Public health guidance on varicella vaccination in the European Union


European Centre for Disease Prevention and Control. Varicella vaccination in the European Union. Stockholm: ECDC; 2015.

​In 2014, ECDC’s Vaccine-Preventable Diseases Programme established a working group to provide guidance on the introduction of varicella vaccination in EU Member States. The pre-consultation document is available here.

This final report was released in February 2015 following a public consultation on the working group’s preliminary guidance report (April 2014) and is intended to support EU Member States in their national decision-making process with regard to childhood varicella vaccination.

Executive summary

The ECDC Guidance on varicella vaccination states that a universal varicella childhood vaccination programme with two-doses has proven to provide full control and reduce the burden of the disease. In addition, the introduction of the vaccine does not appear to directly result in an increase in herpes zoster (HZ) although stronger surveillance systems would give more definitive insight.

Vaccine effectiveness for one-dose vaccination has been estimated around 85% according to the report. A one-dose vaccination has proven to be effective in reducing the burden of the disease but does not necessarily prevent milder forms of varicella, also known as breakthrough varicella (BV), from occurring.

Surveillance from countries that have implemented varicella vaccination in children have shown a rapid decrease of varicella cases, complications, hospitalisation rates and deaths in all age groups.

To date, only six EU/EEA countries (Cyprus, Germany, Greece, Latvia and Lithuania) are recommending universal varicella vaccination for children at the national level and two countries (Spain and Italy) at the regional level. Seventeen countries recommend nationwide vaccination for susceptible teenagers and risk groups only. The report also reviewed the experience of USA on varicella vaccination which started universal childhood vaccination in 1996.

Introducing vaccination programmes

National health authorities should assess, among other aspects, their epidemiological and socioeconomic situations and capacity to reach at least 80% vaccination coverage when planning for varicella vaccination programmes. High coverage level should be achieved to avoid shifting the disease to older age groups.

Also, it is important to take into consideration the differences in incidence and force of infection in countries. The report shows evidence that in some countries, antibodies are acquired at an earlier age and that seroprevalence is lower among children in southern and eastern Europe. These variations could be attributed to differences in use of day care and pre-school facilities and social contacts. Further monitoring the impact of varicella vaccine on HZ remains a priority.

About the Guidance

A public consultation on this technical report was opened on ECDC’s website from 22 April to 23 June 2014.
Information about the public consultation was broadly communicated to stakeholders. In total, 10 contributions were received, of which four were from institutes of public health/public health authority, three from the pharmaceutical industry, and three from the scientific community.