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VZV vaccine

Bruce Phillips bap at MED.PITT.EDU
Fri Apr 21 13:40:36 EST 1995

	Recently, info was provided on the attributes of the newly introduced
VZV vaccine (Varivax).  Some colleagues and I have some concerns over its use.
The arguments I offer are based on several presumptions:

	(1) Chickenpox in children is a rather inocuous disease with a very
low rate of serious complications.  It is uncomfortably for the infected 
child and certainly inconvenient for the parents.

	(2) Chickenpox in adults is a nasty nasty disease with serious
symptomology and an elevated risk of mortality/serious sequelae.

	(3) The current vaccine, while effective in the short term, causes
an immunity that wanes over the years (>5-7 yrs???).  Protection beyojnd
10 years is compromised.

	(4) No one knows the effects of this vaccine on patients >10 years
after use. Questions regarding latency, etc. are unanswered as are the
liklihood of reactivated disease later in life.

	If children are protected by the vaccine but that immunity is not
maintained in adulthood- presuming it can be with repeated boosters- is it
possible that an increased susceptibility to chickenpox in adults might be
the result?  If so, the consequences just might be worse than encountered
in adults prior to the vaccine's introduction.  Practically speaking, it has
proven difficult to get people to maintain immunization schedules- witness
the benefits from the live polio vaccine in contrast to using inactivated virus
whose immunity is less long term.

	I would like to hear other views.   Thanks. 

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