Aggiornamento
I nuovi vaccini: pro e contro, oggi
PNEUMOCOCCAL, MENINGOCOCCAL AND VARICELLA VACCINATION: ADVANTAGES AND DISADVANTAGES TODAY
IRENE BERTI1, TIZIANA GUERRERA2, DINO FARAGUNA3
1Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
2Clinica Pediatrica, Policlinico Universitario di Udine
3Dipartimento Materno-Infantile, Ass 2, Monfalcone - Gorizia
Gennaio 2006 - pagg. 19 -30
Abstract
This paper gives updated information on heptavalent anti pneumococcal conjugate vaccine, anti meningococcal C conjugate vaccine and anti varicella vaccination, with the purpose of providing a critical picture on advantages and disadvantages of extensive programs for these new vaccinations. The data analyzed regard both the efficacy of each product and the influence of wide immunization strategies.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Whitney CG. The potential of pneumococcal
conjugate vaccines for children. Ped
Infect Dis J 2002;21:961-70.
2. Overturf GD. Pneumococcal vaccination of children. Semin Ped Infec Dis 2002;1:155- 64.
3. O’Dempsey TJ, McArdle TF, Lloyd-Evans N, et al. Pneumococcal disease among children in rural area of West Africa. Pediatr Infect Dis J 1996;15:431-7.
4. von Kries R, Siedler A, Schmitt HJ, Reinert RR. Proportion of invasive pneumococcal infections in German children preventable by pneumococcal conjugate vaccines. Clin Infect Dis 2000;31:482-7.
5. Laurichesse H, Romaszko JP, Nguyen LT, et al. Clinical characteristics and outcome of patients with invasive pneumococcal disease, Puy-de-Dome, France, 1994-1998. Eur J Clin Microbiol Infect Dis 2001;20:299-308.
6. Dominguez A, Salleras L, Cardenosa N, et al. The epidemiology of invasive Streptococcus pneumoniae disease in Catalonia (Spain). A hospital-based study. Vaccine 2002;20: 2989-94.
7. D’Ancona F, Salmaso S, Barale A, et al. Incidence of vaccine preventable pneumococcal invasive infections and blood culture practices in Italy. Vaccine 2005;23:2494-500.
8. Attualità sull’epidemiologia e la prevenzione delle infezioni da Sp in età pediatrica. Roma, 8 settembre 2003.
9. Pompa MG, Salmaso S, Caporali MG, Rizzuto E. Streptococcus pneumoniae meningitis in Italy, 1994-98. Ann Ig 1999;11:261-3.
10. Esposito S, Madore DV, Gironi S, et al. Theoretic coverage of heptavalent pneumococcal conjugate vaccine in the prevention of community-acquired pneumonia in children in Italy. Vaccine 2003;21:2704-7.
11. Marchisio P, Principi N, Sorella S, Sala E, Tornaghi R. Etiology of acute otitis media in human immunodeficiency virus-infected children. Pediatr Infect Dis J 1996;15:58-61.
12. Tozzi AE, Panei P, Ciofi degli Atti M, Anemona A, Scuderi G, Salmaso S. Epidemiology of invasive infections with Haemophilus influenzae type b in the world and in Italy. Ann Ig 1995;7(4):235-41.
13. Hausdorff WP, Bryant J, Paradiso PR. Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use. Part
1. Clin infect Dis 2000;30:100-21.
14. Black S, Shinefield H, Fireman B, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Ped Infect Dis J 2000;19:187-95.
15. Lexau CA, Lynfield R, Danila R, et al. Changing Epidemiology of Invasive Pneumococcal Disease Among Older Adults in the Era of Pediatric Pneumococcal Conjugate Vaccine. JAMA 2005;294:2043-51.
16. Eskola J, Kilpi T, Palmu A, et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001;344: 403-9.
17. Principi N, Esposito S. Efficacia della vaccinazione antipneumococcica con vaccino eptavalente coniugato nella prevenzione della meningite, della polmonite e dell’otite media acuta del soggetto di età pediatrica. Copertura teorica offerta dal vaccino in Italia. Ann Ig 2002(7);14:21-3.
18. Pantosti A, D’Ambrosio F, Tarasi A, Recchia S, Orefici G, Mastrantonio P. Antibiotic susceptibility and serotype distribution of Streptococcus pneumoniae causing meningitis in Italy, 1997-1999. Clin Infect Dis 2000; 3:1373-9.
