Although the Selleckchem Dorsomorphin incidence of varicella and related morbidity have decreased dramatically in the U.S. and Canada following the introduction of routine 1-dose
varicella vaccination , , , ,  and , post licensure studies have confirmed some of the above concerns. Varicella outbreaks occur within highly vaccinated populations , ,  and  and one dose of vaccine has been observed to be 80–85% effective against any disease presentation , , , ,  and . It remains unclear though whether the lower efficacy estimated in post licensure studies, compared to the results from clinical trials, are due to waning over time  and . However, breakthrough varicella is generally mild and less contagious than varicella in unvaccinated persons  and . ABT737 Finally, surveillance studies in the U.S. have shown a small increase in zoster , ,  and . However, it is too early to link these increases with varicella vaccination as many of the U.S. surveillance
systems do not have pre-program zoster incidence data and increases in age-specific zoster incidence rates have been observed in other countries prior to varicella vaccination programs  and . A clinical trial was conducted (among healthy children followed up for 10 years) to measure the efficacy of 2 doses of varicella vaccine compared to 1-dose . The efficacy for 2 doses was significantly higher than for 1-dose of varicella vaccine (98% versus 94%) . Given the high number of breakthrough Edoxaban cases in vaccinees, the higher efficacy of 2 doses compared to 1-dose and continuing endemic disease, the U.S. Advisory Committee on Immunization Practices (ACIP) adopted a recommendation that children between 4 and 6 years of age receive a second dose of varicella vaccine . The panel also recommended that a second catch-up dose of varicella vaccine be given to anyone who previously had received one dose . In countries, such as Canada,
that have introduced a 1-dose varicella vaccination program, policymakers will be asked to make recommendations and decisions regarding the introduction of a second dose of varicella vaccination. In other countries, that have yet to introduce varicella vaccination, policy questions will be related to whether they should be introducing varicella vaccination and, if so, using how many doses. The aim of this study is to examine the potential short and long-term population-level impact of a 1-dose versus a 2-dose varicella vaccination program on the epidemiology of varicella and zoster, using Canada as an example. The modeled population is assumed to be stable and is stratified into 101 age cohorts (0, 1,., 100+). The birth rate is constant through each year and age-specific all cause mortality rates were taken from Statistics Canada .