Expanded spectrum of varicella disease and the need for vaccination in India

ABSTRACT

Varicella vaccine was first licensed in Japan and South Korea in 1989 for use in healthy children and was introduced in US in 1995. So far, 29 countries have adopted varicella vaccine in their universal immunization program (UIP). No Asian country, India included, has adopted the varicella vaccine as part of their UIP. The extra-cutaneous sites for VZV diseases are central nervous system and gastrointestinal tract, the expanded disease spectrum includes vasculopathy, myelitis, inflammatory bowel disease, perforated ulcers, and gastritis. The actual disease burden of varicella is not known as most of the infected individuals may not visit the physician. The amplifiable VZV DNA will not always be detectable in cerebrospinal fluid (CSF) samples in protracted illnesses such as vasculopathies, but demonstrable anti-VZV IgG in CSF has diagnostic value. The World Health Organization (WHO) position paper 2014 recommends two doses of varicella and zoster vaccines in targeted population. In India, varicella vaccine is not included in the UIP due to the cost and the belief that lifelong immunity occurs following primary infection. The expanded spectrum of VZV disease and the mounting body of evidence, however, suggest the need for both varicella and zoster vaccines in routine immunization schedule.

KEYWORDS:

• Varicella zoster virus (VZV)
• chickenpox
• herpes zoster
• varicella vaccine
• zoster vaccine
• disease spectrum of VZV

Acknowledgments

We acknowledge the financial support provided by Scheme for Promotion of Academic and Research collaboration (SPARC) Graduate grant Program, Ministry of Human resource development, Government of India, IIT Kharagpur, India.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

PS contributed to the conception, study design, data analysis, data interpretation, critical revision of intellectual content, reviewed and revised the final manuscript. The final approval of the version to be published and preparation of the paper. IA contributed to the data analysis, interpretation, and preparation of the manuscript and revised the manuscript. SNJ contributed to writing the section on the incidence, cost-economic data, and financial impact of varicella and zoster diseases in India and revised the manuscript RR, LNR and SV contributed to the interpretation of data and drafting of the manuscript.

Additional information

Funding

The work was supported by the Scheme for Promotion of Academic and Research Collaboration [SPARC/2018-2019/P851/SL].