19. Moro ML, Pantosti A, Boccia D. Gruppo EARSS-Italia. Antibiotic microbial resistance surveillance in invasive infections caused by Streptococcus pneumoniae and Staphylococcus aureus: the EARSS (European Antimicrobial Resistance Surveillance System) project in Italy (April 1999-April 2000). Ann Ig 2002;14: 361-367.
20. Monaco M, Gomelli R, D’Ambrosio F, Del Grosso M, Pantosti A. Evaluation of erythromycin resistance in Streptococcus pneumoniae in Italy. J Antimicrob Chemother 2005;55:256-9.
21. Whitney CG, Klugman KP. Vaccines as tools against resistance: the example of pneumococcal conjugate vaccine. Semin Pediatr Infect Dis 2004;15:86-93.
22. Marchisio P, Esposito S, Schito GC, Marchese A, Cavagna R, Principi N. Hercules Project Collaborative Group. Nasopharyngeal carriage of Streptococcus pneumoniae in healthy children: implications for the use of heptavalent pneumococcal conjugate vaccine. Emerg Infect Dis 2002;8:479-84.
23. Ciriminna S, Cuccia M. “Herd immunità” della vaccinazione antipneumococcica e impatto delle campagne vaccinali. Ann Ig 2002 (7);14;39-42.
24. O’Brien KL, Dagan R. The potential indirect effect of coniugate pneumococcal vaccines. Vaccine 2003;21:1815-25.
25. Kyaw MH, Jones IG, Campbell H. Prevention of pneumococcal disease in children. Pneumococcal conjugate vaccines: their use globally could have a major impact on public health. Acta Paediatr 2001; 90:473-6.
26. Marchetti M, Colombo GL. Cost-effectiveness of Universal pneumococcal vaccination for infants in Italy. Vaccine 2005;23:4565- 76.
27. Veenhoven R, Bogaert D, Uiterwaal C, et al. Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomised study. Lancet 2003;361:2189-95.
28. Porat N, Arguedas A, Spratt BG, et al. Emergence of Penicillin-Nonsusceptible Streptococcus pneumoniae Clones Expressing Serotypes Not Present in the Antipneumococcal Conjugate Vaccine. J Infect Dis 2004;190: 2154-61.
29. Huang SS, Platt R, Rifas-Shiman SL, Pelton SI, Goldmann D, Finkelstein JA. Post- PCV7 changes in colonizing pneumococcal serotypes in 16 Massachusetts communities, 2001 and 2004. Pediatrics 2005;116:408-13.
30. Whitney C, Farley M, Hadler J, et al. For the active bacterial core surveillance program of the emerging infections program network. Increasing prevalence of multidrug- resistant Streptococcus pneumoniae in the United States. N Engl J Med 2000;343: 1917-24.
31. Cartwright K, Noah N, Peltola H. Meningococcal Disease Advisory Board. Meningococcal disease in Europe: epidemiology, mortality, and prevention with conjugate vaccines. Report of a European advisory board meeting. Vienna, Austria, 6-8 October, 2000. Vaccine 2001;19:4347-56.
32. Pollard A, Levin M. Vaccines for prevention of meningococcal disease. Pediatr Infect Dis J 2000;19:333-45.
33. Tikhomirov E, Santamaria M, Esteves K. Meningococcal disease: public health burden and control. World Health Stat Q 1997; 50:170-7.
34. Campagne G, Garba A, Fabre P, et al. Safety and immunogenicity of three doses of a Neisseria meningitidis A + C diphtheria coniugate vaccine in infants from Nigeria. Pediatr Infect Dis J 2000;19:144-50.
35. Salleras L, Dominguez A, Cordenosa N. Dramatic decline of serogroup C meningococcal disease in Catatonia (Spain) after a mass vaccination campaign with meningococcal C coniugate vaccine. Vaccine 2003;21: 729-33.
36. Pollard AJ. Global epidemiology of meningococcal disease and vaccine efficacy. Pediatr Infect Dis J 2004;23(12):S274-9.
37. Trotter CL, Andrews NJ, Kaczmarski EB, Miller E, Ramsay ME. Effectiveness of meningococcal serogroup C conjugate vaccine 4 years after introduction. Lancet 2004;364: 365-7.
