67-484: The MMRV vaccine is a combination vaccine which combines the attenuated virus measles , mumps , rubella (German measles), and varicella (chickenpox). The MMRV vaccine has similar immunogenicity and overall safety profiles to the MMR vaccine administered with or without the varicella vaccine. The MMRV vaccine is typically given to children between one and two years of age. Several companies supply MMRV vaccines. Proquad
134-488: A combined measles, mumps, rubella and varicella vaccine (MMRV). Twelve European countries (Austria, Andorra, Cyprus, Czech Republic, Finland, Germany, Greece, Hungary, Italy, Latvia, Luxembourg and Spain) have universal varicella vaccination (UVV) policies, though only six of these countries have made it available at no cost via government funding. EU member states that have not implemented UVV cite reasons such as "a perceived low disease burden and low public health priority,"
201-548: A community with many unvaccinated children. The resulting outbreak infected 34 people, mostly children and virtually all unvaccinated; three of them were hospitalized. The public health response required making almost 5,000 phone calls as part of contact tracing , arranging and performing testing as needed, and arranging emergency vaccination for at-risk people who had had contact with this person. Taxpayers and local healthcare organizations likely paid more than US$ 167,000 in direct costs to contain this one outbreak. A major epidemic
268-619: A good blood count and are receiving appropriate treatment. Specific antiviral medication, such as acyclovir, famciclovir, or valacyclovir, are not recommended 24 hours before and 14 days after vaccination. Serious side effects are very rare. From 1998 to 2013, only one vaccine-related death was reported: an English child with pre-existent leukemia. On some occasions, severe reactions such as meningitis and pneumonia have been reported (mainly in inadvertently vaccinated immunocompromised children) as well as anaphylaxis . The possible mild side effects include redness, stiffness , and soreness at
335-463: A household expecting a newborn, health care workers , adults who may be exposed occupationally to varicella (for example, people who work with young children), immigrants and refugees from tropical regions, people receiving chronic salicylate therapy (for example, acetylsalicylic acid [ASA])," and others. Australia has adopted recommendations for routine immunization of children and susceptible adults against chickenpox. Other countries, such as
402-624: A larger trial was undertaken in September and October 1962, in New York City with the assistance of the WHO: 131 children received the live Enders-attenuated Edmonston B strain plus gamma globulin , 130 children received a "further attenuated" vaccine without gamma globulin, and 173 children acted as control subjects for both groups. As also shown in the Nigerian trial, the trial confirmed that
469-596: A live attenuated measles vaccine was undertaken in 1960 by the British paediatrician David Morley in a village near Ilesha , Nigeria; in case he could be accused of exploiting the Nigerian population, Morley included his own four children in the study. The encouraging results led to a second study of about 450 children in the village and at the Wesley Guild Hospital in Ilesha. Following another epidemic,
536-500: A rate of febrile seizures of 9 per 10,000 vaccinations with MMRV, as opposed to 4 per 10,000 for separate MMR and varicella shots; U.S. health officials known as the ACIP therefore do not express a preference for use of MMRV vaccine over separate injections. Rare but serious adverse events reported following Proquad vaccination include allergic reactions , including swelling of the lips, tongue, or face; difficulty breathing or closing of
603-595: A single shot followed by a booster. One form is called "Attenuvax". The measles component of the MMR vaccine uses Attenuvax, which is grown in a chick embryo cell culture using the Enders' attenuated Edmonston strain. Following ACIP recommendations, Merck decided not to resume production of Attenuvax as standalone vaccine on 21 October 2009. A 2022 study in the American Economic Journal found that
670-594: A two-dose series 3 months apart (a minimum interval of 4 weeks). For individuals 13–18 years old, the catch-up vaccination should be given 4 to 8 weeks apart (a minimum interval of 4 weeks). The varicella vaccine did not become widely available in the United States until 1995. In the UK, the vaccine is only available on the National Health Service for those who are in close contact with someone who
737-508: Is based on a live but weakened strain of measles. It comes as a dried powder which is mixed with a specific liquid before being injected either just under the skin or into a muscle. Verification that the vaccine was effective can be determined by blood tests. The measles vaccine was first introduced in 1963. In that year, the Edmonston-B strain of measles virus was turned into a vaccine by John Enders and colleagues and licensed in
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#1732776270174804-441: Is common worldwide. Although it was declared eliminated from the U.S. in 2000, high rates of vaccination and excellent communication with those who refuse vaccination are needed to prevent outbreaks and sustain the elimination of measles. Of the 66 cases of measles reported in the U.S. in 2005, slightly over half were attributable to one unvaccinated teenager who became infected during a visit to Romania. This individual returned to
