Recommendations from the National Varicella Consensus Conference

Recommendations from the National Varicella Consensus Conference

The National Varicella Consensus Conference was spon­sored by the Laboratory Centre for Disease Control (LCDC), Health Canada, and held from May 5 to 7, 1999, in Montreal, Quebec. The first varicella vaccine in Canada, a live attenuated Oka strain vaccine, was licensed in December 1998 and is recommended by the National Advisory Committee on Immunization (NACI) for primary immunization of healthy persons aged 12 months or older.

Currently, varicella vaccine is not universally accepted by all health care professionals or the public. Multiple competing priorities for public health resource allocation at the provin­cial/territorial or local level increase the likelihood that the timing of implementation of varicella vaccination programs will differ widely among provinces and territories. In addition, a number of logistic challenges to the implementation of rou­tine vaccination programs exist with the currently licensed freezer-stable vaccine, which is the most heat-sensitive of all vaccine products currently available. The primary challenges are the cost of the vaccine, and the storage and handling re­quirements (specific issues include inadequate freezer capac­ity, cost of freezer space for both public health delivery and physicians’ offices, and potential difficulties with delivery of the vaccine to remote areas).

Modelling data suggest that unless high coverage with varicella vaccine is uniformly achieved in all jurisdictions, there is a danger of causing a shift in the epidemiology of varicella to the adult population with a resulting increase in morbidity. Thus, more than for any routinely used vaccine, the urgent need for national consensus on the potential benefits of routine varicella vaccination and the strategy for implementing routine vaccination programs was recognized.

The goal of the conference was to present a forum for fed­eral, provincial, and territorial public health representatives, clinical experts, and other professional stakeholders to discuss and exchange ideas on issues related to the varicella vaccine, in­cluding implementation of population-based vaccination pro­grams, provider and public acceptance of the vaccine, and ways to maximize the benefits of the vaccine for the Canadian popu­lation.

The specific objectives of the conference were to discuss and exchange ideas on

  • national goals for the control of varicella and herpes zoster;
  • a coordinated approach to implementation of varicella vaccination programs in all provinces and territories;
  • post-marketing research needs for varicella zoster virus (VZV)-related disease and varicella vaccine.

The conference included broad participation from all major stakeholders identified. To create a balance of perspectives and professional diversity, participants were assigned to one of five concurrent working groups related to the following content areas: 1. Public health goals and objectives for vari­cella control and vaccine coverage; 2. Development and im­plementation of varicella vaccination programs; 3. Varicella vaccine use in special populations; 4. Promotion of varicella vaccination programs; and 5. Surveillance needs (disease and vaccine related).

Working group participants were asked to deliberate on specific questions relating to their content area and to propose recommendations based on those questions. The proposed recommendations from each group were presented to the plenary session for discussion in a process of consensus building, based on set criteria, to arrive at final recommendations.

This report is an abstract of the full conference proceedings and presents the final consensus recommendations. Addi­tional details about the conference, including a description of the process, a summary of the plenary discussions leading to the recommendations, and a list of participants, have been published in the full conference proceedings. A pharmacy you can

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