Emergency vaccination against chickenpox. The chickenpox vaccine has a lot of pros, but there are also cons. Chickenpox can be severe in adults

Called a childhood disease because most people experience it before the age of 12. Its causative agent is one of the types of herpes virus (type 3). But not only children suffer from chickenpox; adults who did not have it in childhood and were not vaccinated can also get sick. In children, this disease is mild, but the older the person, the more serious the severity of the disease. Children may also experience a complication of this disease - for example, a severe course was noted in one out of ten children with chickenpox. But in adults, the statistics are different - almost every third patient experiences complications, for example, in the form of scars on the skin, severe fever, pneumonia, otitis media, or pustular skin infections.

Is it possible for an adult to be vaccinated against chickenpox and how is it tolerated? What vaccines exist against this disease?

This disease is especially dangerous for pregnant women and people with immunodeficiency, for example, people living with HIV, undergoing chemotherapy, or receiving other types of immunosuppression (immune suppression). Oncological diseases and taking corticosteroid hormones are also factors that reduce immunity, so such individuals also have a high risk of getting sick.

There is a possibility that people who have had chickenpox may experience its long-term consequence - shingles. This disease is caused by the same type of herpes as chickenpox, but it is severe and often recurs.

Should an adult be vaccinated against chickenpox? This procedure is optional and is carried out at will. But vaccination is the only way to prevent chickenpox in adults who did not have it as children.

When should adults be vaccinated against chickenpox? The vaccine can be given at any age, regardless of whether the person has been ill or not. Vaccination, if there is an indication for it, is carried out free of charge in the clinic upon referral from a physician.

Pregnancy is a dangerous period in terms of infections and, in particular, chickenpox. This disease can lead to miscarriage, miscarriage, fetal pathology, and underdevelopment of organs and limbs in the child. Pregnant women with preschool children living with them should be especially afraid of chickenpox. It is not recommended to get vaccinated during pregnancy, but doing it when planning it is highly advisable. The vaccination should be done 3 months before conception.

People after myocardial infarction, with severe chronic diseases of the heart, lungs, and kidneys should also be vaccinated against chickenpox. The disease can lead to decompensation of the process, exacerbation, and serious consequences.

In old age, vaccination is not contraindicated, and in some cases it is recommended. It is definitely worth getting vaccinated if you are in a risk group.

It is necessary to get vaccinated against chickenpox after contact with a patient, for emergency prevention. It is done within three days, and it blocks the disease for early stage.

Contrary to the popular belief that if you had chickenpox in childhood, then it does not threaten you throughout your life, there are cases when people become infected with this disease even after suffering from it in childhood. Scientists attribute this to the fact that the virus, like any other, is capable of mutating over time. After 10–20 years, you may get chickenpox again, because it will be caused by a different strain of the virus. Therefore, vaccination against chickenpox indicated for adults at risk, even if they had it in childhood.

Pros and cons of vaccination

The benefits of vaccination are significant.

The disadvantages include the following facts.

1. Vaccination in childhood does not guarantee that a child will not get chickenpox. The process will only be delayed until adulthood.
2. Vaccination is carried out with a live virus, therefore, a vaccinated person can be infectious to others.
3. There is a possibility of developing post-vaccination chickenpox.
4. Immunity against chickenpox begins to develop immediately after vaccination. But maximum effectiveness is achieved only after 1.5 months.

What vaccines are there?

Names of chickenpox vaccinations for adults:

Both vaccines contain live but weakened chickenpox viruses of the third type, Oka strain. They can be used in both adults and children. Okavax is produced by the French company Sanofi, and Varilrix is ​​produced by the British company GlaxoSmithKline. They can be used both planned and for emergency prevention.

But there is some difference - “Okavax” is done once, and “Varilrix” is done in two stages. The second Varilrix vaccination is administered 1.5–2.5 months after the first.

Where do adults get the chickenpox vaccine? It is inserted into the upper third of the shoulder under the skin. If it is not possible to inject subcutaneously, then it can be done intramuscularly. You cannot administer drugs intravenously. The gluteal region is not suitable for injection of the vaccine, since the subcutaneous fatty tissue there is significantly pronounced and the drug will take a very long time to be absorbed.

How long does the chickenpox vaccine last in adults? Okavax forms long-lasting immunity for many years. Studies on the drug Varilrix have shown that full immunity lasts for at least a year. Any chickenpox vaccine for adults will need to be repeated, as none of them provide lifelong immunity.

Contraindications

Chickenpox vaccination for adults has contraindications:

• acute pathology;
• leukopenia below 1200 in 1 ml of blood;
• strong reaction to previous administration;
• taking immunoglobulins (you can get vaccinated 3 months after they are discontinued).

What reactions can the body have?

Reactions to vaccination in both children and adults are rare. These are mainly local manifestations in the form of pain at the injection site, redness and swelling. These symptoms are observed from the first days, but quickly disappear. Up to 5% of vaccinated people, in addition to local reactions, may experience:

It is possible that post-vaccination chickenpox will develop, which will have all its manifestations, but will proceed more easily and without complications.

The occurrence of allergic reactions cannot be ruled out. You should especially be wary of anaphylactic shock and Quincke's edema.

In conclusion, let us repeat the main points.

1. Whether or not to get vaccinated against chickenpox is decided by each individual.
2. It is advisable to consult a doctor about the presence of indications and contraindications.
3. People at risk should be vaccinated first.
4. The vaccine protects not only against chickenpox, but also against herpes zoster, a long-term consequence of the disease.
5. Vaccines can also be used as emergency prevention after contact with a person with chickenpox.
6. It is advisable to get this vaccination when planning a pregnancy.

The disadvantages of vaccination include the possibility of developing post-vaccination chickenpox, the infectiousness of the vaccinated person, the short duration of immunity and its long-term formation.

Varicella (chickenpox) is a common viral infection that affects people mainly in childhood. Most of the population have encountered the disease and consider it safe. This is evidenced by statistical data, the dry numbers of which hide serious complications and consequences for the child.

Vaccinating a child against chickenpox is a relatively new procedure in Russia, introduced in 2008. This safe way protect the child from viral infection for a long time and prevent complications of the disease after growing up.

Therefore, every parent should know the advantages and disadvantages of the procedure and adequately assess the need for vaccination for the child.

The causative agent of the disease is the varicella zoster virus (VZ), which can reproduce only in the human body. Features of the virus are high volatility and contagiousness (infectiousness). The possibility of infection after contact with the pathogen is equal to 100%.

The source of the virus is a patient with chickenpox, less often with herpes zoster.

From his body the pathogen large quantities released when talking, coughing, sneezing. The virus is transmitted from a sick mother to the fetus through the birth canal or infected amniotic fluid.