871-428: Is a vaccine that protects against chickenpox . One dose of vaccine prevents 95% of moderate disease and 100% of severe disease. Two doses of vaccine are more effective than one. If given to those who are not immune within five days of exposure to chickenpox it prevents most cases of disease. Vaccinating a large portion of the population also protects those who are not vaccinated. It is given by injection just under
938-553: Is available privately, with a second dose to be given a year after the first. The varicella vaccine is not recommended for seriously ill people, pregnant women, people who have tuberculosis, people who have experienced a serious allergic reaction to the varicella vaccine in the past, people who are allergic to gelatin , people allergic to neomycin , people receiving high doses of steroids , people receiving treatment for cancer with x-rays or chemotherapy , as well as people who have received blood products or transfusions during
1005-523: Is inadvisable for some people to receive the measles or MMR vaccine, including cases of: John Franklin Enders , who had shared the 1954 Nobel Prize in Medicine for work on the polio virus, sent Thomas C. Peebles to Fay School in Massachusetts, where an outbreak of measles was underway; Peebles was able to isolate the virus from blood samples and throat swabs, and was later able to cultivate
1072-465: Is made from the Oka/ Merck strain of live attenuated varicella virus. The Oka virus was initially obtained from a child with natural varicella, introduced into human embryonic lung cell cultures, adapted to and propagated in embryonic guinea pig cell cultures, and finally propagated in a human diploid cell line originally derived from fetal tissues ( WI-38 ). Takahashi and his colleagues used
1139-508: Is marketed by Merck and was approved in 2005, for use in the United States by the Food and Drug Administration (FDA) for children ages twelve months through twelve years. An MMRV vaccine called Priorix Tetra by GlaxoSmithKline has been approved in Germany and Australia. The MMRV vaccine, a combined MMR and varicella vaccine, simplifies administration of the vaccines. One 2008 study indicated
1206-556: Is not otherwise practised in the UK. Since 2013, the MMRV vaccine is offered for free to all Brazilian citizens. The Roman Catholic Church is opposed to abortion. Nevertheless, the Pontifical Academy for Life stated in 2017 that "clinically recommended vaccinations can be used with a clear conscience and that the use of such vaccines does not signify some sort of cooperation with voluntary abortion". On 21 December 2020,
1273-499: Is not recommended during pregnancy ; however, the few times it has been given during pregnancy no problems resulted. The vaccine is available either by itself or along with the MMR vaccine , in a version known as the MMRV vaccine . It is made from weakened virus . A live attenuated varicella vaccine, the Oka strain, was developed by Michiaki Takahashi and his colleagues in Japan in
1340-491: Is on the World Health Organization's List of Essential Medicines . As outbreaks easily occur in under-vaccinated populations, non-prevalence of disease is seen as a test of sufficient vaccination within a population. One dose is about 93% effective while two doses of the vaccine are about 97% effective at preventing measles. Before the widespread use of the vaccine, measles was so common that infection
1407-476: Is particularly vulnerable to chickenpox. As there is an increased risk of shingles in adults due to possible lack of contact with chickenpox-infected children providing a natural boosting to immunity, and the fact that chickenpox is usually a mild illness, the NHS cites concerns about unvaccinated children catching chickenpox as adults when it is more dangerous. However, the vaccine is approved for 12 months and up and
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#17327762701741474-512: Is reduced for children who receive the varicella vaccine, but not eliminated. The CDC stated in 2014: "Chickenpox vaccines contain weakened live VZV, which may cause latent (dormant) infection. The vaccine-strain VZV can reactivate later in life and cause shingles. However, the risk of getting shingles from vaccine-strain VZV after chickenpox vaccination is much lower than getting shingles after natural infection with wild-type VZV." The risk of shingles
1541-444: Is significantly lower among children who have received varicella vaccination, including those who are immunocompromised. The risk of shingles is approximately 80% lower among healthy vaccinated children compared to unvaccinated children who had wild-type varicella. A population with high varicella vaccination also has lower incidence of shingles in unvaccinated children, due to herd immunity . The WHO recommends one or two doses with
1608-602: Is still common, which typically leads to an overestimation of effectiveness. Some vaccinated children have been found to lose their protective antibody in as little as five to eight years. However, according to the World Health Organization (WHO): "After observation of study populations for periods of up to 20 years in Japan and 10 years in the United States, more than 90% of immunocompetent persons who were vaccinated as children were still protected from varicella." However, since only one out of five Japanese children were vaccinated,
1675-430: The MMRV vaccine (a combination of MMR with the chickenpox vaccine ). The measles vaccine is equally effective for preventing measles in all formulations, but side effects vary for different combinations. The World Health Organization (WHO) recommends measles vaccine be given at nine months of age in areas of the world where the disease is common, or at twelve months where the disease is not common. Measles vaccine
