[Varicella and zoster vaccines]

The varicella vaccine (OKA strain) first used in Japan in 70's was introduced into the routine infants immunisation schedule of United States in 1995. Two other new varicella vaccines have been just licensed: a tetravalent measles-mumps-rubella-varicella vaccine (MMRV) and a zoster vaccine for more than 60 years old adults. In Europe varicella vaccine is not introduced in routine infant schedule, except in Germany, and only used for targeted aims. This reluctance is justified by several considerations: the fear of a shift of varicella to adults by low vaccine coverage, the risk of increasing zoster in adults by a mass vaccination. Several recent varicella outbreaks in highly vaccinated children stress the possible need for a routine second dose of vaccine in infants. The cost-effectiveness studies results are not similar in different countries and the benefits are indirect (time off work).Varicella is often considered as a mild disease, in spite of a better knowledge of complications and health benefits in United-States, where vaccination has resulted in a dramatic decline of deaths, hospitalisations and varicella-related complications. The new tetravalent MMRV vaccine could stimulate Europe to implement routine vaccination, provided that an efficient surveillance for varicella and shingles be instituted.