According to statistics, about 70–90% of the population suffers from chickenpox before the age of 15 years. After entering the body, the virus integrates into the human nerve ganglia, where it remains in a passive state for life. An infected person gains lasting immunity to chickenpox.

There are cases of re-infection of people who have had chickenpox or reactivation of the virus. This occurs when the immune system is severely weakened.

Infection with the varicella zoster virus is benign, complications are observed in 5% of cases of pathology. The most dangerous of them is pneumonia. The accession is also celebrated bacterial infection(pyoderma), which can develop into sepsis.

Less commonly, the following may develop:

• encephalitis;
• myocarditis;
• arthritis;
• hepatitis;
• nephritis.

In cases of infection of a pregnant woman, a teratogenic effect of the virus on the fetus is possible. The probability of malformations of the eyes, limbs, brain and spinal cord is 1–2%. Possible miscarriage early stages and congenital infection syndrome in the fetus after childbirth.

Infection with the virus in adults is especially dangerous. In these cases, a disease develops - herpes zoster, which affects the nerve fibers. The pathology is characterized by a severe course, prolonged pain and the development of complications.

Vaccination will help prevent all these complications. The advantages of vaccination are confidence in the health of the child, guaranteed safety of children attending collective institutions and confidence in a safe pregnancy for girls of childbearing age.

How does the vaccine work?

After a virus (antigen) enters the body, the immune system produces special cells (antibodies) that are aimed at eliminating it. The VZ virus is distinguished by long-term persistence in the human body, and accordingly antibodies are preserved.

In addition, the virus remains forever in the immunological memory. When it re-enters the body, a faster immune response is formed. The pathogen is eliminated unnoticed by the person or the infection proceeds in a mild form.

The principle of vaccination is based on these features of the immune system. This is an artificial increase in immunity to disease by introducing antigens into the body. Attenuated strains of the VZ virus are used as antigens for chickenpox.

Chickenpox vaccines

In Russia, two vaccines are registered and used against chickenpox. These are the drugs Okavax and Varilrix. Both vaccines contain live attenuated (weakened) strains of the Varicella Zoster virus (Oka strain).

Scientists at the Japanese Biken Research Institute obtained a specific strain for the vaccine from a vesicle of a boy named Oka who had a typical form of chickenpox. This strain of the virus received its name - Oka. Subsequently, new vaccines were developed based on this strain in the USA and Europe.

The products differ in vaccination technique, excipients, supply and proven level of effectiveness. Therefore, when choosing a specific vaccine, they are guided by factors of convenience for patients, individual contraindications and the availability of drugs in a medical institution.

The vaccine is produced by the Japanese Biken Research Foundation, the official distributor is the French pharmaceutical concern SANOFI PASTEUR.

The first vaccine containing attenuated varicella zoster virus was created in 1974. It was registered and recommended for widespread use in 1986.

One dose of the drug (0.5 ml) contains a live attenuated VZ virus of at least 1000 PFU (plaque-forming units).

Auxiliary components:

• sodium chloride 1.14 mg;
• potassium dihydrogen phosphate 0.29 mg;
• potassium chloride 0.03 mg;
• sodium hydrogen phosphate dodecahydrate 3.14 mg;
• sucrose 25 mg;
• sodium glutamate 0.36 mg;
• kanamycin monosulfate up to 7 mcg;
• erythromycin lactobionate up to 2 mcg.

Additional components are absolutely harmless to the body of a healthy person of any age.

The vaccine is administered once. Research methods have proven that one dose of the drug leads to the formation of long-term immunity in 95% of patients.

The vaccine was developed by the English pharmaceutical concern GlaxoSmithKline plc and is produced at a plant located in Belgium.

Main substance (in a dose of 0.5 ml): live attenuated VZ virus with a specific activity of at least 3.3 lg PFU.

Excipients:

• human serum albumin 1 mg;
• neomycin sulfate not less than 25 mcg;
• lactose 32 mg;
• sorbitol 6 mg;
• mannitol 8 mg;
• amino acids 8 mg.

The drug does not contain preservatives.

The effectiveness of the vaccine is achieved with two doses. The time interval between them is at least 1.5–3 months. In this case, the efficiency is 98–100%.

The instructions for the drug indicate a single dose for patients under 13 years of age. Most pediatricians recommend not waiting until this age.

Which vaccine is better tolerated by a child?

The drugs differ in the frequency of administration, the percentage of effectiveness and the composition of additional substances. According to the majority of immunologists who rely on their practice, there are no cases of illness after using Varilrix. After vaccination with Okavax, infection occurs, but the disease is mild.

Varilrix is ​​a drug for chickenpox vaccination in the state immunization program of European countries and the United States. This further proves his advantage over Okavax.

The choice of drug may be influenced by the patient's sensitivity to the antibiotics contained in Varilrix. If the body is hypersensitive during the first administration of Varilrix, it is replaced with Okavax. The drugs are interchangeable, and the effectiveness of immunization is not reduced.

How long does the vaccine last?

Specific immunity to antigens is formed within 6 weeks after vaccination. The vaccine is effective for a long time, but does not provide a 100% guarantee against infection with the virus. The drug reduces the risk of infection to 95–98% and the development of complications in case of possible infection.

The duration of action of the vaccine is confirmed by studies conducted in people vaccinated 20 years ago. Antibodies to the chickenpox virus were found in their bodies. According to vaccine manufacturers, their duration of action reaches up to 30 years.

Vaccination dates

WHO and vaccine manufacturers recommend vaccination after the age of 1 year. This is the only time limit; otherwise there are no restrictions. In the absence of contraindications, vaccination can be done at any age, at a time convenient for the patient. Indications for vaccination are people who have not been vaccinated and have not had chickenpox before.

Is it worth getting the chickenpox vaccine?

The chickenpox vaccination is not included in the compulsory vaccination schedule for children in Russia. This is a voluntary decision of parents, who must adequately evaluate all the pros and cons of the procedure. Since the procedure is optional, documents for refusal and medical withdrawal are not required.

Arguments for vaccination

Parents are always wary of vaccinations. They are frightened by possible complications, in the descriptions of which one can find pathologies with a high risk of death.

Chickenpox vaccination is easily tolerated by children. Serious complications occur in cases of violation of contraindications, use with incompatible drugs and violation of vaccination technique.

Vaccination will help prevent complications:

• Chickenpox in childhood is considered a relatively mild disease.

However, in Lately Severe cases of pathology with severe intoxication, fever, pain in muscles and joints, damage to the mucous membranes of the eyes and mouth are becoming increasingly common. It is assumed that the virus will gradually mutate - the formation of new forms that are resistant to antibodies of the immune system.

