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VARICELLA VACCINE -- USE AND STRATEGIES.

On March 17 the FDA licensed the varicella vaccine Varivax. Many pediatricians will not give the vaccine until it is "officially" recommended by the American Academy of Pediatrics. The Academy's guidelines appear in the May issue of Pediatrics. One dose of varicella vaccine is recommended for children between 12 and 18 months of age who have no history of varicella, although children up to 13 years of age may receive a "catch up" vaccination. From 13 years on, two doses of vaccine are recommended, preferably four to eight weeks apart. Immunocompromised children should not receive this live attenuated vaccine, but there are exceptions -- such as those on low-dose prednisone (below 2mg/kg/d) for asthma and nephrosis. Anyone with a history of chickenpox does not require vaccination. Whether those over 18 years without such a history should be serologically screened and immunized only if seronegative, or simply immunized without serologic testing, is unclear. A cost-effectiveness study appearing in the same issue finds that testing adolescents with a negative or uncertain history of chickenpox is significantly more cost-effective than vaccinating all teens with a negative history. Their decision-analysis model found that a "test all" policy in a hypothetical cohort of 10,000 adolescents without a history of chickenpox cost $287 for each case of chickenpox prevented, versus $517 in a "vaccinate all" policy. In children between 6 and 12 years, the respective costs were $164 and $166. (In an earlier study, the authors determined the cost per case of preventing varicella in preschoolers to be just over $2.) Comment: Depending on the practice setting (office, public clinic, or HMO), costs will vary. A "test-all-susceptible" policy in teens, though most cost-effective, is clinically the least effective, since another visit might be necessary; those who foot the bill will probably not feel that the extra cost of the extra visit is worthwhile.

— RA Dershewitz

Published in Journal Watch General Medicine May 16, 1995

Citation(s):

Lieu TA, et al. Cost-effectiveness of varicella serotesting versus presumptive vaccination of school-age children and adolescents. Pediatrics 1995 May 95 632-638.

• Medline abstract (Free)

Committee on Infectious Diseases. Recommendations for the use of live, attenuated varicella vaccine. Pediatrics 1995 May 95 791-796.

• Medline abstract (Free)