Routine childhood vaccinatio in Germany - well-founded?

Abstract

Varicella is the most frequent vaccine preventable disease of childhood inGermany. Though usually mildly proceeding severe complications may occur, particularlyamong pregnant women, neonates, adults and the immunocompromised. Later in life 10-20% are afflicted by herpes zoster (HZ) through reactivation of the dormant varicella zostervirus (VZV). With regard to >750 000 varicella cases annually and consequent societal costs Germany has introduced VZV immunization into the routine childhood vaccination schedule in July 2004. As this recommendation is a matter of controversial discussion wereconsidered the underlying data in order to revise it. The success of a universal vaccination recommendation depends on several factors including disease burden, availability of a safe and effective vaccine, cost effectiveness of the vaccination and public perception. Such a programme should rashly achieve high and sustained levels of coverage. Concerning varicella vaccine there are certain issues of controversy which should be considered. Potential harm that may occur as a result of vaccination includes immediate adverse reactions, transmission of varicella from vaccinees, an increased risk of zoster, and a shift in varicella cases to an older age group (and hence more severe disease), waning immunity with time after vaccination especially with a lack of the boosting effect of wild-type virus circulation (95). Furthermore, introducing universal vaccination for children necessitates disease surveillance and modifications of the recommendation as needed. The epidemiology of herpes zoster must be tracked as well as varicella disease trends. The objective of this paper is to review the universal varicella vaccination recommendation in Germany and the underlying data.