• Vesicular rashes with chickenpox and spontaneous scratching often lead to damage to the deep layers of the dermis.

In this case, irreversible scars remain on the child’s face, which can only be removed by surgical methods.

• The varicella zoster virus is neurotropic and, under favorable conditions, can affect the nervous system.

In these cases, encephalitis develops. Damage to the lungs with the development of pneumonia is also possible. These cases are typical for adult patients who are not immune to the virus.

• Vaccination is important to ensure a safe birth and protection from the virus in the first 6 months of life.

Congenital chickenpox syndrome is characterized by a high risk of damage to the central nervous system and other organs, and the infection can affect intrauterine development fetus

Vaccination is especially necessary for children with weak immune system, with chronic pathologies of internal organs, oncohematological diseases and parents who seriously suffered from chickenpox in childhood.

The cons of vaccination

The main argument against the procedure was formed under the influence of an outdated concept - mandatory infection of a child at a young age. This method was practiced before when there were no vaccines. However, even with the advent of specific prevention means, one can hear a recommendation not to isolate the child from the sick.

Yes, after an illness, a child acquires stable immunity, which guarantees safety from the virus for life. But we should not forget about cases of severe disease, which invariably leave pathological consequences in the child’s body.

Possible complications also raise doubts among parents, severe forms of which are observed in 0.15% of all vaccination cases. This is a very small percentage. Analyzing possible complications from the disease itself, the benefits of vaccination are very significant.

Vaccination against chickenpox is generally done for a fee, and the cost of the drug is not small. Not all families have the opportunity to allocate funds for the procedure.

Infectious disease specialists and pediatricians who deal with complications of chickenpox in practice and know everything possible consequences diseases, vaccination is recommended.

Contraindications

The composition of vaccines is constantly being improved and designed so that they can be used in the majority of the population with minimal testing of the body. But each vaccine has a number of contraindications, compliance with which will help to avoid consequences:

• hypersensitivity to the components of the drug;
• acute forms of pathologies (the procedure is postponed until stable remission);
• respiratory, intestinal infections (vaccination is done 2-4 weeks after recovery);
• diseases nervous system(interval 6 months);
• immunodeficiencies (leukemia, lymphoma, blood dyscrasia, HIV infection) with a leukocyte level below 1200 lymphocytes/mm 3 and other pathological indicators;
• pregnancy and lactation (vaccination is done 3 months before the expected conception);
• allergic reaction upon initial administration of the drug;
• surgical treatment (interval 30 days);
• chemotherapy (3 month interval) subject to confirmed immune status.

There are diseases that require a thorough examination of the body and medical supervision. These are chronic pathologies of the cardiovascular system, kidneys, and liver.

Interaction with other drugs

Vaccination against chickenpox is carried out only 3 months after the administration of immunoglobulins and blood transfusion (blood transfusion). Salicylates should not be used for 6 weeks after vaccination; Reye's syndrome may develop.

Combining a vaccine with large doses of hormonal drugs can lead to adverse reactions in the body and reduce the effectiveness of immunization.

The vaccine can be administered simultaneously with the combination measles-rubella-mumps or diphtheria-tetanus-pertussis vaccine. The drugs are administered simultaneously to different places. At the same time, the level of the immune response does not decrease. If vaccines are given in different time, you need to maintain an interval between them of at least 30 days.

The interval between the chickenpox vaccination and other vaccines (not listed above) is at least 30 days.

Preparing for vaccination

Before any vaccination, the child must be examined by a pediatrician. In this case, you need to inform your doctor about all possible deviations in the child’s behavior and condition: lack of appetite, lethargy, suspicious skin rashes. It's important to insist general analysis blood, for the presence of infectious agents in the body.

3-5 days before vaccination, you need to stop visiting collective places (daycare centers, schools or other crowded places).

This is important to prevent infection. The introduction of a vaccine is dangerous even during the incubation period of any viruses and bacteria, the effect of which at this time does not manifest itself externally.

Children with allergic pathologies may be prescribed antihistamines to relieve and prevent symptoms. The doctor makes the decision about this. Basically, they are prescribed a few days before vaccination.

A week before vaccination, new foods should not be introduced into the child’s diet.

This is important to prevent unpredictable reactions from the gastrointestinal tract and allergic reactions.

The day before vaccination, the diet should be light:

• liquid porridges, soups;
• vegetables fruits;
• beverages.

Minimal congestion of the gastrointestinal tract will help the child tolerate vaccination more easily. Avoid eating completely for 1 hour before the procedure.

Before vaccination, they try to prevent the child from overheating and sweating. If this happens, you need to free the child from excess clothing, let him catch his breath and drink water.

Vaccination

Vaccination is carried out by a qualified medical worker who receives special permission to perform the procedure. The basis for admission is annual exams confirming their qualifications.

Before the procedure, you need to make sure that the vaccine is stored in the refrigerator and its shelf life is not violated. The vaccine kit includes a dry substance with active substances (lyophilisate) and a solvent (water for injection).

The solution is made only in a darkened room. When hit sunlight virus strains are quickly inactivated. Storing the finished solution is not permissible.

The vaccine is administered subcutaneously, traditionally in the area of ​​the deltoid muscle of the shoulder. This technique allows you to reduce side local manifestations. Injections under the shoulder blade and into the outer surface of the thigh are possible. Intravenous administration the drug is excluded.

Injection into the buttocks carries a risk of injury sciatic nerve, prolonged absorption due to penetration into the subcutaneous fatty tissue.

After the procedure, the patient is asked to stay in the clinic for 30 minutes to monitor a possible allergic reaction. Parents of vaccinated children should receive advice on lifestyle rules during the post-vaccination period.

Emergency prevention

Emergency prevention is the administration of one dose of the vaccine after contact with a patient. The effectiveness of the vaccine depends on the amount of time that has passed since exposure to the virus.

This is 72 hours after contact with someone with a rash. People who interacted with a sick person 2-3 days before the rash appeared should be vaccinated within 24 hours. After this time, the procedure is useless.

Immediately after vaccination, the child can be given mineral water or herbal decoction to drink. You should not stay for a long time in the clinic, where the risk of infection is one of the highest.

You must refrain from eating for 1 hour. Over the next 2-3 days, food is given in the minimum amount possible. They are fed light and liquid meals. Breastfeeding is also limited.

On the first day after vaccination water treatments are excluded. Contaminated areas of the body are wiped with a moistened towel, avoiding the injection area. In the following days, if not high temperature, you can swim.

After vaccination you cannot:

• use vitamin D (an allergic reaction is possible);
• visit crowded places;
• swim in ponds, pools;
• use antihistamines that dry out the mucous membranes of the respiratory tract (Suprastin, Tavegil).

If in kindergarten or there is collective immunization at school, it is better to stick to the home regimen for 2-3 days.