38. Cartwright K, Noah N, Peltola H, et al. On behalf of the Meningococcal Disease Advisory Board. Meningococcal disease in Europe: Report of a European advisory board meeting. Vienna, 6-8 October, 2000. Vaccine 2001; 19:4347-56.
39. Finn R, Groves C, Coe M, Pass M, Harrison LH. Cluster of serogroup C meningococcal disease associated with attendance at a party. South Med J 2001;94:1192-4.
40. Rosenstein NE, Perkins BA, Stephens DS. Meningococcal disease. N Engl J Med 2001; 344:1378-88.
41. Jodar L, Feavers IM, Salisbury D, Granoff DM. Development of vaccines against meningococcal disease. Lancet 2002;359: 1499-508.
42. Perez-Trallero E, Vicente D, Montes M, Cisterna R. Positive effect of meningococcal vaccination on serogroup replacement in Neisseria meningitidis. Lancet 2002;360:953.
43. Moe GR, Dave A, Granoff DM. Epitopes recognized by a nonautoreactive murine anti- N-propionyl meningococcal group B polysaccharide monoclonal antibody. Infect Immun 2005;73:2123-8.
44. Salmaso S, Mandolini D, Scalia Tomba G, Esposito N. La prevenzione della varicella in Italia: strategie di vaccinazione. Ann Ig 2002; 14 (suppl 6): 35-44.
45. Ciofi degli Atti M, Rota MC, Salmaso S, et al. Monitoring varicella in Italy. Ann Ig 2002; 14:11-9.
46. SPES, dati 2002.
47. Nicolosi A, Sturkenboom M, Mannino S, Arpinelli F, Cantarutti L, Giaquinto C. The incidence of varicella: correction of a common error. Epidemiology 2003;14:99-102.
48. Floret D. La varicelle de l’enfant immunocompetent: complications et facteurs de risque. Med Mal Infect 1998;28,Special:775-81.
49. Volpi A, Gentile G, Pica F, Suligoi B and Slavip Study Group. Antiviral treatment of varicella in pediatric practice in the Latium region of Italy: results of an observational study. Pediatr Infect Dis J 2001;21:739-43.
50. Deguen S, Chau NP, Flahault A. Epidemiology of chickenpox in France (1991-95). J Epidemiol Community Health 1998;52(1): 46S- 49S.
51. Melzer SM, Molteni RA, Marcuse EK, Rivara FP. Characteristics and financial performance of a pediatric faculty inpatient attending service: a resource-based relative value scale analysis. Pediatrics 2001;108:79-84.
52. Sauerbrei A, Wutzler P. Neonatal varicella. J Perinatol 2001;21:545-9.
53. Manfredi R, Chiodo F, Titone L, et al. Chickenpox complications among immunocompetent hospitalized children in Italy. Acyclovir- Chickenpox Italian Study Group. Pediatr Med Chir 1997;19:99-104.
54. Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med 2005;352:450-8.
55. Petaros P, Marchetti F. La varicella. Medico e Bambino 2005;24:89-98.
56. Asano Y, Yoshikawa T, Suga S, et al. Postexposure prophylaxis of varicella in family contact by oral acyclovir. Pediatrics 1993; 92:219-22.
57. Salmaso S, Mandolini D, Scalia Tomba G, Esposito N. Prevention of varicella in Italy: vaccination strategies. Ann Ig 2002; 14(4 Suppl 6):35-44.
58. Shinefield H, Black S, Williams WR, et al. Dose-response study of a quadrivalent measles, mumps, rubella and varicella vaccine in healthy children. Pediatr Infect Dis J 2005; 24:670-5.
59. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005;352:2271-84.
60. Shinefield H, Black S, Digilio L, et al. Evaluation of a quadrivalent measles, mumps, rubella and varicella vaccine in healthy children. Pediatr Infect Dis J 2005;24:665-9.
61. Taylor JA. Herd immunity and the varicella vaccine. Arch Pediatr Adolesc Med 2001; 155:440-41.
62. Zhou F, Harpaz R, Jumaan AO, Winston CA, Shefer A. Impact of Varicella Vaccination on health care utilization. JAMA 2005;294: 797-802.
63. Brisson M, Edmunds WJ. Varicella vaccination in England and Wales: cost-utility analysis. Arch Dis Child 2003;88:862-9.
64. Brisson M, Edmunds WJ. Epidemiology of Varicella-Zoster Virus in England and Wales. J Med Virol 2003;70(1):S9-14.
65. Somministrazione simultanea di più vaccini nella stessa seduta. Supplemento alla rivista Italiana di Immunologia e Allergologia Pediatrica. Agosto 2005.
