pox party

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A dangerous trend in the USA

Pox Parties

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Fever

Headache

Sore throat

TirednessBlisters

Itching

Chicken pox(Varicella)

http://www.cdc.gov

American parents’ first reaction

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Each year

USA - Before 1995

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4 million people would get the chicken pox

About 10,500 – 13,000 were hospitalized

100 to 150 died

Majority : healthy

children and adults

http://www.cdc.govWalter A., Orenstein M.D., National Immunization Program. Overview of the US Vaccination Program

Why a VZV vaccine?

5MMWR, Advisory Committee on Immunization Practices (ACIP). Prevention of Varicella. July 12, 1996, Vol 45, No RR-11

• > 90% of adults immune to VZV

Varicella develops in nearly all persons living in the US

• Bacterial infection of skins lesions, pneumonia, dehydratation, encephalitis, hepatitis

Complications rate higher for persons ≥ 15 and < 1 years of age

• No safety concerns after the administration of > 2 million doses in these countries

VZV vaccine licensed in several European countries (1984), Japan (1986), Korea (1988)

• Afebrile, fewer vesicular lesions, shorter duration of illness

Varicella is less severe among vaccinated persons than unvaccinated persons

• 18 per 100000 persons/year for vaccinated people• 77 per 100000 persons/year after natural Varicella

Difference of incidence of herpes zoster

Cost-effectiveness of a Routine Varicella Vaccination program for US children

6Lieu, Tracy A et al. Cost-effectiveness of a Routine Varicella Vaccination program for US Children. JAMA; 1994; 271 (5), 375-381

$35/dose

One dose/child under 6

At school entry, vaccination coverage level = 97% by the 6th year

30-year period following introduction

• Varicella treatment : Acyclovir• Vaccinated people : no Acyclovir

• Complications

Medical costs

• Parents missing work when their children have the chickenpox ($201)

• Adults contracting chickenpox

Work-loss costs

• 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

Taking into account



Savings from Varicella disease prevention : $1.3 billion for the 1-dose program, $1.4 billion for the 2-dose program.

Recommendation map

Kg: KindergartenGr: School Grade

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%)

The other hand

Not natural

Side effects

•Mild : fever (≤1/10), rash (1/25)•Moderate: Seizure (jerking/staring) caused by fever (very rare)•Severe: pneumonia

FEAR

The French point of view

HAS: AVIS DU CONSEIL SUPÉRIEUR D'HYGIÈNE PUBLIQUE DE FRANCESECTION MALADIES TRANSMISSIBLESRelatif à la vaccination contre la varicelle

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

Same incidence, same complications, same risks…

•1 death•30 severe complications•30.000 cases/year (nowadays incidence is about 600.000 cases/year)

Considering that: 15 years of vaccine coverage of children of 11 years-old is necessary to save:

•increasing of the disease in the teenage and adult population •Increasing of zoster outcomes in the senior population.

Plus:

Measles, mumps…

Risk of 20 years of imprisonment: under biohazard regulation (like anthrax)Danger for workers of mailing companies

“ils sont fous ces américains”

New drifts :Mailing/selling infected clothes, saliva samples, infected lollipops...

Looking for more dangerous diseases:

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