Presented by MJ Levin. University of Colorado School of Medicine, CO, USA.

Universal immunization of children in the USA has greatly reduced the incidence of varicella and its complications. However, there are two major concerns: 1) the appearance of breakthrough varicella in 8–15% of exposed childhood vaccines implies that their future protection against varicella as adults will be suboptimal;2) the vaccine-induced decline in varicella will remove the environmental boosting that may be essential to prevent herpes zoster (HZ) in our current elderlypopulation. Thus, it is suggested that the age-specific incidence of HZ will increase as a result of childhood immunization. The administration of a second dose of varicella vaccine to children is discussed as a solution to the first concern. The solution to the second concern, as well as to the growing problem of HZ in our aging population, is likely to be a vaccine to prevent or attenuate HZ in this high-risk group. A high dose live varicella vaccine, approximately 18 times more potent than the childhood vaccine (but the same virus), safely reduced the frequency of HZ (by 50%) and the pain and suffering (including post-herpetic neuralgia) by >60%. The rationale for administration of this vaccine and the potential issues raised by its use are discussed.

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