66. Dagan R, Eskola J, Leclerc C, Leroy O. Reduced response to multiple vaccines sharing common protein epitopes that are administered simultaneously to infants. Infect Immun 1998;66:2093-8.
67. Peltola H. What would be happen if we stopped vaccination? Lancet 2000;356:s21- s22.
2. Overturf GD. Pneumococcal vaccination of children. Semin Ped Infec Dis 2002;1:155- 64.
3. O’Dempsey TJ, McArdle TF, Lloyd-Evans N, et al. Pneumococcal disease among children in rural area of West Africa. Pediatr Infect Dis J 1996;15:431-7.
4. von Kries R, Siedler A, Schmitt HJ, Reinert RR. Proportion of invasive pneumococcal infections in German children preventable by pneumococcal conjugate vaccines. Clin Infect Dis 2000;31:482-7.
5. Laurichesse H, Romaszko JP, Nguyen LT, et al. Clinical characteristics and outcome of patients with invasive pneumococcal disease, Puy-de-Dome, France, 1994-1998. Eur J Clin Microbiol Infect Dis 2001;20:299-308.
6. Dominguez A, Salleras L, Cardenosa N, et al. The epidemiology of invasive Streptococcus pneumoniae disease in Catalonia (Spain). A hospital-based study. Vaccine 2002;20: 2989-94.
7. D’Ancona F, Salmaso S, Barale A, et al. Incidence of vaccine preventable pneumococcal invasive infections and blood culture practices in Italy. Vaccine 2005;23:2494-500.
8. Attualità sull’epidemiologia e la prevenzione delle infezioni da Sp in età pediatrica. Roma, 8 settembre 2003.
9. Pompa MG, Salmaso S, Caporali MG, Rizzuto E. Streptococcus pneumoniae meningitis in Italy, 1994-98. Ann Ig 1999;11:261-3.
10. Esposito S, Madore DV, Gironi S, et al. Theoretic coverage of heptavalent pneumococcal conjugate vaccine in the prevention of community-acquired pneumonia in children in Italy. Vaccine 2003;21:2704-7.
11. Marchisio P, Principi N, Sorella S, Sala E, Tornaghi R. Etiology of acute otitis media in human immunodeficiency virus-infected children. Pediatr Infect Dis J 1996;15:58-61.
12. Tozzi AE, Panei P, Ciofi degli Atti M, Anemona A, Scuderi G, Salmaso S. Epidemiology of invasive infections with Haemophilus influenzae type b in the world and in Italy. Ann Ig 1995;7(4):235-41.
13. Hausdorff WP, Bryant J, Paradiso PR. Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use. Part
1. Clin infect Dis 2000;30:100-21.
14. Black S, Shinefield H, Fireman B, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Ped Infect Dis J 2000;19:187-95.
15. Lexau CA, Lynfield R, Danila R, et al. Changing Epidemiology of Invasive Pneumococcal Disease Among Older Adults in the Era of Pediatric Pneumococcal Conjugate Vaccine. JAMA 2005;294:2043-51.
16. Eskola J, Kilpi T, Palmu A, et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001;344: 403-9.
17. Principi N, Esposito S. Efficacia della vaccinazione antipneumococcica con vaccino eptavalente coniugato nella prevenzione della meningite, della polmonite e dell’otite media acuta del soggetto di età pediatrica. Copertura teorica offerta dal vaccino in Italia. Ann Ig 2002(7);14:21-3.
18. Pantosti A, D’Ambrosio F, Tarasi A, Recchia S, Orefici G, Mastrantonio P. Antibiotic susceptibility and serotype distribution of Streptococcus pneumoniae causing meningitis in Italy, 1997-1999. Clin Infect Dis 2000; 3:1373-9.
19. Moro ML, Pantosti A, Boccia D. Gruppo EARSS-Italia. Antibiotic microbial resistance surveillance in invasive infections caused by Streptococcus pneumoniae and Staphylococcus aureus: the EARSS (European Antimicrobial Resistance Surveillance System) project in Italy (April 1999-April 2000). Ann Ig 2002;14: 361-367.
20. Monaco M, Gomelli R, D’Ambrosio F, Del Grosso M, Pantosti A. Evaluation of erythromycin resistance in Streptococcus pneumoniae in Italy. J Antimicrob Chemother 2005;55:256-9.
