PEDIATRICS Vol. 107 No. 3 March 2001, pp. 612

Varicella Vaccine Question

To the Editor.

The varicella vaccine update calls again on pediatricians to administer the varicella vaccine.¹ We have supported the Academy's 1995 position statement on this vaccine and encouraged all of our families to have their children vaccinated. But the update raises an alarming prospect: if <90% of children receive the varicella vaccine, the varicella disease burden on unvaccinated children and adults will increase (ie, those who become infected with varicella are likely to be sicker and require more medical care).

Considering the medical community's inability to reach 90% vaccination rates for any other vaccines, the varicella vaccine campaign has the potential for producing more harm than good, especially in disadvantaged children and adults who are less likely to be vaccinated. Having created this terrible dilemma, what steps will the Academy take to ensure a 90% vaccination rate?

Myles Abbott
East Bay Pediatric Journal Club
Berkeley, CA 94705

REFERENCE

1. American Academy of Pediatrics, Committee on Infectious Diseases Varicella vaccine update. Pediatrics. 2000; 105:136-141 [Abstract/Free Full Text]

In Reply.

As noted by Abbott and colleagues, the recent statement from the AAP's Committee on Infectious Diseases, "Varicella Vaccine Update,"¹ states that mathematical models predict that if varicella vaccine coverage in children is >90%, a greater proportion of cases will occur at older ages but the varicella disease burden will decrease for children and adults.² Abbott and colleagues are concerned that if coverage is <90%, the disease burden of varicella among adults will increase. After the introduction of the measles and rubella vaccine, the disease burden decreased for children and adults at coverage levels substantially <90%. We believe that the experience with varicella vaccine is likely to be similar and that coverage among children in the United States of 90% or greater is a realistic goal for the near future. National vaccination coverage among children aged 19 to 35 months for 3 doses of pertussis vaccine and diphtheria and tetanus toxoids (DTP/DTaP), 3 doses of poliovirus vaccine, 3 doses of Haemophilus influenzae type b vaccine, and 1 dose of measles-containing vaccine is currently >90%.³ The introduction of other new vaccines has taken several years to reach similar levels. National coverage among children aged 19 to 35 months for varicella vaccine was 43% in 1998 (the last year for which national data are available). These data reflect immunizations that were administered 6 to 24 months earlier, and there is evidence of a continued and substantial increase in coverage during the past 2 years. Healthy People 2010 objectives for varicella vaccine coverage are >90% for children 19 to 35 months of age and >95% at school entry.⁵ The best way to achieve these objectives is through varicella immunization requirements for child care and school entry. Currently 23 states have such requirements, and an additional 4 states are in the process of considering or implementing them. The AAP strongly encourages pediatricians to support public health officials in the development and implementation of varicella immunization requirements for child care and school entry.

Michael A. Gerber
Neal A. Halsey
Jon S. Abramson
For the American Academy of Pediatrics
Committee on Infectious Diseases

REFERENCES

1. American Academy of Pediatrics, Committee on Infectious Diseases Varicella vaccine update. Pediatrics. 2000; 105:136-141
2. Halloran ME, Cochi SE, Lieu TA, Wharton M, Fehrs L Theoretical epidemiologic and morbidity effects of routine varicella immunization of preschool children in US. Am J Epidemiol. 1994; 140:81-104 [Abstract/Free Full Text]
3. Centers for Disease Control and Prevention National vaccination coverage levels among children aged 19-35 monthsUnited States, 1998. Morb Mortal Wkly Rep. MMWR. 1999; 48:829-830 [Medline]
4. Centers for Disease Control and Prevention. Unpublished data