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Scientists Recommend Childhood Chickenpox Vaccination

A universal varicella vaccination programme should be introduced as part of the routine childhood schedule, scientists advising the UK's health departments said.

Vaccination should be given in two doses – at 12 and 18 months of age – using the combined measles, mumps, rubella, and varicella (MMRV) vaccine, the Joint Committee on Vaccination and Immunisation (JCVI) recommended on Tuesday.

The Committee took into consideration new evidence that hospitalisations caused by varicella had previously been underestimated, that social mixing restrictions during the COVID-19 pandemic had created a larger pool of children at risk of varicella, and that susceptible people may continue to be vulnerable to catching varicella as they head into adulthood.

A spokesperson for the Department of Health and Social Care said it was considering the advice.

Vaccination Would "Dramatically" Reduce Cases of Chickenpox

Evidence from countries which included varicella in their routine vaccination schedule suggested it "rapidly and dramatically" cut the number of cases of varicella, scientific advisers said. 

Dr Gayatri Amirthalingam, deputy director of public health programmes at the UK Health Security Agency (UKHSA), said: "The JCVI's recommendations will help make chickenpox a problem of the past and bring the UK into line with a number of other countries that have well-established programmes." Germany, Canada, Australia, and the US are among countries that offer routine varicella vaccination.

Varicella is very common, with most children having the illness during childhood. Recent data from the UKHSA indicated that approximately half of children were affected by varicella by the time they were 4 years old, rising to 90% by the time they reached the age of 10. During the COVID-19 pandemic, restrictions on social mixing led to a reduction in cases of varicella in younger age groups and left a larger pool of children susceptible to the infection.

Although most varicella cases in children are relatively mild, parents may have to take time off work, and some children go on to develop complications. These can include bacterial infection of skin lesions and, in rare cases, encephalitis, pneumonitis, and stroke. "These complications can result in hospitalisation and very rarely may result in death," the JCVI noted.

In 2009, experts on the Committee ruled out a UK-wide programme, as evidence at the time suggested that introducing one might cause an upsurge of shingles in middle-aged adults. However, more recent research from the US had disproved that theory, the UKHSA said.

Also, a study by the University of Bristol, that provided new information on the impact on children and the NHS from varicella, had made the case for vaccination more compelling, the Agency said.

The JCVI has also recommended a later catch-up programme to prevent a gap in immunity.

Combined Vaccine the Preferred Option

Using the combined MMRV vaccine as a first dose has been associated with a slightly increased rate of febrile seizures when compared with using separate MMR and varicella vaccines at the same visit. However, the JCVI statement noted that febrile seizures were "usually benign and self-limiting" and unlikely to cause long-term effects or harm. Evidence suggested that one additional febrile seizure is seen for every 2300 doses given compared with using separate vaccines.

Commenting to the Science Media Centre, Helen Bedford, professor of children's health at Great Ormond Street Institute of Child Health, University College London, said: "The addition of a vaccine to the UK vaccination schedule to protect children against chickenpox will be welcomed by many parents. Although chickenpox is usually a mild infection, children have an itchy rash and often a fever, which makes them feel very miserable."

"Providing our children with this additional vaccine would be a welcome addition to the highly successful UK vaccination programme."

Editor's note: This article was updated on 15 November to expand on the core reasons why the JCVI made its recommendations.