21. Whitney CG, Klugman KP. Vaccines as tools against resistance: the example of pneumococcal conjugate vaccine. Semin Pediatr Infect Dis 2004;15:86-93.
22. Marchisio P, Esposito S, Schito GC, Marchese A, Cavagna R, Principi N. Hercules Project Collaborative Group. Nasopharyngeal carriage of Streptococcus pneumoniae in healthy children: implications for the use of heptavalent pneumococcal conjugate vaccine. Emerg Infect Dis 2002;8:479-84.
23. Ciriminna S, Cuccia M. “Herd immunità” della vaccinazione antipneumococcica e impatto delle campagne vaccinali. Ann Ig 2002 (7);14;39-42.
24. O’Brien KL, Dagan R. The potential indirect effect of coniugate pneumococcal vaccines. Vaccine 2003;21:1815-25.
25. Kyaw MH, Jones IG, Campbell H. Prevention of pneumococcal disease in children. Pneumococcal conjugate vaccines: their use globally could have a major impact on public health. Acta Paediatr 2001; 90:473-6.
26. Marchetti M, Colombo GL. Cost-effectiveness of Universal pneumococcal vaccination for infants in Italy. Vaccine 2005;23:4565- 76.
27. Veenhoven R, Bogaert D, Uiterwaal C, et al. Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomised study. Lancet 2003;361:2189-95.
28. Porat N, Arguedas A, Spratt BG, et al. Emergence of Penicillin-Nonsusceptible Streptococcus pneumoniae Clones Expressing Serotypes Not Present in the Antipneumococcal Conjugate Vaccine. J Infect Dis 2004;190: 2154-61.
29. Huang SS, Platt R, Rifas-Shiman SL, Pelton SI, Goldmann D, Finkelstein JA. Post- PCV7 changes in colonizing pneumococcal serotypes in 16 Massachusetts communities, 2001 and 2004. Pediatrics 2005;116:408-13.
30. Whitney C, Farley M, Hadler J, et al. For the active bacterial core surveillance program of the emerging infections program network. Increasing prevalence of multidrug- resistant Streptococcus pneumoniae in the United States. N Engl J Med 2000;343: 1917-24.
31. Cartwright K, Noah N, Peltola H. Meningococcal Disease Advisory Board. Meningococcal disease in Europe: epidemiology, mortality, and prevention with conjugate vaccines. Report of a European advisory board meeting. Vienna, Austria, 6-8 October, 2000. Vaccine 2001;19:4347-56.
32. Pollard A, Levin M. Vaccines for prevention of meningococcal disease. Pediatr Infect Dis J 2000;19:333-45.
33. Tikhomirov E, Santamaria M, Esteves K. Meningococcal disease: public health burden and control. World Health Stat Q 1997; 50:170-7.
34. Campagne G, Garba A, Fabre P, et al. Safety and immunogenicity of three doses of a Neisseria meningitidis A + C diphtheria coniugate vaccine in infants from Nigeria. Pediatr Infect Dis J 2000;19:144-50.
35. Salleras L, Dominguez A, Cordenosa N. Dramatic decline of serogroup C meningococcal disease in Catatonia (Spain) after a mass vaccination campaign with meningococcal C coniugate vaccine. Vaccine 2003;21: 729-33.
36. Pollard AJ. Global epidemiology of meningococcal disease and vaccine efficacy. Pediatr Infect Dis J 2004;23(12):S274-9.
37. Trotter CL, Andrews NJ, Kaczmarski EB, Miller E, Ramsay ME. Effectiveness of meningococcal serogroup C conjugate vaccine 4 years after introduction. Lancet 2004;364: 365-7.
38. Cartwright K, Noah N, Peltola H, et al. On behalf of the Meningococcal Disease Advisory Board. Meningococcal disease in Europe: Report of a European advisory board meeting. Vienna, 6-8 October, 2000. Vaccine 2001; 19:4347-56.
39. Finn R, Groves C, Coe M, Pass M, Harrison LH. Cluster of serogroup C meningococcal disease associated with attendance at a party. South Med J 2001;94:1192-4.
40. Rosenstein NE, Perkins BA, Stephens DS. Meningococcal disease. N Engl J Med 2001; 344:1378-88.
41. Jodar L, Feavers IM, Salisbury D, Granoff DM. Development of vaccines against meningococcal disease. Lancet 2002;359: 1499-508.
