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La vacuna de la varicela se presenta como una vacuna eficaz, efectiva, eficiente y segura. Previene la morbilidad, las complicaciones, la gravedad y los costes económicos y sociales que origina la varicela.

La vacuna de la varicela se ha incorporado al arsenal de inmunizaciones como la primera vacuna contra un herpesvirus, ya que la vacuna contra el virus herpes simple tipo 2, el herpes genital, está en fase de ensayos clínicos avanzados y se continúa investigando otra muy necesaria, la vacuna contra el citomegalovirus.

Actualmente, desde 1998, está comercializada en nuestro país la primera vacuna de la varicela (Varilrix, SmithKline Beechman), pero como una especialidad farmacéutica " de uso hospitalario ".

Situación actual de la varicela.

La varicela es, actualmente, la enfermedad exantemática más frecuente en la población infantil de los paises desarrollados. Esta enfermedad es habitualmente benigna pero puede tener complicaciones, a veces graves y que incluso ponen en peligro la vida del paciente. Éstas son más frecuentes en inmunodeprimidos, personas con afecciones pulmonares o cutáneas crónicas, embarazadas, etc.

Son también importantes los efectos sociales y económicos de la varicela: gastos directos debidos a la medicación y hospitalizaciones; gastos indirectos debidos al absentismo escolar y laboral, así como los ocasionados por la otra manifestación de la infección, el herpes zóster.

La edad de aparición actual es principalmente en niños menores de 10 años.

Las complicaciones de la varicela más frecuentes en niños inmunocompetentes son las infecciones bacterianas secundarias. Streptococcus pyogenes y Staphylococcus aureus son los principales microrganismos responsables de la sobreinfección. Las de origen cutáneo son las más frecuentes, seguidas de las pulmonares (la mayor letalidad de la varicela en el adulto se debe a la neumonía).También se dan complicaciones neurológicas siendo la ataxia cerebelosa aguda la más frecuente.

En el niño inmunodeprimido y en el adulto las complicaciones más frecuentes se deben al propio virus varicela-zoster que da lugar a una forma clínica, la varicela diseminada.

La varicela puede ser una causa de muerte.

Vacuna de la varicela

La inmunización frente a la varicela previene su morbilidad, gravedad, la incidecia de herpes zoster y los costes económicos y sociales que ocasiona la varicela.

Eficacia y efectividad: es muy efectiva para proteger al niño sano frente a la infección y reducir la gravedad de la enfermedad en caso de contraerla (95%). La inmunidad persiste al menos 10 años después de la vacunación. En niños inmunodeprimidos la protección es inferior pero importante, del 85%.

Eficiencia : los beneficios económicos de la vacunación superan los costes derivados del diagnóstico y tratamiento de los enfermos y de sus complicaciones, así como los derivados del absentismo escolar y laboral que ocasiona la varicela.

Seguridad: es una vacuna segura y bien tolerada. Las reacciones adversas más frecuentes en inmunodeprimidos y adultos son:

1. Exantema vesiculoso o maculopapuloso, localizado en el lugar de la inyección o generalizado.

2. Reacción local: dolor, eritema e induración

3. Fiebre

4. Otros:cefalea, astenia,convulsiones febriles, sintomas de vias respiratorias superiores

Recomendaciones de uso de la inmunización

Inmunización sistemática del niño. La vacunación se realizará a los 15 meses de edad, junto con la vacuna triple vírica.

Todos los adolescentes y adultos susceptibles. Es prioritaria en mujeres susceptibles en edad fértil y en el personal sanitario.

Los contactos susceptibles de un caso de varicela. Si se administra en los tres días posteriores al contacto la vacunación es efectiva.

Los pacientes inmunodeficientes requieren unas condiciones inmunitarias favorables que son difíciles de conseguir para la vacunación.

Los pacientes con alteraciones de la inmunidad humoral pueden recibir la vacuna de la varicela. Sin embargo, ésta no se debe administrar a pacientes con deficiente inmunidad celular, como los infectados por el virus de la inmunodeficiencia humana.

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