicella zoster virus. As of 2019, standalone varicella vaccines are available in all 27 European Union member countries, and 12 of these have universal varicella vaccination policies. Other countries that vaccinate against varicella include Canada, Australia, and Japan, which was one of the first countries to vaccinate against chickenpox.
| Characteristics | Values |
|---|---|
| Countries that recommend all non-medically exempt children receive the varicella vaccine | 23 |
| Countries that recommend vaccinating only high-risk groups | 9 |
| Countries that recommend varicella vaccination in only parts of the country | 3 |
| Countries that offer standalone varicella vaccines | 27 European Union member countries |
| Countries that offer a combined measles, mumps, rubella, and varicella vaccine (MMRV) | 16 |
| Countries with universal varicella vaccination (UVV) policies | 12 European countries (Austria, Andorra, Cyprus, Czech Republic, Finland, Germany, Greece, Hungary, Italy, Latvia, Luxembourg, and Spain) |
| Countries that have made UVV available at no cost via government funding | 6 |
| Countries that have introduced universal varicella vaccinations | Korea |
| Countries with targeted recommendations for the vaccine | United Kingdom |
| Countries with routine varicella vaccination | United States, Japan, Canada, Australia |
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What You'll Learn
The US's anti-vaccine stance
The US has a complex relationship with vaccines. On the one hand, routine vaccination against the varicella-zoster virus (chickenpox) is performed in the US, and the incidence of chickenpox has been dramatically reduced as a result. The US also has a history of developing vaccines, with the chickenpox vaccine first being licensed in the US in 1995. The US Centers for Disease Control and Prevention (CDC) recommends 2 doses of the varicella vaccine for children, adolescents, and adults who do not have evidence of immunity.
However, there is also a notable anti-vaccine stance within the US. This is evidenced by the presence of vocal groups of individuals who oppose vaccination for a variety of reasons, including the belief that vaccines are dangerous, ineffective, or unnecessary. This has led to a recent decline in vaccination rates in the US. Additionally, some US politicians and government officials have contributed to the anti-vaccine sentiment. For example, Robert F. Kennedy Jr., a well-known vaccine skeptic, served as head of the Health and Human Services (HHS) department under the Donald Trump administration. Kennedy's team was accused of seeking non-existent data to justify anti-vaccine narratives and of attempting to reshape federal health agencies in ways that could reduce their effectiveness.
The anti-vaccine stance in the US has had tangible impacts on public health. For instance, in 2014, approximately 270,000 cases of measles were reported globally, resulting in over 140,000 deaths, mostly in children under five. While vaccination against measles is highly effective, the anti-vaccine sentiment has contributed to lower vaccination rates, putting children at risk.
Furthermore, the state of Florida under the DeSantis administration has indicated plans to eliminate all state vaccine mandates, although broader statutory changes would require legislative action. This has prompted scrutiny and concerns at the federal level, with President Trump expressing reservations about Florida's plan and defending the effectiveness of vaccines during a press conference.
In summary, while the US has a history of vaccine development and routine vaccination programs, there is a notable anti-vaccine stance within the country that has impacted public health and policy. The US thus exemplifies the complex dynamics surrounding vaccination, with some individuals and groups strongly opposed to vaccines, while others recognize their importance in preventing disease and saving lives.
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Countries vaccinating against varicella
Varicella, also known as chickenpox, is a highly contagious disease caused by the varicella zoster virus. The World Health Organization (WHO) recommends routine vaccination against varicella, but only if a country can maintain more than 80% vaccination coverage. This is because high vaccine coverage is essential for effective disease prevention.
The United States was the first country to introduce universal varicella vaccination, and it has seen a significant reduction in chickenpox cases, from four million per year before the vaccine to approximately 390,000 cases annually as of 2014. Canada and Australia also recommend varicella vaccination for children and susceptible adults. Japan was among the first countries to vaccinate against chickenpox, developing a live attenuated varicella vaccine in the early 1970s.
Some countries, like the United Kingdom, have not yet introduced routine varicella vaccination. This may be due to concerns about shifting the disease burden to older age groups and the cost-effectiveness of universal vaccination. However, studies have shown that universal vaccination significantly reduces the incidence of varicella and hospitalizations, especially in children under four years old.
The CDC in the United States recommends two doses of the varicella vaccine for children, adolescents, and adults who lack immunity. The first dose is typically given between 12 months and three years of age, with a booster shot administered between three-and-a-half and five years of age in some countries. The zoster vaccine, a larger-than-normal dose of the varicella vaccine, is recommended for adults over 50 to reduce the risk of shingles and postherpetic neuralgia.
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Serious complications of varicella
Varicella, or chickenpox, is a highly contagious disease caused by the varicella-zoster virus (VZV). While it primarily affects children, it poses a greater risk to adolescents, adults, pregnant women, immunocompromised individuals, and neonates. The classic symptom of chickenpox is a rash that turns into itchy, fluid-filled blisters that eventually scab over. However, serious and potentially fatal complications can arise from this disease, especially in vulnerable populations. Here are some of the serious complications associated with varicella:
Secondary Bacterial Infections
The most common complication of chickenpox is secondary bacterial infection, which can lead to severe sepsis, necrotizing fasciitis, toxic shock syndrome, and even death. The usual bacterium causing these infections is Group A Streptococcus, which gains entry through the skin barrier breached by the spots.