Reaction to vaccination

In general, chickenpox vaccination is easily tolerated by patients, regardless of age. Local and general reactions are rarely observed with full compliance with vaccination rules.

Develop more often local symptoms. This is a slight induration, pain, swelling and redness at the injection site. They do not cause concern and are eliminated within 2-3 days.

Common symptoms occur in 0.1-5% of patients:

• increased body temperature below 38°C;
• a rash similar to chickenpox, but less pronounced;
• headache;
• conjunctivitis;
• rhinitis, cough;
• diarrhea, vomiting, abdominal pain;
• pruritis (local itching);
• enlargement and tenderness of the cervical lymph nodes;
• general weakness.

Similar symptoms may develop 7-21 days after vaccination. These are delayed reactions of the body to strains of the virus that do not require treatment and indicate active immunization.

If the child’s temperature is poorly tolerated, it is permissible to relieve it with an antipyretic drug based on ibuprofen or paracetamol. The use of antihistamines and other drugs is pointless.

The reason to consult a doctor is a fever above 39°C, a profuse rash all over the body, progression of symptoms for more than 3 days, convulsions, loss of consciousness, and the formation of a purulent abscess at the injection site.

Complications

According to WHO, 1,500 cases of post-vaccination complications have been registered worldwide among 10 million patients.

• encephalitis;
• herpes zoster (mild form);
• thrombocytopenia;
• neurological disorders (impaired sensitivity);
• erythema multiforme syndrome;
• arthritis.

The main reasons for these cases are violations of recommendations during vaccination.

Answers on questions

Here are doctors' answers to the most common questions about vaccination that concern all parents.

Can chickenpox develop?

Many parents mistake the appearance of a rash and fever after vaccination for chickenpox. The symptoms are really similar to light form chickenpox, however, is not. These are signs of activation and formation of antibodies against the virus, which are called chickenpox-like.

An infection can develop if contraindications for the use of the vaccine are violated: immunodeficiencies, chemotherapy, severe pathologies, etc.

Is it possible to go for a walk?

Given that normal temperature bodies can and should be walked. Fresh air will help the body quickly cope with the unpleasant manifestations of the vaccine. To do this, choose uncrowded places and park areas.

Is a vaccinated person contagious?

A vaccinated person is a source of non-contagious infection for 3 weeks. The risk of infection in healthy people is very small. The danger comes from contact of a vaccinated person with people at risk: pregnant women (especially in the first trimester) and patients with pathologies characterized by immunodeficiencies.

Is it possible to wet the vaccination site?

It is advisable not to wet the injection site for 2 days. After any vaccination, it is important to monitor the body’s reaction to the injected virus. One of the markers of the body's condition is the skin, according to appearance which can detect disturbances in antigen uptake. Water in this case acts as an irritant, invariably causing redness, which interferes with an adequate assessment.

Maybe it's better to get over it?

After an illness, a strong immunity is formed, guaranteeing protection against infection for life. Just remember that it is impossible to predict how the disease will progress. The effects of the dosed and weakened virus introduced during vaccination are predictable. They do not cause serious complications with a percentage close to 100.

Where to do the procedure and cost of vaccination

Vaccination is carried out in community clinics, vaccination centers or private clinics. The institution must have a license for medical activities, the list of which includes work on preventive vaccinations.

Vaccination against viral smallpox is not included in the list of mandatory preventive measures approved by the Ministry of Health of the Russian Federation. Therefore, the procedure can generally only be done for a fee. The cost of the Okavax and Varilrix vaccines is the same, from 2,500 to 5,000 rubles.

A significant difference in prices is achieved due to the inclusion in the price of the vaccine of consultations with pediatricians, services for the procedure, etc. This may affect the increase in prices and temporary shortages of drugs in a certain area.

You can often find promotions with big discounts on vaccines. This mainly happens when large stocks accumulate in the clinic and there is a risk of expiration. Therefore, if you have a question about vaccination, it is better to contact several clinics; the prices in many of them are unreasonably high.

Vaccination against chickenpox is included in the calendar of preventive vaccinations for epidemic indications.

In cases of outbreak of extensive foci of infection, the Ministry of Health of the Russian Federation makes a decision to immunize children and adults at risk who have not previously been vaccinated and have not had chickenpox. In this case, the procedure will be free. It is carried out in local clinics.

Vaccination against smallpox virus is included in many European countries and the USA. The experience of these countries proves the effectiveness of immunoprophylaxis of the disease, so many experts recommend introducing this procedure in Russia with funding from the federal budget. It is quite possible that this procedure will appear in our vaccination calendar in the coming years and will be free.

Vaccination against herpes is used for frequent relapses of the disease, to weaken the activity of the virus, prolong remission and prevent the development of complications, as well as for preventive purposes. Before vaccination, you should weigh the pros and cons, since the immunobiological drug has a number of restrictions on its use.

Indications for use

The herpes vaccine is given for both preventive and therapeutic purposes. Main indications for use:

1. Immunoprophylaxis is intended to prevent infection with viruses of types 1 and 2, which cause disease on the lips and genitals (more details).
2. Vaccine prevention will help prevent the activation of the virus (herpes zoster), which is already in the human body and causes herpes zoster (if the immune system is weakened, after suffering viral and infectious diseases etc.).
3. Immunoprophylaxis is indicated for people suffering from frequent relapses of genital and labial herpes, which are difficult to treat. Helps to reduce the symptoms of the disease and achieve stable remission.
4. Vaccination is recommended for people over 60 years of age, people with immunodeficiency (HIV infection, oncology), as well as women at the stage of planning pregnancy, if they have frequent occurrence rashes on lips.

Herpes vaccine

The polyvalent herpes vaccine is the development of a new generation, with which you can act on various subtypes of the herpes virus - types 1, 2, 6, etc.

The Vitagerpavac vaccine has good effectiveness. The immunobiological drug activates cellular immunity, thanks to which the body fights the effects of herpes.

Instructions for use medicine prescribes features of use and contraindications for use. They must be taken into account to prevent the development of side effects and complications.

special instructions

Immunoprophylaxis is not carried out during the active phase of herpes. If it is not possible to achieve a stable stage of remission, at least 7-10 days must pass after the last signs of the disease disappear. In this case, the person must be under medical supervision for several days.

Herpes vaccine injections are given only as directed. You cannot decide on your own whether or not to vaccinate. The procedure is carried out in a clinic or hospital. After the manipulation, how the body responded to the administration of the drug within 30 minutes is taken into account.

Women cannot be vaccinated against herpes during pregnancy: the introduction of an immunobiological drug can provoke an adverse effect on the fetus.