1742-529: The "further attenuated" vaccine was superior to the Edmonston B vaccine, and caused significantly fewer instances of fever and diarrhea. 2,000 children in the area were vaccinated with the further-attenuated vaccine. Maurice Hilleman at Merck & Co. , a pioneer in the development of vaccinations, developed an improved version of the measles vaccine in 1968 and subsequently the MMR vaccine in 1971, which vaccinates against measles, mumps and rubella in
1809-451: The 1980s. An outbreak of almost 30,000 cases in 1990 led to a renewed push for vaccination and the addition of a second vaccine to the recommended schedule. No more than 220 cases were reported in any year from 1997 to 2013, and the disease was believed no longer endemic in the United States. In 2014, 667 cases were reported. The benefits of measles vaccination in preventing illness, disability, and death have been well documented. Within
1876-817: The MMRV vaccine occur 7 to 10 days after vaccination. In children age 4–6, there is no evidence for an increased risk in febrile seizures after the administration of Proquad compared to the separate administration of MMR and Varicella vaccines. Proquad was approved for medical use in the United States in September 2005, in the European Union in April 2006, in Australia in February 2007, and in Canada in May 2014. Priorix Tetra
1943-431: The Oka strain to develop a live attenuated varicella vaccine in Japan in the early 1970s. This strain was further developed by pharmaceutical companies such as Merck & Co. and GlaxoSmithKline . American vaccinologist Maurice Hilleman 's team at Merck then used the Oka strain to prepare a chickenpox vaccine in 1981. Japan was among the first countries to vaccinate for chickenpox. The vaccine developed by Hilleman
2010-497: The United Kingdom, have targeted recommendations for the vaccine, e.g., for susceptible health care workers at risk of varicella exposure. In the UK, varicella antibodies are measured as part of the routine of prenatal care , and by 2005 all National Health Service personnel had determined their immunity and been immunized if they were non-immune and have direct patient contact. Population-based immunization against varicella
2077-406: The United States of children immunized that revealed protection for at least 11 years. Studies were conducted in Japan which indicated protection for at least 20 years. People who do not develop enough protection when they get the vaccine may develop a mild case of the disease when in close contact with a person with chickenpox. In these cases, people show very little sign of illness. This has been
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2144-514: The United States, two doses are recommended by the CDC. For a routine vaccination, the first dose is administered at 12 to 15 months of age and a second dose at age 4–6 years. However, the second dose can be given as early as 3 months after the first dose. If an individual misses the timing for the routine vaccination, the individual is eligible to receive a catch-up vaccination. For a catch-up vaccination, individuals between 7 and 12 years old should receive
2211-414: The United States. In 1968, an improved and even weaker measles vaccine was developed by Maurice Hilleman and colleagues, and began to be distributed, becoming the only measles vaccine used in the United States since 1968. About 86% of children globally had received at least one dose of the vaccine as of 2018. In 2021, at least 183 countries provided two doses in their routine immunization schedule. It
2278-704: The Vatican's doctrinal office, the Congregation for the Doctrine of the Faith , further clarified that it is "morally licit " for Catholics to receive vaccines derived from fetal cell lines or in which such lines were used in testing or development, because "passive material cooperation in the procured abortion from which these cell lines originate is, on the part of those making use of the resulting vaccines, remote" and "does not and should not in any way imply that there
2345-531: The World Health Organization. The immune response to measles vaccine can be impaired by the presence of parasitic infections such as helminthiasis . The World Health Organization (WHO) recommends two doses of vaccine for all children. In countries with high risk of disease the first dose should be given around nine months of age. Otherwise it can be given at twelve months of age. The second dose should be given at least one month after
2412-453: The annual exposure of these vaccinees to children with natural chickenpox boosted the vaccinees' immune system. In the United States, where universal varicella vaccination has been practiced, the majority of children no longer receive exogenous (outside) boosting, thus, their cell-mediated immunity to VZV ( varicella zoster virus ) wanes – necessitating booster chickenpox vaccinations. As time goes on, boosters may be necessary. Persons exposed to
2479-437: The antibody after five years, and 8% had already caught wild chickenpox in that five-year period. Herpes zoster (shingles) most often occurs in the elderly and is only rarely seen in children. The incidence of herpes zoster in vaccinated adults is 0.9/1000 person-years, and is 0.33/1000 person-years in vaccinated children; this is lower than the overall incidence of 3.2–4.2/1000 person-years. The risk of developing shingles
2546-477: The case of children who get the vaccine in their early childhood and later have contact with children with chickenpox. Some of these children may develop a mild chickenpox also known as breakthrough disease. Another vaccine, known as zoster vaccine , is simply a larger-than-normal dose of the same vaccine used against chickenpox, and is used in older adults to reduce the risk of shingles (also called herpes zoster) and postherpetic neuralgia , which are caused by
