Improving surveillance of varicella in Europe in response to increasing availability of varicella vaccine

Last week, the United Kingdom received its first licensed varicella (chickenpox) vaccine. Despite the availability of the new vaccine there are currently no plans to introduce it into the routine immunisation schedule in the UK (currently the vaccine is licensed only for susceptible individuals over the age of 12 years and younger individuals who may be in contact with high risk patients). Indeed, European countries have been slow to introduce widespread chickenpox vaccination, despite the apparent success of the programme in reducing chickenpox incidence in the United States (1). This may be due to a lack of perceived need for chickenpox vaccine among parents and healthcare professionals as observed in Canada, along with concerns regarding the safety of the vaccine when used in routine programmes (2). There are two safety concerns: first, that an inadequate chickenpox vaccination programme will lead to an increase in adult cases (which are generally more severe); and second, that vaccination will lead to an increase in zoster (shingles) in the medium term. What is the basis for these concerns and what surveillance data are available from countries that have introduced the vaccine (notably the US) that may shed light on these issues?