Injections are given subcutaneously in middle third forearms. Adults and children are prescribed different courses of vaccination. The required dosage and dosage regimen of the drug is determined individually, depending on the state of health and the desired goal (treatment or prevention of herpes virus infection).

Contraindications

Vaccination is contraindicated for people during exacerbations of herpes virus infection or other infectious and somatic pathologies. This is due to the fact that the body is weakened and is unable to give an adequate reaction in response to the introduction of the vaccine.

Active phase of AIDS, and others acute diseases are categorical contraindications to immunoprophylaxis against herpes.

The active phase of AIDS is a categorical contraindication to immunoprophylaxis against herpes.

The chickenpox vaccination is a specific method of preventing the disease, with which you can prevent the occurrence of infection, and if it develops, alleviate the course, speed up the recovery process and prevent the formation of complications. The vaccine is characterized by high efficiency and a small number of contraindications for use.

The chickenpox vaccination is a specific method of preventing the disease, with which you can prevent the occurrence of infection, and if it develops, alleviate the course, speed up the recovery process and prevent the formation of complications.

Indications

The chickenpox vaccination can be done at any age, as long as the person has not previously had this infection.

Vaccination is intended to prevent chickenpox, since this disease is characterized by 100% contagiousness (infectiousness).

For adults

Routine chickenpox vaccination for adults is indicated in the following cases:

1. Severe somatic diseases, which include diabetes, arterial hypertension, cardiovascular failure, severe pathologies of the liver, kidneys, etc. In a weakened body, the occurrence of chickenpox can lead to the development of complications, since the human immune system is not able to resist the virus.
2. Acute leukemia during remission. Vaccination will help to form lasting immunity to the disease and prevent the development of infection, which can intensify the course of the oncological process.
3. Long-term treatment with drugs that have the ability to reduce immunity. These include drugs that are used in the treatment of malignant neoplasms.
4. Patients who will undergo any organ transplantation in the near future.

For children

Vaccination against chickenpox is included in the vaccination schedule as recommended. However, many doctors, including Dr. Komarovsky, recommend that it be carried out in preschool age, citing the fact that even in the most prosperous countries in the world there are severe complications after an infection. Therefore, even if vaccination is not free and has a high cost, this should not become an obstacle to immunization.

Immunization against chickenpox is recommended for all children over 2 years of age. After all, outbreaks of infection are most often recorded in preschool institutions. The vaccination should be done before going to camp or other health facilities, if the child has not previously had chickenpox.

Vaccination is indicated for children with immunodeficiency, severe damage to the kidneys, liver, heart defects and oncology.

Before pregnancy

If a woman has not previously had chickenpox, it is advisable to get vaccinated when planning pregnancy. We must not allow the disease to occur during gestation; it will result in adverse consequences. In the first trimester, chickenpox threatens miscarriage or intrauterine fetal death, and in later- development of the disease immediately after the birth of the child.

Kinds

There are several types of chickenpox vaccine, but not all of them are approved for use. IN Russian Federation They use 2 types of immunobiological preparations, with the help of which it is possible to develop protective antibodies against type 3 herpes. These are Varilrix (manufactured by GlaxoSmithKline Biologicals, Belgium) and Okavax (manufactured by SANOFI PASTEUR, France). The main difference between immunobiological drugs and chickenpox is the packaging and vaccination schedule (number of doses).

Varilrix

The Varilrix vaccine contains a weakened varicella zoster virus, which contributes to the production of protective antibodies and enhanced immunity. Recommended for use by both children and adults. It is used for routine and emergency vaccination against chickenpox.

To develop immunity in an adult, 2 doses of the vaccine are required, which provides 100% protection for the person.

The price of the drug is high, but its quality is beyond doubt. Varilrix is ​​well tolerated and does not lead to the development adverse reactions and complications.

Okavax

The vaccine is indicated for use in all age groups, including children over 1 year of age. Helps prevent the development of the disease; after one dose, 90% of vaccinated people develop immunity. The Okavax vaccine kit contains 2 vials, one of which contains dried weakened viruses, the other contains a solvent.

The name “Okavax” is familiar to people in many countries; the immunobiological drug is successfully used not only for routine prevention of the disease, but also to prevent the development of infection after contact with a sick person.

The Okavax vaccine kit contains 2 vials, one of which contains dried weakened viruses, the other contains a solvent.

Chickenpox vaccination schedule

There are 2 vaccination schedules, which are based on the patient’s age:

• for children, one dose of an immunobiological drug is sufficient;
• adults are vaccinated twice - with an interval of 1.5-2 months.

When they do

Vaccination against chickenpox is indicated for use in the following cases:

1. Planned. Designed to strengthen human health and increase the body's resistance to the action of viruses from the herpes simplex group. The vaccine is given to children over 12 months and adults at any age without restrictions.
2. Emergency. It is carried out within 48-72 hours after contact with a patient with chickenpox. The developed defense will prevent the development of the disease, and in the event of an infection it will prevent serious complications.

Chickenpox vaccination

Chickenpox vaccinations

How long does it last?

Antibodies against the zoster virus remain in the human body for 8-10 years. Sometimes this figure increases to 20 years. In order to form stable immunity and extend the duration of protection against chickenpox, after this time, immunoprophylaxis should be repeated.

Where to do

The chickenpox vaccine is given in any public clinic. The procedure is carried out in vaccination room after examination by a doctor and filling out all the necessary documentation.

A person can also go to a private clinic, but the cost of vaccination will be much higher, since you need to pay not only for the vaccine itself and the procedure, but also for a doctor’s consultation.

Reaction to vaccination

In most cases, the chickenpox vaccine injection is easy to tolerate. However, due to individual characteristics the human body may develop local and general side effects.

The first signs of reactions to the administration of an immunobiological drug against chickenpox:

• the injection site becomes compacted;
• redness and hyperemia appear on the skin;
• local pain occurs.

These symptoms disappear within a few hours and do not require any treatment. However, sometimes the post-vaccination period occurs with delayed reactions that occur 7-14 days after the administration of the chickenpox vaccine.

At the same time, the body temperature rises, itching and rashes reminiscent of chickenpox appear. Signs of general intoxication appear (weakness, sweating, headache), increase in size and become painful The lymph nodes. Occasionally, short-term diarrhea develops. The rash goes away within a few days.

Is a person contagious after

After immunoprophylaxis against chickenpox for 5-6 weeks, a person is a carrier of the zoster virus. Despite this, he does not pose a danger to others. The only exception is the case when, due to a weakened immune system, the vaccinated person gets chickenpox.

Is it possible to get chickenpox

The chickenpox vaccine contains a weakened virus. The likelihood of its activation and development of infection is extremely low, but it exists. In this case, the disease occurs in a mild form, which is manifested by the appearance of single elements of the rash and is not accompanied by a deterioration in well-being.