Haemorrhagic Chickenpox
Haemorrhagic chickenpox is a severe form of the disease characterised by bleeding into the skin, mucous membranes, and internal organs. It can be life-threatening and requires immediate medical attention.
Encephalitis
Encephalitis is a rare but serious complication of chickenpox, where the brain becomes inflamed due to the varicella virus. This can lead to seizures, confusion, headaches, and other neurological symptoms.
Pneumonia
Pregnant women are at an elevated risk of developing varicella pneumonia, a potentially severe complication. Additionally, maternal varicella can be transmitted to the fetus, resulting in newborn varicella, which can have serious consequences.
Congenital Varicella Syndrome
Maternal varicella during the initial 20 weeks of gestation is associated with congenital varicella syndrome, which can lead to low birth weight, cutaneous scarring, ocular abnormalities, cortical atrophy, psychomotor delay, and hypoplastic limbs.
Shingles (Herpes Zoster)
The varicella-zoster virus remains latent in the body after the initial infection. With advancing age or a weakened immune system, the virus can reactivate and cause shingles, a painful rash that can occur anywhere on the body. Shingles can lead to chronic pain and other neurological complications.
These serious complications highlight the importance of timely intervention and prevention, especially through vaccination, to protect vulnerable individuals from the potentially severe consequences of varicella.
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Reasons countries don't vaccinate against varicella
Chickenpox, caused by the varicella-zoster virus, is often considered a mild illness that most children experience. However, it can lead to serious complications, including haemorrhagic chickenpox, brain infections (encephalitis), and chickenpox pneumonia. While the varicella vaccine effectively prevents severe cases, some countries, like the UK, have opted not to include it in their childhood immunisation programmes. Here are some reasons why:
Economic Factors
The cost-effectiveness of implementing a universal varicella vaccination programme is a significant consideration for many countries. Vaccinating children against chickenpox could potentially reduce productivity as parents take time off work to care for sick children. Additionally, the vaccination programme itself incurs costs.
Shingles Concerns
There are concerns that reducing chickenpox cases among children through vaccination could increase shingles cases in older adults. Shingles, caused by the same varicella-zoster virus, can be a painful and debilitating condition requiring costly treatments. The theory suggests that exposure to infected children boosts adults' immunity and protects them from shingles. However, evidence regarding the link between chickenpox vaccination and shingles incidence is inconclusive.
Rare Side Effects
The varicella vaccine is a live viral vaccine, and about 5% of vaccinated children develop a mild chickenpox rash and fever. When combined with the MMR vaccine, there is a slightly higher risk of convulsions, occurring in one out of 2,300 doses. While rare, these side effects contribute to the decision-making process regarding the inclusion of the varicella vaccine in national immunisation programmes.
Calculated Risk Assessment
In some cases, the decision to forgo universal varicella vaccination is a calculated risk assessment. By not vaccinating children, it is hypothesised that older adults will benefit from reduced shingles risk due to exposure to infected children. This approach aims to prevent disease in a different age group, prioritising the health of older adults over the convenience of childhood vaccination.
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Global increase in varicella vaccination
Chickenpox, or the varicella zoster virus, is a highly contagious disease with a secondary attack rate of over 90%. It can cause serious complications, including haemorrhagic chickenpox, encephalitis, and chickenpox pneumonia. The varicella vaccine was first developed in Japan in the early 1970s and was licensed in the United States in 1995. The U.S. was the first country to introduce universal varicella vaccination, and routine vaccination has dramatically reduced the incidence of chickenpox in the country.
The World Health Organization (WHO) recommends introducing universal varicella vaccination in countries where the disease is a significant burden, provided that more than 80% vaccine coverage can be achieved and sustained. This high level of coverage is crucial for effective disease prevention, and many countries are now providing 2-dose vaccinations to meet this goal.
Canada, for example, recommends varicella vaccination for all healthy children aged 1 to 12 and susceptible adolescents and adults up to 50 years old. The CDC in the United States recommends two doses of the vaccine for children, adolescents, and adults without evidence of immunity. In Australia, vaccination against chickenpox is also routine.
Despite the success of varicella vaccination programs in reducing the incidence and hospitalization rates, especially in children under 4 years old, some countries have postponed universal varicella vaccine introduction due to concerns about shifting the disease to older age groups and increasing herpes zoster cases in the elderly. Additionally, the cost-effectiveness of universal vaccination has been a consideration for many countries.
Overall, the global increase in varicella vaccination has been driven by the desire to prevent serious complications from chickenpox and reduce the disease's burden worldwide. The success of vaccination programs in countries like the United States has provided valuable insights and encouraged the expansion of vaccination efforts in other nations.
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Frequently asked questions
Yes, the US does vaccinate heavily against varicella. The US has a routine vaccination program against the varicella zoster virus, and there has been a dramatic reduction in chickenpox cases. The US has two types of chickenpox vaccines licensed for use: the single-antigen varicella vaccine and the measles, mumps, rubella, and varicella (MMRV) vaccine.
Many countries vaccinate against varicella, including Japan, Canada, Australia, and all 27 European Union member countries. In the UK, varicella antibodies are measured as part of prenatal care, but population-based immunization is not practised.
The varicella vaccine is 70-90% effective in preventing varicella and more than 95% effective in preventing severe varicella. The vaccine has led to a significant decrease in chickenpox cases, hospitalizations, and deaths. However, the rate of shingles infection has increased as adults are less exposed to infected children, which naturally boosts immunity to shingles.
