Rationale for Recommending Varicella Vaccination Into the Swedish National Immunisation Programme

Area of Science:

• Public Health
• Vaccinology
• Epidemiology

Background:

• Swedish law mandates vaccinations in the National Immunisation Programme (NIP) must be effective, cost-effective, and ethically sound.
• The Public Health Agency of Sweden (PHAS) assessed varicella vaccination against these criteria.

Purpose of the Study:

• To evaluate the feasibility and impact of introducing varicella vaccination into Sweden's NIP.
• To determine optimal vaccination schedules, cost-effectiveness, and ethical considerations.

Main Methods:

• Comprehensive literature review.
• Disease modelling for dose timing and population impact.
• Health economic analysis.
• Ethical review focusing on vaccine acceptance and equitable access.

Main Results:

• Varicella vaccines are safe and highly effective, with two doses offering near-complete protection against severe disease.
• Modelling suggests high coverage and catch-up vaccination can eliminate varicella transmission within 2-3 years, conferring herd immunity.
• A recommended schedule of two doses (18 months and 7-8 years), co-administered with MMR, ensures durable immunity and acceptance.
• Health economic analyses indicate the programme will be cost-saving.

Conclusions:

• The Swedish government will incorporate varicella vaccination into the NIP from 2027.
• Catch-up vaccination will be offered to susceptible individuals up to 18 years.
• Implementation through child and school health services will ensure equitable access.