Contraindications

Chickenpox vaccination has some restrictions on its use that must be taken into account. Absolute contraindications include the following conditions:

1. Acute somatic disease and exacerbation of chronic pathology.
2. Acute respiratory and intestinal viral infections. Vaccination is done no earlier than 3-4 weeks after complete recovery.
3. In severe immunodeficiency, accompanied by a sharp drop in the level of lymphocytes (less than 1200 cells per 1 ml). This pathology occurs in malignant neoplasms, AIDS, long-term use of glucocorticosteroids, etc.
4. Individual allergic reaction to neomycin and other substances that are part of chickenpox vaccines.
5. Carrying out emergency immunoprophylaxis (administration of immunoglobulins) or using blood products within 6 months before the planned vaccination.

Relative contraindications include chronic diseases heart, liver, kidneys and other organs, a tendency to seizures, weakened immunity and a history of allergic reactions to the administration of other immunobiological drugs. If there are relative contraindications, vaccination is possible, but it is better to do it after a thorough examination of the patient and laboratory and instrumental studies.

Sometimes it is necessary to postpone vaccination for a while. When will there be convincing stabilization? chronic process, this may indicate a minimal risk of complications.

Complications after the chickenpox vaccine

The likelihood of developing complications after vaccination is extremely low. Most often, an allergy to the components of the drug develops, which manifests itself in the form of a rash, itching and swelling of the skin. Goes away after using antihistamines.

Other possible consequences include:

• herpes zoster (shingles);
• joint pathologies;
• encephalitis;
• changes in skin sensitivity;
• the appearance of erythema;
• changes in blood parameters (decrease in the number of platelets in the blood).

Pros and cons

Immunoprophylaxis has both advantages and disadvantages. On the one hand, with the help of vaccination, a stable, intense immunity to chickenpox is formed. However, it does not persist for life, and revaccination will be required after 5-10 years.

Vaccination helps protect a child or adult from developing the disease through contact with a sick person. This will make it possible to avoid the spread of infection and eliminate family outbreaks.

The main disadvantage of immunoprophylaxis is the likelihood of adverse reactions and complications. But this is noted with any vaccination. In addition, it is common knowledge that young children get chickenpox more easily than adults. Therefore, if you vaccinate a child, no one can guarantee that he will not get sick in 15-20 years, then the infection will be much more severe, with the development of complications.

If a person cannot decide whether he needs vaccination against chickenpox or not, he must be tested for the presence of antibodies to the zoster virus in the blood. Sometimes you can have a mild form of chickenpox and not even know it.

WHO position paper

The World Health Organization (WHO), through its Global Program on Vaccines and Immunization (GPVI), offers information and recommendations on vaccines used in the Expanded Program on Immunization. In line with its global commitment, the organization produces a series of regularly updated WHO position papers on other vaccines and vaccine combinations against diseases of international public health concern. These documents primarily address the use of vaccines in large-scale immunization programs; Limited immunization for personal protection, carried out mainly in the private sector, could be a good addition to national programs, but is not covered in these documents. WHO position papers summarize basic information on relevant diseases and vaccines and provide an opinion on WHO's current position on their use in a global context. The documents have been reviewed by a number of experts both inside and outside WHO and are intended for use primarily by public health workers in countries as well as managers of immunization programs. However, WHO position papers may also be of interest to international funding agencies, vaccine manufacturers, the medical community and scientific publications.

Summary and conclusions

Varicella (chickenpox) is an acute, highly contagious viral disease, distributed throughout the world. While chickenpox is a relatively mild illness in childhood, it can become more serious in adults. It can be fatal, especially in newborns and those with weakened immune systems. Varicella zoster virus (VZV) is the causative agent that exhibits little genetic variation and is not found in animals. After infection, the virus remains latent in the ganglia and, following subsequent reactivation, VZV can cause herpes zoster, a disease primarily affecting the elderly and immunocompromised individuals. Although individual cases may be prevented or ameliorated by specific immunoglobulin or antiviral treatment, control of chickenpox can only be achieved through widespread immunization. Varicella vaccines using the Oka strain of VZV have been on the market since 1974. Positive results regarding safety, effectiveness and cost-effectiveness analyzes have supported the rationale for their introduction into childhood immunization programs in a number of industrialized countries. After following study populations for 20 years in Japan and 10 years in the United States, more than 90% of immunocompetent individuals vaccinated in childhood were still protected against varicella.

Information regarding some aspects of varicella immunization is still incomplete. The duration of protection against varicella and herpes zoster without natural infection with the virus, the epidemiological impact of childhood immunization at different levels of immunization coverage, and the effect of immunization in preventing herpes zoster among adults and the elderly with a history of varicella need to be studied more carefully. Moreover, little information is available from developing countries regarding the incidence of varicella and herpes zoster, as well as the incidence and role of secondary infections. However, varicella is unlikely to be a priority vaccine-preventable disease in most developing regions.

Decision-makers about the use of varicella vaccine as part of routine immunization programs should consider the epidemiology, public health significance of the infection, and the socioeconomic significance of varicella relative to other public health problems where resources are limited.

• In most developed countries, there are other vaccine-preventable diseases that cause significantly higher morbidity and mortality, making varicella vaccine not a high priority for routine introduction into national immunization programs.
• Routine immunization of children against varicella may be considered in countries where the infection is a relatively significant public health and socioeconomic development problem, where the vaccine can be obtained and where it can be achieved and maintained. high level vaccination coverage (85%-90%). (Immunizing children at lower coverage levels could theoretically change the epidemiology of the infection and increase the number of serious cases among older children and adults.)
• In addition, the vaccine can be offered in any country to adolescents and adults without a history of chickenpox in individually, especially those who are at high risk of contracting or spreading the infection. This use of the vaccine among adolescents and adults does not pose a risk of epidemiological changes because exposure of children to VZV remains unaffected.

General information

Public Health Aspects

Chickenpox is a highly contagious viral disease with a worldwide distribution. In the temperate climate of the Northern Hemisphere, chickenpox occurs mainly in late winter - early spring. The incidence of secondary cases approaches 90% among susceptible household contacts. The causative agent, varicella zoster virus (VZV), is transmitted by airborne droplets or by direct contact, and patients are usually contagious several days before the onset of the rash and until the rash crusts over. Once one case occurs among susceptible individuals, it is very difficult to prevent an outbreak. Since the subclinical form of infection is quite rare, almost every person has encountered the disease. Mild forms of infection may sometimes go undiagnosed or misdiagnosed. Thus, in temperate regions, most adults with a negative history of varicella are seropositive when tested.

