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Monday, 30 August 2004
Page: 26767

Senator Allison asked the Minister representing the Minister for Health and Ageing, upon notice, on 14 July 2004:

With reference to the proposed chickenpox (varicella) vaccine subsidy:

(1) Is it correct that: (a) the only people who are at risk of complications from chickenpox are those with serious immune suppression, and that almost all of those who have died from chickenpox had been treated prior to their deaths with steroids, anti-virals or other immune-suppressive drugs; (b) the experience in Japan, the country which has used this vaccine for the longest time, has been that rather than preventing chickenpox, vaccination has simply moved the disease from childhood to adulthood, when this normally benign disease can be more dangerous; (c) the use of this vaccine has led to an increase in shingles (Herpes zoster) infections in children and that this painful illness used to be unheard of in young people but is now becoming more and more common in countries where this vaccine is used; and (d) this vaccine contains Neomycin which, according to the manufacturer's directions ( section13/chapter153/153c.jsp), should only be used topically or orally and never injected because of the high toxicity of this drug when administered in this way.

(2) Given that chickenpox is a relatively benign disease, what, if any, are the benefits of subsidising the vaccine.

Senator Patterson (Minister for Family and Community Services and Minister Assisting the Prime Minister for the Status of Women) —The Minister for Health and Ageing has provided the following answer to the honourable senator's question:

(1) (a) Chickenpox (varicella zoster virus) is usually a disease of childhood, with estimates of up to 90% of all individuals infected in childhood.1 It is highly contagious and usually self-limiting with low morbidity and mortality rates. In some individuals, though, complications can arise and increased death rates are seen in neonates and immunocompromised people.2,3

Some studies identify predisposing factors for severe chickenpox infection as use of intermittent or long-term steroid treatment, women who are pregnant or postpartum, children with cancer or bone marrow transplants, HIV infection or other immune-suppression.3,4

(b) One study published in 1997 from Japan4 indicated that since vaccine licensure for healthy children in 1989, chickenpox vaccine has shifted the age distribution of chickenpox cases from children into adulthood, with an increase in the social costs to society. This study was referenced in a later edition of the New England Journal of Medicine.5 Whilst chickenpox vaccine was first licensed in Japan, vaccine coverage in the population has been quite limited.4

(c) Current data from countries with chickenpox vaccination programs have shown no evidence that chickenpox vaccination programs increase childhood shingles rates. However, full evaluation of these programs is continuing. Most cases of shingles are in individuals over 50 years of age.6

(d) The website address to which you refer indicates the uses for the antibiotic product neomycin, which is manufactured by Merck, Sharpe and Dohme. Neomycin is given to people who have specific bacterial infections, and should only be given by mouth (oral) or onto the skin (topical), depending on the product's formulation.

Vaccine manufacturers use trace amounts of neomycin in varicella vaccines to prevent bacterial contamination of the product as it is being manufactured. The GlaxoSmithKline product, Varilrix, contains 25 g of neomycin per dose of vaccine, while the CSL sponsored product, Varivax Refrigerated, contains only a trace amount of neomycin (less than 5 g).

There have been many clinical trials conducted on both varicella vaccine products available in Australia. All clinical trials have concluded that both vaccines are safe, and effective against chickenpox.

(2) On the advice of the Chief Medical Officer for Australia, Professor John Horvath, the Minister for Health and Ageing has asked the Australian Technical Advisory Group on Immunisation (ATAGI) to review the most recent evidence about chickenpox vaccine, and to update its advice about the benefits and costs of introducing the vaccine into the National Immunisation Program.

The Minister for Health and Ageing has been advised that at its July meeting ATAGI formulated a process for reviewing the evidence, and is expected to provide advice to the Minister late in 2004 or early in 2005.

1 Meyer PA, Seward JF, Jumaan AO, Wharton M. Varicella mortality: trends before vaccine licensure in the United States, 1970-1994. Journal of Infectious Diseases 2000;182:383-90.

2 Moffitt JE, Feldman S. Varicella vaccine. Annals of Allergy, Asthma and Immunology 1996;76:381-383.

3 World Health Organization. Varicella vaccines. Weekly Epidemiological Record 1998;73(32):241-248.

4 Takayama N, Ajisawa A, Negishi M, Masuda G, Minamitani M. Varicella in adulthood: clinical features, severity scores, source of infection and complications. Kansenshogaku Zasshi 1997;11:1113-1119.

5 Wack RP. More on varicella immunization. New England Journal of Medicine 1998 338(26):1927.

6 MacIntyre CR, Chu CP, Burgess MA. Use of hospitalization and pharmaceutical prescribing data to compare the prevaccination burden of varicella and herpes zoster in Australia. Epidemiology of Infection 2003;131:675-682.