Varicella vaccine for children

Seven fatal varicella infections in children were potentially avoidable: A report from IMPACT centres from 2000 to 2005

A varicella vaccine for children has been readily available in Canada since 2000, but some parents and physicians doubt the need for it. The Immunization Monitoring Program, ACTive (IMPACT) network of pediatric hospitals tabulated 1900 varicella-related hospitalizations and seven varicella-related deaths from 2000 to 2005. The present report describes these fatal cases, demonstrating the unpredictable and avoidable nature of life-threatening varicella complications. The knowledge that healthy children can die of chickenpox could influence parents to accept the recommended vaccination. Deaths from varicella should cease to occur, given the safe alternative of, and free access to, vaccination in current provincial programs.

Disparities in varicella vaccine coverage in the absence of public funding

Varicella vaccine has been licensed in Canada since December 1998 but not provided free in all provinces. Through a cross-sectional telephone survey to a random sample of parents, we assessed factors associated with varicella vaccine uptake in the absence of public funding. Parents of children aged 2-3 years (Group I) and 6-7 years (Group II) were contacted between March and May 2003 in British Columbia, Canada. Response rate was 82% (Group I=571; Group II=704). Among susceptible children, varicella vaccine coverage was 21% (95% CI 18-25%) and 28% (95% CI 22-33%), respectively. There were significant disparities in vaccine coverage based on income and residence. Physician or nurse recommendation was a strong determinant of vaccine uptake as were belief in the safety and efficacy of vaccine. Among parents of susceptible children, 59% (343/582) would vaccinate their child if it were provided free; 25% (148/582) were undecided.

Varicella vaccination for grades 4 and 5 students: from theory to practice

BACKGROUND

In 2002-2003, as part of a pilot project, varicella vaccination was offered to susceptible students in grades 4 and 5 in schools whose health services are provided by a local community services centre in Montréal. This immunization campaign was merged with the hepatitis B immunization programme.

OBJECTIVES

To calculate the proportion of grade 4 and 5 students susceptible to varicella; to calculate the proportion of susceptible students who agree to be vaccinated; to compare the proportion of susceptibles who agree to be vaccinated when varicella vaccination is offered with the first or the second dose of hepatitis B; and to assess whether a catch-up varicella immunization programme would affect the vaccine coverage of a concurrent hepatitis B vaccination programme.

METHODS

The proportions of susceptible students and of parents of susceptibles who consented to vaccination were calculated. The proportions of parents of susceptibles who consented to vaccination were compared for both immunization strategies: varicella vaccination given with the first or second dose of hepatitis B vaccine. Logistic regression was performed to identify possible associations between consent to varicella vaccination and the various variables collected. Rates of vaccine coverage against hepatitis B after two doses were compared for the years 2000-2001 and 2002-2003.

RESULTS

Of 3,856 registered students, 3,486 (90.4%) returned consent forms. Among the 3,272 students for whom information was available, 441 (13.5%) were susceptible, including 394 (89.3%) who consented to vaccination. The rates of vaccine coverage in the schools after two doses of hepatitis B vaccine were exactly the same for the 2000-2001 and 2002-2003 school years.

CONCLUSION

Varicella vaccination of susceptible grade 4 and 5 students associated with a coincident hepatitis B vaccination campaign can be performed without negative impact on the hepatitis B vaccination programme.

Varicella vaccination for grades 4 and 5 students: from theory to practice

BACKGROUND

In 2002-2003, as part of a pilot project, varicella vaccination was offered to susceptible students in grades 4 and 5 in schools whose health services are provided by a local community services centre in Montréal. This immunization campaign was merged with the hepatitis B immunization programme.

OBJECTIVES

To calculate the proportion of grade 4 and 5 students susceptible to varicella; to calculate the proportion of susceptible students who agree to be vaccinated; to compare the proportion of susceptibles who agree to be vaccinated when varicella vaccination is offered with the first or the second dose of hepatitis B; and to assess whether a catch-up varicella immunization programme would affect the vaccine coverage of a concurrent hepatitis B vaccination programme.

METHODS

The proportions of susceptible students and of parents of susceptibles who consented to vaccination were calculated. The proportions of parents of susceptibles who consented to vaccination were compared for both immunization strategies: varicella vaccination given with the first or second dose of hepatitis B vaccine. Logistic regression was performed to identify possible associations between consent to varicella vaccination and the various variables collected. Rates of vaccine coverage against hepatitis B after two doses were compared for the years 2000-2001 and 2002-2003.

RESULTS

Of 3,856 registered students, 3,486 (90.4%) returned consent forms. Among the 3,272 students for whom information was available, 441 (13.5%) were susceptible, including 394 (89.3%) who consented to vaccination. The rates of vaccine coverage in the schools after two doses of hepatitis B vaccine were exactly the same for the 2000-2001 and 2002-2003 school years.

CONCLUSION

Varicella vaccination of susceptible grade 4 and 5 students associated with a coincident hepatitis B vaccination campaign can be performed without negative impact on the hepatitis B vaccination programme.

Stroke after varicella vaccination

Two children presented with acute hemiparesis 5 days and 3 weeks following varicella vaccination. Both showed unilateral infarction of the basal ganglia and internal capsule, a distribution consistent with varicella angiopathy. Both children had small patent foramen ovale (PFO), and one child also had severe iron-deficiency anemia, which may have predisposed the patient to this adverse effect.