In temperate countries, most cases occur before the age of 10 years. The epidemiology is less clear in tropical regions, where a relatively large proportion of the adult population in some countries is seronegative. Chickenpox is characterized by an itchy vesicular rash, usually starting on the scalp and face and initially accompanied by fever and general malaise. As the rash gradually spreads to the body and limbs, the first vesicles dry out. Usually all crusts disappear after 7–10 days.

Although varicella is a relatively benign childhood disease and is rarely considered a significant public health problem, the disease can sometimes be complicated by VZV pneumonia or encephalitis, which can be persistent or fatal. Disfiguring scars may result from secondary infection of the vesicles; in addition, necrotizing fasciitis or septicemia may occur as a result of such infection. In the United States and Canada, invasive group A streptococcal infections, complicating chickenpox, occur with alarming frequency. Other serious manifestations include pneumonitis (more common in adults), rarely congenital varicella syndrome (caused by chickenpox contracted during the first 20 weeks of pregnancy), and perinatal varicella in newborns whose mothers develop chickenpox between 5 days before and 48 hours after. childbirth In patients with immunodeficiencies, including HIV infection, chickenpox is severe, and cases of herpes zoster may recur. Severe and fatal chickenpox may also occur in children taking steroid hormones for the treatment of asthma. In general, complications and deaths from chickenpox are more common in adults than in children. The case fatality rate (deaths per 100,000 cases) among healthy adults is 30-40 times higher than among children aged 5-9 years. Therefore, when implementing an immunization program, it is important to ensure high levels of immunization coverage to ensure that prevention programs do not cause varicella epidemiology to change, resulting in higher incidence rates among adults.

About 10-20% of chickenpox cases go on to develop herpes zoster, or shingles, a painful, vesicular rash on the skin. Most cases of herpes occur after the age of 50 or in people with weakened immune systems. It is a relatively common complication in HIV-positive individuals. Herpes can sometimes lead to such permanent neurological lesions, such as cranial nerve palsy and cross hemiplegia, or visual impairment after herpes ophthalmia. Almost 15% of all people with shingles experience pain or paresthesia in the area of ​​the affected skin for at least several weeks, and sometimes permanently (postherpetic neuralgia). Disseminated and, in some cases, herpes zoster with fatal can be observed in cancer patients, AIDS and other conditions associated with immunodeficiency. Transmission of VZV from people with herpes zoster can cause chickenpox in non-immune contacts.

The causative agent of infection

VZV is a double-stranded DNA virus belonging to the herpesvirus family. Only one serotype is known, and humans are its only reservoir. VZV enters the human body through the nasopharyngeal mucosa and almost without exception causes clinical disease in susceptible individuals. Incubation period usually 14-16 (10-21) days. After chickenpox, the virus remains in the sensory nerve ganglia, where it can later reactivate and cause herpes zoster. Serum antibodies against viral membrane proteins and glycoproteins are used in diagnostic tests, but they are less reliable because they depend on immunity, especially in the case of herpes zoster. As with other human herpesviruses, a nucleoside analogue of acyclovir inhibits VZV replication, although less effectively than with Herpes simplex.

Immune response

Natural infection confers lifelong immunity to varicella in almost all immunocompetent individuals. Newborns of immune mothers are protected by passively acquired antibodies during the first months of their life. Temporary protection for persons who do not have immunity can be obtained by administering specific varicella zoster immunoglobulin within three days of exposure to the infection. Immunity acquired during the course of the disease does not prevent either the occurrence of latent VZV infection or the possibility of subsequent activation in the form of herpes zoster. Although antibody detection tests have been used successfully as an indicator of past infection or response to vaccination, failure to detect antibodies against VZV does not necessarily indicate susceptibility, as appropriate cellular immunity may still be present. On the other hand, about 20% of individuals aged 55–65 years do not demonstrate detectable cellular immunity to VZV, despite the presence of persistent antibodies and a history of chickenpox. Herpes zoster is clearly associated with a fall in VZV-specific T cell levels, and an episode of herpes zoster activates a specific T cell response.

Rationale for vaccination as an infection control approach

Other than vaccination, there are no countermeasures to control the dissemination of varicella or the incidence of herpes zoster in a susceptible community. Varicella-zoster immune globulin and herpes medications are very expensive and are mainly used as prophylaxis after exposure to infection or to treat chickenpox in people at high risk of developing severe disease. Due to its extreme contagiousness, chickenpox affects almost all children and young adults worldwide. Each year from 1990 to 1994, before the chickenpox vaccine was available, there were about 4 million cases of the disease in the United States. Of this number, approximately 10,000 cases required hospitalization and 100 patients died. Although varicella is generally not considered a significant public health problem, the socioeconomic impact of the disease in industrialized countries, where it affects almost every child and is a cause of absenteeism from work, should not be underestimated.

Recently marketed varicella vaccines have demonstrated safety and effectiveness. From a societal perspective, a recent cost-effectiveness analysis in the United States found that varicella immunization was worth the cost of one in five. Even when only direct costs were taken into account, the benefits almost equaled the costs. Similar studies are not conducted in developing countries. However, the socioeconomic aspect of chickenpox is likely to be less important in countries with different social system. On the other hand, the importance of chickenpox and herpes zoster for health care may increase in regions with high levels of endemic HIV infection.

There is still no documented evidence that the chickenpox vaccine, given to children or adults, will provide protection against shingles. However, a number of indicators, including the results of immunization of certain immunodeficient groups of the population, look encouraging. The public health impact of this vaccine, as well as socio-economic The effect of its use will increase significantly if it is proven that the vaccine protects the entire population from shingles. In developed countries, large amounts of money are spent on medical care for complicated cases of herpes zoster in immunocompromised or elderly people, and the increasing incidence of herpes zoster in areas affected by HIV infection is well known.

Chickenpox vaccines

The chickenpox vaccines currently available on the market are produced using the so-called Oka VZV strain, which has been modified through sequential propagation in different cell cultures. Different compositions Such live, attenuated vaccines have undergone rigorous testing and have been approved for use in Japan, the Republic of Korea, the USA, and several European countries. Some vaccines are approved for use at ages 9 months and older.

After one dose of the above vaccines, seroconversion occurs in approximately 95% of healthy children. From a logistical and epidemiological point of view, the optimal age for chickenpox vaccination is 12-24 months. In Japan and several other countries, one dose of vaccine is considered sufficient, regardless of age. In the United States, 2 doses of the vaccine given 4-8 weeks apart are recommended for adolescents and adults, of whom 78% seroconverted after the first dose and 99% after the second dose. Children under 13 years of age receive only one dose.

Small studies conducted with vaccines other than those currently licensed in the United States indicate that when the vaccine is administered within 3 days of exposure to VZV, at least 90% protective efficacy can be expected. Chickenpox in people who have received the vaccine is much milder than in people who have not been vaccinated. Required further research to determine the effectiveness of a currently licensed drug when used after exposure to the virus, particularly during outbreaks.

