Varicella-zoster virus vaccination under the exogenous boosting hypothesis: Two ethical perspectives

Luyten, Jeroen; Ogunjimi, Benson; Beutels, Philippe

doi:10.1016/j.vaccine.2014.10.015

Cited by 14 publications

(6 citation statements)

References 15 publications

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“…The authors concluded that better understanding of the processes is therefore needed [114]. If routine infant varicella vaccination causes an albeit small increase in the incidence of HZ, there is a potential ethical dilemma whereby varicella vaccination although protecting one population (children) might have a deleterious effect on older individuals [39]. Other workers have proposed a more pragmatic approach in which zoster vaccination is used to supplement the varicella program and prevent HZ in older adults [40,41].…”

Section: Evidence For Varicella Vaccinationmentioning

confidence: 99%

Varicella vaccination - the global experience

Wutzler

Bonanni

Burgess

et al. 2017

Expert Review of Vaccines

143

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Introduction Varicella, although a frequently benign childhood disease, nevertheless represents a considerable health burden. WHO recommends including varicella vaccines in universal routine vaccination programs, and maintaining coverage >80%. Many countries have successfully introduced varicella vaccination and have benefited from lower disease burden, but many others have not adopted the vaccine. Reasons include cost commitment for a ‘mild childhood disease’ or concerns that vaccination will shift varicella to older age groups or increase herpes zoster incidence. Areas covered This literature review summarizes the effectiveness and epidemiological impact of varicella immunization programs. Expert commentary Varicella vaccines are immunogenic with acceptable safety profiles. One and two dose schedules are highly effective against varicella and large reductions in disease incidence, particularly moderate-severe disease, have been widely reported. There is currently no evidence to suggest that the introduction of varicella vaccination results in a shift of varicella disease burden to older age groups. Although epidemiological studies have shown an increased incidence of herpes zoster since the vaccines were launched, there are many other contributing factors, and indeed, this secular trend was evident before their introduction. In conclusion, varicella vaccination easily fits into existing immunization programs and significantly reduces the often underestimated burden of varicella.

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Section: Evidence For Varicella Vaccinationmentioning

confidence: 99%

Varicella vaccination - the global experience

Wutzler

Bonanni

Burgess

et al. 2017

Expert Review of Vaccines

143

View full text Add to dashboard Cite

show abstract

“…Following naturally acquired VZV infection, VZV-specific antibody and CMI responses continue to be re-boosted not only by reactivation of latent virus, but also exogenous re-exposure to VZV. Without the occasional exogenous VZV re-exposure, VZV-specific immune responses decline and VZV reactivation could lead to clinical manifestations of HZ [Hope-Simpson, 1965; Luyten et al 2014]. Although more evidence is needed to support the exogenous-boosting hypothesis [Ogunjimi et al 2013], future studies on its long-term effect on HZ incidence may shed more light.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of varicella (VZV) vaccination: an update for the clinician

Wang

Zhu

2016

Therapeutic Advances in Vaccines

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Varicella-zoster virus (VZV) infection causes two distinct clinical conditions. Primary varicella infection results in chickenpox, a contagious rash illness typically seen among children. VZV can reactivate years after the initial infection to cause herpes zoster (HZ) and lead to post-herpetic neuralgia, a common complication resulting in persistent pain that may last for years after the zoster rash resolves. A person's risk of having longer lasting and more severe pain associated with HZ increases with age. Since the introduction of VZV vaccines, the rates of infection, hospitalizations, and mortality have declined. In this review, we discuss in detail current VZV vaccines available for the prevention of VZV and HZ infections. Varilrix (GSK Biologicals, UK), Varivax (Merck, USA) and the combined measles, mumps, rubella, and varicella (MMRV) vaccine contain the live attenuated Oka strain of VZV for routine varicella vaccination. While Zostavax is the only HZ vaccine currently approved for use in the United States and the European Union [EMEA, 2011], a subunit vaccine candidate called HZ/su has recently shown improved efficacy for zoster prevention in two clinical trial phase III studies. VariZIG, a post-exposure prophylactic, uses zoster immune globulin to prevent VZV infection in those who have recently been in contact with VZV but lack evidence of varicella immunity and are contraindicated to receive the varicella vaccine. Further, we discuss the skin tropic and neurotropic factor VZV ORF7 gene and its involvement in varicella infection, reactivation and latency in ganglia. Ultimately, these studies can contribute to the development of a neuroattenuated vaccine candidate against varicella or a vector for delivery of other virus antigens.

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“…Appeals to the well-being of society as a whole have also been made in arguments against recommending routine childhood varicella vaccine. For example, Luyten et al (2014) argue that one cannot justify universal childhood varicella vaccination, from the point of view of aggregate well-being, due to the significant short-term losses in QALYs (associated with the loss of exogenous boosting) that such a program would cause. These kinds of arguments are cited as a primary motivation for decisions by many European countries not to recommend routine childhood varicella vaccination (Gaillat et al 2011).…”

Section: One Virus Two Diseases Several Vaccines and Some Problemamentioning

confidence: 99%

Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices

Malm

Navin

2020

The American Journal of Bioethics

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Some societies tolerate or encourage high levels of chickenpox infection among children to reduce rates of shingles among older adults. This tradeoff is unethical. The varicella zoster virus (VZV) causes both chickenpox and shingles. After people recover from chickenpox, VZV remains in their nerve cells. If their immune systems become unable to suppress the virus, they develop shingles. According to the Exogenous Boosting Hypothesis (EBH), a person's ability to keep VZV suppressed can be 'boosted' through exposure to active chickenpox infections. We argue that even if this hypothesis were true, immunization policies that discourage routine childhood varicella vaccination in order to prevent shingles for other people are unethical. Such policies harm children and treat them as mere means for the benefit of others, and are inconsistent with how parents should treat their children and physicians should treat their patients. These policies also seem incompatible with institutional transparency.

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Varicella-zoster virus vaccination under the exogenous boosting hypothesis: Two ethical perspectives

Cited by 14 publications

References 15 publications

Varicella vaccination - the global experience

Varicella vaccination - the global experience

Efficacy of varicella (VZV) vaccination: an update for the clinician

Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices

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