Ref Number = ASPR0018
Dominicus Husada
Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo Academic General Hospital, Surabaya
Email: dominicushusada@yahoo.com
Varicella disease or chickenpox is an often encountered contagious disease in children that is caused by the Varicella-Zoster virus. This disease is characterized by fever and various types of rashes. Transmission occurs through droplets or direct contact. Even though most patients will recover spontaneously after a few days, a small number of others can become severe, have complications, and even die. The more potentially dangerous groups are pregnant women and neonates. Some more complex problems in varicella include congenital varicella syndrome, secondary infection with some harmful bacteria, disseminated varicella in the immunocompromized group, and neonatal varicella.
One of the efforts to prevent varicella is through immunization. The first vaccine was discovered in 1974 in Japan. The strain used was isolated by Michiaki Takahashi and continues to be used today. Varicella vaccine is available in a single or combination form. The efficacy based on clinical research data is very good. The United States is the first country to make it mandatory since 1995. In the Indonesian Pediatrician Association immunization schedule, the varicella vaccine can be given from the age of 1 year. In other countries, varicella vaccines are given twice. 
The German study found 86% effectiveness when compared to the unvaccinated group. At one dose, the Oka strain vaccine gives 86% effectiveness. In comparison, other varicella strain vaccines have only reached 56%. Antibody levels measured by the ELISA method also showed higher results in the group receiving the Oka strain vaccine. Breakthrough cases, hospitalization rates, and mortality rates were significantly different in the group using the varicella vaccine. In long-term use, the varicella vaccine certainly reduces the incidence of varicella significantly.
In terms of safety, fever (14.7%), rash (around 4%), and complaints at the injection site (19%) were the most common. The data came from the surveillance of the incidence of adverse events following immunization in children aged 1-12 years during the phase III clinical trial. Varicella vaccine does not cause an increase in the incidence of shingles, and even in the long run will also reduce the number of shingles patients.
Measles to this day is one of the biggest causes of infant death. Indonesia occupies the 6th position in the world as a country with the largest cases of measles. Measles outbreaks have recently been reported to increase worldwide, mainly due to decreased immunization coverage. Measles complications include diarrhea, otitis media, pneumonia, encephalitis, and seizures.
The incidence of mumps or parotitis in Indonesia is not well known. A study in grades 1-6 elementary school in Jakarta found 62.5% of children aged 5-7 years admitted by their parents had suffered from mumps. More than half of the population aged 5-12 years already have immunity in their blood. The most common complications of mumps are orchitis, pancreatitis, deafness, and death.
Indonesia occupies the highest position in terms of the number of rubella patients compared to other Asian countries. Complications of rubella include arthritis, encephalitis, bleeding, orchitis, and nephritis. Congenital rubella surveillance has been intensified in several countries in recent years, including in Indonesia. This disease causes damage to the fetus, by primarily attacking the eyes, heart, hearing, and brain. Reports from Japan in 2013 found that of nearly 4000 cases of rubella that occurred during the outbreak that year, only 5% had received previous rubella immunizations.
WHO provides recommendations for the MMR vaccine. The contents of the recommendation include the three vaccine components which read as follows: Measles immunization is recommended for all vulnerable children and adults where and the standard is twice the vaccination in childhood; immunization of mumps is recommended in countries with established basic vaccination programs, has the capacity to achieve high coverage, and where the reduction of mumps is important because of public health problems; rubella immunization must be included in the measles vaccine in the form of MR or MMR. At present, there are very many countries recommending 2 doses of MMR vaccine. 
The MMR vaccine uses the measles attenuated Enders strain, Jeryl Lynn's mumps strain, and the Wistar RA rubella strain. Safety aspects for each component have been proven good, including from the results of observations for 32 years (1978-2010). The most common adverse effects are rashes, enlarged glands, fever, swallowing pain, and headache. Serious adverse effects include arthritis, neuropathy, and thrombocytopenia. Immunogenicity with one MMR vaccination is 95% (measles), 96% (mumps), and 99% (rubella).
Keywords: varicella, measles, mumps, rubella, immunization
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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