42. Perez-Trallero E, Vicente D, Montes M, Cisterna R. Positive effect of meningococcal vaccination on serogroup replacement in Neisseria meningitidis. Lancet 2002;360:953.
43. Moe GR, Dave A, Granoff DM. Epitopes recognized by a nonautoreactive murine anti- N-propionyl meningococcal group B polysaccharide monoclonal antibody. Infect Immun 2005;73:2123-8.
44. Salmaso S, Mandolini D, Scalia Tomba G, Esposito N. La prevenzione della varicella in Italia: strategie di vaccinazione. Ann Ig 2002; 14 (suppl 6): 35-44.
45. Ciofi degli Atti M, Rota MC, Salmaso S, et al. Monitoring varicella in Italy. Ann Ig 2002; 14:11-9.
46. SPES, dati 2002.
47. Nicolosi A, Sturkenboom M, Mannino S, Arpinelli F, Cantarutti L, Giaquinto C. The incidence of varicella: correction of a common error. Epidemiology 2003;14:99-102.
48. Floret D. La varicelle de l’enfant immunocompetent: complications et facteurs de risque. Med Mal Infect 1998;28,Special:775-81.
49. Volpi A, Gentile G, Pica F, Suligoi B and Slavip Study Group. Antiviral treatment of varicella in pediatric practice in the Latium region of Italy: results of an observational study. Pediatr Infect Dis J 2001;21:739-43.
50. Deguen S, Chau NP, Flahault A. Epidemiology of chickenpox in France (1991-95). J Epidemiol Community Health 1998;52(1): 46S- 49S.
51. Melzer SM, Molteni RA, Marcuse EK, Rivara FP. Characteristics and financial performance of a pediatric faculty inpatient attending service: a resource-based relative value scale analysis. Pediatrics 2001;108:79-84.
52. Sauerbrei A, Wutzler P. Neonatal varicella. J Perinatol 2001;21:545-9.
53. Manfredi R, Chiodo F, Titone L, et al. Chickenpox complications among immunocompetent hospitalized children in Italy. Acyclovir- Chickenpox Italian Study Group. Pediatr Med Chir 1997;19:99-104.
54. Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med 2005;352:450-8.
55. Petaros P, Marchetti F. La varicella. Medico e Bambino 2005;24:89-98.
56. Asano Y, Yoshikawa T, Suga S, et al. Postexposure prophylaxis of varicella in family contact by oral acyclovir. Pediatrics 1993; 92:219-22.
57. Salmaso S, Mandolini D, Scalia Tomba G, Esposito N. Prevention of varicella in Italy: vaccination strategies. Ann Ig 2002; 14(4 Suppl 6):35-44.
58. Shinefield H, Black S, Williams WR, et al. Dose-response study of a quadrivalent measles, mumps, rubella and varicella vaccine in healthy children. Pediatr Infect Dis J 2005; 24:670-5.
59. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005;352:2271-84.
60. Shinefield H, Black S, Digilio L, et al. Evaluation of a quadrivalent measles, mumps, rubella and varicella vaccine in healthy children. Pediatr Infect Dis J 2005;24:665-9.
61. Taylor JA. Herd immunity and the varicella vaccine. Arch Pediatr Adolesc Med 2001; 155:440-41.
62. Zhou F, Harpaz R, Jumaan AO, Winston CA, Shefer A. Impact of Varicella Vaccination on health care utilization. JAMA 2005;294: 797-802.
63. Brisson M, Edmunds WJ. Varicella vaccination in England and Wales: cost-utility analysis. Arch Dis Child 2003;88:862-9.
64. Brisson M, Edmunds WJ. Epidemiology of Varicella-Zoster Virus in England and Wales. J Med Virol 2003;70(1):S9-14.
65. Somministrazione simultanea di più vaccini nella stessa seduta. Supplemento alla rivista Italiana di Immunologia e Allergologia Pediatrica. Agosto 2005.
66. Dagan R, Eskola J, Leclerc C, Leroy O. Reduced response to multiple vaccines sharing common protein epitopes that are administered simultaneously to infants. Infect Immun 1998;66:2093-8.
67. Peltola H. What would be happen if we stopped vaccination? Lancet 2000;356:s21- s22.
Corrispondenza: dino.faraguna@ass2.sanita.fvg.it