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Do the Benefits of Varicella Vaccination Outweigh the
Long-Term Risks? A Decision-Analytic Model for Policymakers and Pediatricians.
Rothberg M, Bennish ML, Kao JS, Wong JB.
Division of Clinical Decision Making, Informatics and Telemedicine, Department
of Medicine, New England Medical Center, Tufts University School of Medicine,
Boston, Massachusetts; and Center for Clinical Decision Making, Faculty of
Health Sciences, Ben Gurion University, Beer Sheva, Israel.
Although varicella vaccine is recommended for infants, many physicians and
parents have withheld vaccination from infants because of concerns about the
vaccine's long-term efficacy. We used a decision-analytic Markov model to
examine the effects of decreasing vaccine efficacy on individuals and society.
The model incorporated published data on age-specific incidence, morbidity, and
mortality rates, as well as data on shifting disease burden from childhood to
adulthood as vaccine compliance increases. The effects of 2 vaccination
strategies---vaccinating infants at age 12 months and waiting to vaccinate until
children are 10 years of age---were compared with the effects of no vaccination.
If the efficacy of the vaccine were to decrease by 75%, then 50% compliance with
vaccination at age 12 months would save 1800 life-years and 12,800
quality-adjusted life-years annually in the United States. The quality-adjusted
life expectancy of individuals vaccinated at age 12 months would be 63 h longer
than that of nonvaccinated individuals and would increase to 79 h as vaccination
compliance increases and the burden of chickenpox shifts to adulthood. Varicella
vaccination of infants at age 12 months appears to be beneficial, even if the
efficacy of the vaccine declines substantially.
PMID: 11880952 [PubMed - as supplied by publisher]
ALL INFORMATION, DATA, AND
MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.
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