When given at different sites and using different syringes, giving varicella vaccine and other vaccines at the same time is as safe and effective as giving the same vaccines several weeks apart. However, to elicit the same immune response as monovalent varicella vaccine, the dose of the varicella component must be increased when included in a tetravalent vaccine in combination with measles-mumps-rubella vaccine. A multivalent vaccine has not yet been licensed.

According to Japanese experience, immunity to chickenpox after vaccination lasts for 10-20 years. In the United States, childhood varicella vaccination provides 70–90% protection against infection and >95% protection against severe disease 7–10 years after immunization. After investigating an outbreak of varicella in a day hospital, post-licensing effectiveness was 100% in preventing severe cases and 86% in preventing the disease itself. The attack rate among unvaccinated susceptible children was 88%. It is likely, but not yet proven, that some protection is also achieved against herpes zoster.

However, in Japan, as in the United States, vaccination coverage in the population is very limited, and the continued circulation of wild VZV is likely to cause post-immunization natural revaccination. Thus, the long-term protection caused by the vaccine alone is difficult to assess at this time.

For immunocompromised individuals, including those with advanced HIV infection, immunization against varicella is currently contraindicated due to concerns about the spread of disease caused by the vaccine. However, the safety of the vaccine in asymptomatic HIV-infected children with a CD4 count >1000 has been assessed, and killed vaccine varicella vaccine is being studied in VZV-positive bone marrow transplant recipients in whom repeated doses of the vaccine have reduced the severity of herpes zoster. Moreover, in carefully monitored trials, patients with leukemia in remission or cancer patients before chemotherapy, as well as uremia patients awaiting kidney transplantation, received the vaccine. In most cases, 1-2 doses of the vaccine resulted in a high level of protection with moderate side effects. These patients also experienced a significant reduction in the incidence of herpes zoster.

Adverse post-vaccination manifestations

In healthy children, adverse post-vaccination manifestations are limited to swelling and redness at the injection site during the first hours after immunization (27%), and in some cases (< 5 %) вакцинированные переносят mild illness, similar to chicken pox, with rash for four weeks. In a placebo-controlled study of 900 healthy children and adolescents, pain and redness at the injection site were the only adverse events post-vaccination. The vaccine was also well tolerated by those previously vaccinated by mistake. Rare cases of mild herpes zoster following immunization indicate that currently used vaccine strains may cause latent infection with a subsequent risk of reactivation. After licensing and distributing more than 10 million vaccine doses in the United States, the Vaccine Adverse Event Reporting System (VAERS) has received reports of encephalitis, ataxia, pneumonia, thrombocytopenia, arthropathy, and erythema multiforme following immunization. These manifestations may not have a causal relationship with immunization, and they occur at a significantly lower frequency than after naturally acquired illness.

Contraindications to vaccination against chickenpox

This includes a history of anaphylactic reactions to any component of the vaccine (including neomycin), pregnancy (due to a theoretical risk to the fetus, pregnancy should be avoided for 4 weeks after vaccination), ongoing severe disease, and progressive immune disorders of any type. Current treatment with steroids (adults 20 mg per day, children >1 mg per day) is considered a contraindication for varicella vaccination, except in patients with acute lymphocytic leukemia in stable remission. The presence of congenital immune disorders in close family members is a relative contraindication. It is good that varicella zoster immunoglobulin (VZIG) and antiviral drugs are available in case an immunocompromised person receives the vaccine by mistake. Transfusions of blood, plasma, or immunoglobulin administered less than five months before or three weeks after immunization will likely reduce the effectiveness of the vaccine. Due to the theoretical risk of developing Raye's syndrome, the use of salicylates is not recommended within 6 weeks of varicella vaccination.

WHO general position on new vaccines

Vaccines for widespread use must:

• meet quality requirements as defined in the relevant Global Vaccine Quality Program policy statement;
• be safe and have a significant impact on the disease itself in all target populations;
• if intended for infants or young children, be easily adaptable to the immunization schedule and timing of childhood immunization programs;
• do not significantly affect the immune response to other vaccines administered at the same time;
• be designed to meet general technical constraints, such as cold chain storage and storage capabilities;

Have appropriate prices for different markets.

WHO position on varicella vaccines

Available varicella vaccines meet the above WHO requirements for use in industrialized countries. However, from a global perspective, there are limitations in terms of price and storage. For example, one of the available vaccines requires storage at -15°C and use within 30 minutes of reconstitution.

The likelihood that every child will contract varicella, coupled with a socioeconomic situation involving high indirect costs per case, makes varicella a relatively important disease in industrialized countries with temperate climates. It is estimated that the costs of routine immunization of children against this infection in such countries are economically justified. Limited serological studies indicate that susceptibility to varicella is more common among adults in tropical climates than in temperate climates. Thus, from a public health perspective, varicella may be a more important infection in tropical regions than previously thought, especially in areas of high HIV endemicity. Determining the significance of varicella in a global context requires further study. On the other hand, in most developing countries, other new vaccines, such as hepatitis B, rotavirus, Haemophilus influenzae conjugate and pneumococcal vaccines, have the potential to be much more important for public health and should be given higher priority than varicella vaccine. smallpox Therefore, WHO currently does not recommend the inclusion of varicella vaccination in routine immunization programs in developing countries.

The chickenpox vaccine can be used either for personal protection susceptible adolescents and adults, or at the population level, to protect all children, as part of a national immunization program. Immunization of adolescents and adults will provide protection for those at risk, but will not have a significant impact on the epidemiology of infection at the population level. On the other hand, widespread routine use of the vaccine to immunize children will have a significant impact on the epidemiology of the disease. If consistently high levels of vaccination coverage can be achieved, the infection could literally disappear. If only partial vaccine coverage can be achieved, the epidemiology may shift, leading to an increase in the number of cases among older children and adults. Thus, routine childhood immunization programs should emphasize achieving high, sustained immunization coverage.

Although observations in selected groups of immunocompromised individuals indicate that childhood immunization against varicella also reduces the risk of herpes zoster, the follow-up period since vaccine introduction is too short to allow firm conclusions to be drawn regarding the effectiveness of vaccination in preventing herpes zoster among children. general population. Moreover, rigorous studies of immunization in adults and the elderly are required before recommendations can be made regarding the use of varicella vaccine for the prevention of herpes zoster in these age groups.

Recommendations regarding the possible use of this vaccine for individuals with certain immunodeficiency conditions are beyond the scope of this article. Recommendations are provided by several expert panels, such as the Advisory Committee on Immunization Practices (ACIP) in the United States.