Vaccination strategies against varicella

Chickenpox is not always a benign disease. The clinical relevance of the entity relies on the complications, more frequent in adults, immunodeficient hosts and very young children. The burden of the disease is high, due to consume of health resources and indirect social costs: loss of working hours of family members or caretakers, loss of days of school and other expenses. There is an efficient and safe vaccine against this disease. Some countries have opted for systematic vaccination of all children in their second year of life as well as all susceptible adolescents and individuals belonging to certain groups at high risk to develop severe disease. Other countries, Spain among them since 2005, have decided to immunize only susceptible adolescents and other high risk population. In any case, no matter what strategy is chosen, a long term epidemiologic follow-up of the incidence of chickenpox and its complications in different age groups will be necessary. The same follow-up should be applied for Herpes Zoster disease. We discuss the different vaccination strategies (universal children vaccination, susceptible adolescent vaccination or high risk population immunization) and the factors considered to choose one of the strategies: costs, benefits and risks, including the possible changes on age groups distribution of chickenpox and herpes zoster cases that universal vaccination can cause in the future.