title: Varicella-zoster virus vaccination under the exogenous boosting hypothesis: two ethical perspectives.
abstract: The varicella-zoster virus (VZV) causes two diseases: varicella ('chickenpox') and herpes zoster ('shingles'). VZV vaccination of children reduces exposure to chickenpox in the population and it has been hypothesized that this could increase the prevalence of shingles. This 'exogenous boosting' effect of VZV raises an important equity concern: introducing a vaccination program could advance the health of one population group (children) at the expense of another (adults and elderly). We discuss the program's justifiability from two ethical perspectives, classic utilitarianism and contractualism. Whereas the former framework might offer a foundation for the case against introducing this vaccination, the latter offers a basis to justify it.
authors.affiliation: Department of Social Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom; Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium. Electronic address: jeroen.luyten@uantwerp.be.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Luyten
authors.affiliation: Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
authors.forename: Benson
authors.initials: B
authors.lastname: Ogunjimi
authors.affiliation: Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia.
authors.forename: Philippe
authors.initials: P
authors.lastname: Beutels
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006562:Herpes Zoster / Q000139:chemically induced* / Q000453:epidemiology*; D053061:Herpes Zoster Vaccine / Q000008:administration & dosage* / Q000009:adverse effects*; D014645:Herpesvirus 3, Human / Q000276:immunology*; D006801:Humans; D017589:Immunization Programs / Q000941:ethics; D014611:Vaccination / Q000941:ethics* / Q000379:methods*
chemical_list: D053061:Herpes Zoster Vaccine
keywords: Chickenpox; Equity; Immunization; Intergenerational; Justice; Shingles; Zona