Recommendations from the National Varicella Consensus Conference: RESEARCH NEEDS

Consensus Conference: RESEARCH NEEDS

Participants identified a number of research needs and pri­orities related to varicella, outlined below. It was also recom­mended that these priorities be brought to the attention of appropriate funding bodies so that research funds can be made available to address them.
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  • General immunization issues such as the need for booster doses and waning immunity should be addressed.
  • Studies should be done to assess the molecular epidemiology of VZV strains in Canada.
  • Mechanisms of and susceptibility to VZV embryopathy should be defined.
  • Models should be used to predict when surveillance systems should shift from aggregate to case-by-case reporting and when special studies should be done for case investigation. Surveillance data should be periodically fed back into the models to improve their predictive capacity.
  • Appropriate and safe immunization strategies should be determined for immunocompromised patients, including HIV-infected persons; cancer patients in remission; solid organ transplant recipients; bone marrow transplant recipients; patients with hypogammaglobulinemia; leukemia patients (eg, whether to immunize three months after treatment, and the role of acyclovir); persons with chronic lung disease (eg, cystic fibrosis); and other immunocompromised individuals such as those receiving cyclosporine treatment.
  • Studies should be done to determine the potential for early use of vaccine in anatomically compromised individuals (eg, persons with pulmonary conditions or skin disease); persons with chronic heart disease; and preoperative cases (for elective surgeries).
  • History and serologic status of health care workers should be investigated to establish

1. a Canadian profile among the age groups in this population; 2. the benefits of booster vaccine, if any; and

3. the potential need to revise the definition of health care worker with respect to potential work exposure.

  • Epidemiological studies should be undertaken to determine whether any of the following groups are at higher risk and should be identified as priorities for specific immunization strategies: Aboriginal persons (eg, whether Aboriginal children are at higher risk of complications from varicella, whether invasive group A streptococcal infections are more common, whether children are at risk for missed vaccination opportunities because of relocation); homeless persons; and immigrants (eg, seroprevalenceinformation to determine endemicity from country of origin).

• Special studies in pregnant women should be carried out to determine how many times a pregnant woman should be screened; the loss of immunity; and prospective (anonymous) varicella prevalence among pregnant women or babies.



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