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Home Eurosurveillance Weekly Release  2003: Volume 7/ Issue 51 Article 7
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Eurosurveillance, Volume 7, Issue 51, 18 December 2003

Citation style for this article: Nardone A. Varicella vaccination recommended for healthcare workers in the United Kingdom. Euro Surveill. 2003;7(51):pii=2350. Available online:

Varicella vaccination recommended for healthcare workers in the United Kingdom

Anthony Nardone ( , Health Protection Agency Communicable Disease Surveillance Centre, London, England.

The Chief Medical Officer for England has recently published a new varicella vaccination policy for healthcare workers (HCW) in the United Kingdom (UK), which recommends vaccination for HCWs who have no definite history of the disease and are seronegative (1). These recommendations are for HCWs who have any direct contact with patients and include paramedic (e.g. ambulance drivers) and ancillary staff (e.g. cleaners). A prioritisation of these staff for vaccination has also been recommended with precedence given to those working with immunocompromised individuals (e.g. in oncology and transplant wards). Vaccinated HCWs who develop symptoms are recommended to report to occupational health departments to avoid the possibility of secondary transmission.

Varicella vaccination is not recommended for listed contraindications that include pregnancy. An important risk for HCWs is the inadvertent vaccination of pregnant individuals. In the United States, surveillance of inadvertent immunisation of pregnant women with the Oka/Merck strain (VARIVAX) has not identified any specific risk to the foetus (2). The establishment of such a register, to monitor possible sequelae following such an event, is a feature of the recent recommendations in the (UK).

The UK is one of the first European countries to publish official recommendations for varicella vaccination. A survey of the immunisation policies amongst countries participating in the European Sero-Epidemiological Network (ESEN2, has recently been undertaken. A wide variety of different policies for varicella vaccination have been implemented or are being considered amongst the participating countries. The immunisation of seronegative professional HCWs has (or is) being considered by only a handful of other European countries. Interestingly, in some countries, a recommendation to vaccinate all seronegative individuals involved in the care of children is also being considered.

Vaccination against varicella has been recommended in the United States for all susceptible people aged 12 months or older since 1995 (3). Of those countries participating in ESEN2, only one country has introduced (in 2001) mass vaccination against VZV targeted at a similar age group as the US vaccination. However, concerns have been raised of the effectiveness of such a strategy, as it may result in an increase in cases of zoster disease, because of the lack of boosting of immune responses in older individuals (4,5). Furthermore, a mass vaccination campaign with a suboptimum coverage could result in an increase in the average age of infection to those ages in which the disease and its sequelae are more severe (4).

  1. Department of Health. Chickenpox (Varicella) Immunisation for Health Care Workers. Letter from the Chief Medical Officer, the Chief Nursing Officer, Chief Dental Officer and the Chief Pharmaceutical Officer. PL/CMO/2003/8. 4 December 2003. (
  2. Merck Research Laboratories. Pregnancy Registry for Varivax: The Seventh Annual Report 2002. Merck Pregnancy Registries, Worldwide Product Safety and Epidemiology. West Point: Merck & Co; 2003.
  3. Vázquez M, LaRussa PS, Gershon AA, Steinberg SP, Freudigman K, Shapiro ED. The effectiveness of the varicella vaccine in clinical practice. N Engl J Med 2001; 344: 955-60.
  4. Edmunds WJ, Brisson M. The effect of vaccination on the epidemiology of varicella zoster virus. J Infect 2002; 44: 211-9.
  5. Thomas SL, Wheeler JG, Hall AJ. Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study. Lancet 2002; 360: 678-82.

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