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Deaths from chickenpox in England and Wales 1995-7: analysis of routine mortality data

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7321.1091 (Published 10 November 2001) Cite this as: BMJ 2001;323:1091

Rapid Response:

Data are a persuasive argument against mass vaccination

The authors conclude that there are not persuasive arguments for mass
vaccination. In fact, I think that their data provide persuasive argument
against such mass vaccination programs as we have here in the USA.

The study demonstrates that 19% of the cases, but 81% of the deaths,
are in adults, which is consistent with earlier data. Varicella is much
more likely to be lethal among adults than among children.

As with other vaccines, one would expect the immunity from V-Z
vaccine to wane in 15-20 years. Thus, if we vaccinate children we will
have a large cohort of young adults who are not immune to chickenpox,
unless they all come in to get boosters. This seems unlikely, given the
low likelihood of regular doctor visits for people in their 20's. However,
there will still be a large reservoir of potential exposure to the virus
in the form of Herpes Zoster. Thus, there is the potential for large-scale
exposure of non-immune young adults to the varicella-zoster virus if there
is a large vaccination program.

It would be far preferable for people to be exposed naturally to
chickenpox and perhaps reserve the vaccine for those who reach young
adulthood without getting chickenpox.

Competing interests: No competing interests

10 November 2001
Daniel Highkin
The Vancouver Clinic, Vancouver, WA, USA