Vaccine regulator advises chickenpox jab for UK children

The UK’s leading authority on vaccinations, the joint committee on vaccination and immunisation, has advised that all children in the UK should be given a chickenpox jab at 12 and 18 months of age. Until now, parents have had to go privately and pay to protect their child against the virus.

Our regular host, Dr Chris Smith, is a consultant virologist and has the story…

Chris - Chickenpox is one of the most common infections in humans. If I picked a person at random off the street here in the UK, but equally this is going to be true in the majority of other Western countries, I've got a 90% chance that I'll pick someone that has a history of having had chickenpox. And in fact, if I then investigate, I'll find that in those people they've still got chickenpox because it's one of the herpes viruses. Those viruses, characteristically, once you've got them, herpes is for life. It lives in certain parts of your body for the rest of your life. And in the case of chickenpox, that means the nervous system. So the chickenpox virus causes an acute disease, which is the spotty itchy rash that we see characteristically in kids because by the time they go to school in the UK, about 90% of children have already had it. But because it then survives in your nervous system for the rest of your life, it can periodically come back as a different manifestation, but equally infectious: that's shingles and it's painful. It's confined to one part of the body and you can obviously infect other people from it. So it's still a threat and can be dangerous in certain parts of the body as well. This is a fairly trivial infection for the vast majority of people, but for some people it can be a threat, particularly the elderly and pregnant women and also people with poor immune systems.

Will - If it's been so well known that it's so widespread and for such a long time, why is this vaccine being pushed to be free now?

Chris - The original decision that was taken by our authorities in the UK, they took the view that, with such high seroprevalence, 90% of people having had the infection, and the fact that if you've got virus circulating in the population you are also topping up people's immunity almost like a booster for free, and because people are running into the infection periodically which helps to protect people from shingles, they suggested we didn't need to pursue vaccination. Other countries took a different view; Australia, America, Canada, Germany, they did go down the route of using this vaccine. There is now a couple of vaccines that we use. They're very safe. They are live attenuated vaccines, they're weakened forms of the chickenpox virus, which shows the immune system what the virus can do, how it works, and therefore how to make an immune response against it - but it doesn't make a person ill and then you have protection for the long term. Those countries that have gone down this route have successfully proved that you don't have a problem with shingles in older people, and we also have vaccines against shingles now as well. So really the reasons not to do this are being taken away and it leaves the argument that when you do have chickenpox in children, whilst it's a trivial infection for the vast majority of people and can be a worry for women who haven't had it and get pregnant, it still means it's very disruptive to a person's family because, if you get a succession of cases, people end up having to take time off work, for example. This can be weeks at a time because the period of infectivity is a week and if you have a child with it and then a child who gets it, and then an adult who gets it, you might be off work for a month. When you do the economics of this, many countries have argued it's much cheaper to offer a vaccine to a young child and protect them from having to put up with the infection and then the family having to have problems caused by that child with the infection. It's much cheaper in the long run to do this and protect them with this vaccine than to just run the gamut of having chickenpox and having to put up with the consequences.

Will - The difference between the current status and the status that they're hoping for is that it's going from a paid vaccination to a free one. Is this free in other countries? Are the UK behind the pace as it were?

Chris - At the moment, while the vaccine is licensed for us to give it to young children, many trials and millions of doses have proven that it's safe and effective. Because it wasn't approved by our health approval bodies as a routine vaccine, parents could access it, but they would have to pay for it. It was costing about 200 pounds or about 300-400 dollars for them to do that. If we move towards this becoming part of the standard vaccination regime for young people, then it will be free because our vaccines are offered at the point of delivery for free. Other countries with other healthcare systems will obviously have a different approach. Different countries with totally different healthcare systems and different funding models will have some elements that are free, some that are subsidised, some that are chargeable. So really it will matter according to where in the different jurisdictions a person is where they're trying to access the care. But what it means for the UK is, if they do put this as part of the routine vaccine programme, it will be free.

Will - As a final point, as you said, eradication would take a lifetime and it's impossible to think that it may happen completely. But should this come into place and the uptake is good and people are keen for it, what would you expect the outcome to be? Do you think this is a good idea?

Chris - Well, what we've seen in other countries is that, unlike the necessity to have chickenpox parties, which were a thriving, flourishing thing here in the UK over the last five decades or so, that sort of thing would disappear. We wouldn't see the burden of lots of cases of chickenpox in young families with parents, them being knocked sideways because they lose lots of time off work and even possibly catch it themselves. And then a problem with women who are pregnant and susceptible to chickenpox becoming nervous that they may have had contact with the infection because it can have dramatic effects on their health, but it can also affect their developing baby's health. So all of those things would be really negated by this. It's a very good vaccine, it's a very safe vaccine, and so we think this is probably a sensible direction of travel now.