comparision of the franch and the american position on the chickenpox vaccine

1. A dangerous trend in the USA
1

2. Headache
Fever
Blisters Tiredness
Itching
Chicken pox
Sore (Varicella)
throat
22
http://www.cdc.gov

3. American parents’ first reaction
3

4. USA - Before 1995
Each year
4 million people would get the
chicken pox
About 10,500 – 13,000 were
hospitalized Majority :
healthy
children and
100 to 150 died adults
http://www.cdc.gov 4
Walter A., Orenstein M.D., National Immunization Program. Overview of the US Vaccination Program

5. Why a VZV vaccine?
Varicella develops in nearly all persons living in the US
• > 90% of adults immune to VZV
Complications rate higher for persons ≥ 15 and < 1 years of age
• Bacterial infection of skins lesions, pneumonia, dehydratation, encephalitis, hepatitis
VZV vaccine licensed in several European countries (1984), Japan (1986), Korea (1988)
• No safety concerns after the administration of > 2 million doses in these countries
Varicella is less severe among vaccinated persons than unvaccinated persons
• Afebrile, fewer vesicular lesions, shorter duration of illness
Difference of incidence of herpes zoster
• 18 per 100000 persons/year for vaccinated people
• 77 per 100000 persons/year after natural Varicella
5
MMWR, Advisory Committee on Immunization Practices (ACIP). Prevention of Varicella. July 12, 1996, Vol 45, No RR-11

6. Cost-effectiveness of a Routine Varicella
Vaccination program for US children
One dose/child under 6 30-year period following introduction
$35/dose At school entry, vaccination coverage level =
97% by the 6th year
Medical costs Work-loss costs
• Varicella treatment : Acyclovir • Parents missing work when their children
• Vaccinated people : no Acyclovir have the chickenpox ($201)
• Complications • Adults contracting chickenpox
Taking into account
• Evidence about vaccine efficacy
• Effects of expected changes in the age distribution of the disease
• Empirical data on the costs of medical utilization and work loss from varicella
6
Lieu, Tracy A et al. Cost-effectiveness of a Routine Varicella Vaccination program for US Children. JAMA; 1994; 271 (5), 375-381

7. Cost-effectiveness of a Routine Varicella
Vaccination program for US children
7
Lieu, Tracy A et al. Cost-effectiveness of a Routine Varicella Vaccination program for US Children. JAMA; 1994; 271 (5), 375-381

8. Cost-effectiveness of a Routine Varicella
Vaccination program for US children
Savings from Varicella disease prevention : $1.3 billion for the 1-dose program,
$1.4 billion for the 2-dose program.
8
Lieu, Tracy A et al. Cost-effectiveness of a Routine Varicella Vaccination program for US Children. JAMA; 1994; 271 (5), 375-381

9. 99

10. Recommendation map
Kg: Kindergarten
Gr: School Grade

11. Effects of vaccination
Hospitalization rate: 2.2 to 3.3/100.000 (1995-1998) to 0.5/100.000 (2004)
Death rate: 0.41 deaths/1,000,000 (1990-1994) to 0.14 (1999-2001) (decrease of 78%)

12. The other hand
FEAR
Not natural
Side effects
•Mild : fever (≤1/10), rash (1/25)
•Moderate: Seizure (jerking/staring) caused by fever (very rare)
•Severe: pneumonia

13. The French point of view
Same incidence, same complications, same risks…
BUT vaccine only recommended in certain cases, if no varicella history:
•Vaccination within 3 days following exposure (adults & immunocompetent)
•Health care workers
•Contact with young children & immunodeficient people
•Children organ recipient
Considering that: 15 years of vaccine coverage of children of 11 years-old is necessary to
save:
•1 death
•30 severe complications
•30.000 cases/year (nowadays incidence is about 600.000 cases/year)
Plus:
•increasing of the disease in the teenage and adult population
•Increasing of zoster outcomes in the senior population.
HAS: AVIS DU CONSEIL SUPÉRIEUR D'HYGIÈNE PUBLIQUE DE FRANCE
SECTION MALADIES TRANSMISSIBLES
Relatif à la vaccination contre la varicelle

14. “ils sont fous ces américains”
New drifts :
Mailing/selling infected clothes, saliva samples, infected lollipops...
Risk of 20 years of imprisonment: under biohazard regulation (like anthrax)
Danger for workers of mailing companies
Looking for more dangerous diseases:
Measles, mumps…