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Volume: 25S5 - August 1999
Proceedings of the National Varicella Consensus Conference
Montreal, Quebec
May 5-7, 1999
Research Needs
Participants identified a number of research needs and priorities related
to varicella, outlined below. It was also recommended that these priorities
be brought to the attention of appropriate funding bodies so that research
funds can be made available to address them.
- General immunization issues, such as the need for booster doses and
waning immunity, should be addressed.
- Studies should be done to assess the molecular epidemiology of VZV
strains in Canada.
- Mechanisms of and susceptibility to VZV embryopathy should be defined.
- Models should be used to predict when surveillance systems should
shift from aggregate to case-by-case reporting and when special studies
should be done for case investigation. Surveillance data should be periodically
fed back into the models to improve their predictive capacity.
- Appropriate and safe immunization strategies should be determined
for immunocompromised patients, including HIV-infected persons; cancer
patients in remission; solid organ transplant recipients; bone marrow
transplant recipients; patients with hypogammaglobulinemia; leukemia
patients (e.g. whether to immunize 3 months after treatment, and the
role of acyclovir); persons with chronic lung disease (e.g. cystic fibrosis);
and other immunocompromised individuals, such as those receiving cyclosporine
treatment.
- Studies should be done to determine the potential for early use of
vaccine in anatomically compromised individuals (e.g. persons with pulmonary
conditions or skin disease); persons with chronic heart disease; and
pre-operative cases (for elective surgeries).
- History and serologic status of health care workers should be investigated
to establish (1) a Canadian profile among the age groups in this population;
(2) the benefits of booster vaccine, if any; and (3) the potential need
to revise the definition of health care worker with respect to potential
work exposure.
- Epidemiologic studies should be undertaken to determine whether any
of the following groups are at higher risk and should be identified
as priorities for specific immunization strategies: aboriginal persons
(e.g. whether aboriginal children are at higher risk of complications
from varicella, whether invasive group A streptococcal infections are
more common, whether children are at risk for missed vaccination opportunities
because of relocation); homeless persons; and immigrants (e.g. seroprevalence
information to determine endemicity from country of origin).
- Special studies in pregnant women should be carried out to determine
how many times a pregnant woman should be screened; the loss of immunity;
and prospective (anonymous) varicella prevalence among pregnant women
or babies.
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