2613-435: The child is 12 months old they should receive two additional doses to ensure long-lasting protection. Adverse effects associated with the MMR vaccine include fever , rash, injection site pain and, in rare cases, red or purple discolorations on the skin known as thrombocytopenic purpura , or seizures related to fever ( febrile seizure ). Numerous studies have found no relationship between MMR vaccine and autism . It
2680-742: The cost and cost-effectiveness , the possible risk of herpes zoster when vaccinating older adults, and rare fevers leading to seizures after the first dose of the MMRV vaccine. "Countries that implemented UVV experienced decreases in varicella incidence, hospitalizations and complications, showing overall beneficial impact." Varicella vaccination is recommended in Canada for all healthy children aged 1 to 12, as well as susceptible adolescents and adults 50 years of age and younger; "may be considered for people with select immunodeficiency disorders; and "should be prioritized" for susceptible individuals, including "non-pregnant women of childbearing age, household contacts of immunocompromised individuals, members of
2747-574: The cost of vaccines, and Vaccines for Children Program may be able to help those who do not have coverage. State law requires vaccinations for school children, but offer exemptions for medical reasons and sometimes for religious or philosophical reasons. All fifty states require two doses of the MMR vaccine at the appropriate age. A different vaccine distribution within a single territory by age or social class may define different general perceptions of vaccination efficacy. Varicella vaccine Varicella vaccine , also known as chickenpox vaccine ,
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2814-490: The deaths were among young children. During 2003, and the first half of 2004, the CDC reported eight deaths from varicella, six of whom were children or adolescents. These deaths and hospital admissions have substantially declined in the US due to vaccination, though the rate of shingles infection has increased as adults are less exposed to infected children (which would otherwise help protect against shingles). Ten years after
2881-464: The disease in the United States and other developed countries. While the vaccine is made with a live virus which can cause side effects, these are far fewer and less serious than the sickness and death caused by measles itself; side effects ranging from rashes to, rarely, convulsions , occur in a small percentage of recipients. Measles vaccination averted 57 million deaths being between 2000 and 2022, as per World Health Organization report. Measles
2948-541: The early 1970s. American vaccinologist Maurice Hilleman 's team developed a chickenpox vaccine in the United States in 1981, based on the "Oka strain" of the varicella virus. The chickenpox vaccine first became commercially available in 1984. It is on the WHO Model List of Essential Medicines . Varicella vaccine is 70% to 90% effective for preventing varicella and more than 95% effective for preventing severe varicella. Follow-up evaluations have taken place in
3015-474: The first 20 years of being licensed in the U.S., measles vaccination prevented an estimated 52 million cases of the disease, 17,400 cases of intellectual disability , and 5,200 deaths. From 1999 to 2004 a strategy led by the WHO and UNICEF led to improvements in measles vaccination coverage that averted an estimated 1.4 million measles deaths worldwide. The vaccine for measles led to the near-complete elimination of
3082-552: The first dose. This is often done at age 15 to 18 months. After one dose at the age of nine months 85% are immune, while a dose at twelve months results in 95% immunity. In the United States, the Centers for Disease Control and Prevention (CDC) recommends that children aged six to eleven months traveling outside the United States receive their first dose of MMR vaccine before departure and then receive two more doses; one at 12–15 months (12 months for children in high-risk areas) and
3149-404: The initial dose given at 12 to 18 months of age. The second dose, if given, should occur at least one to three months later. The second dose, if given, provides the additional benefit of improved protection against all varicella. This vaccine is a shot given subcutaneously (under the skin). It is recommended for all children under 13 and for everyone 13 or older who has never had chickenpox. In
3216-460: The injection site, as well as fever . A few people may develop a mild rash , which usually appears around the injection site. There is a short-term risk of developing herpes zoster (shingles) following vaccination. However, this risk is less than the risk due to a natural infection resulting in chickenpox. Most of the cases reported have been mild and have not been associated with serious complications. Approximately 5% of children who receive
3283-418: The measles vaccine uptake led to increases in income of 1.1 percent and positive effects on employment due to greater productivity by those who were vaccinated. Measles is seldom given as an individual vaccine and is often given in combination with rubella , mumps , or varicella (chickenpox) vaccines. Below is the list of measles-containing vaccines: Most health insurance plans in the United States cover
3350-514: The past five months. Additionally, the varicella vaccine is not recommended for people who are taking salicylates (e.g. aspirin). After receiving the varicella vaccine, the use of salicylates should be avoided for at least six weeks. The varicella vaccine is also not recommended for individuals who have received a live vaccine in the last four weeks, because live vaccines that are administered too soon within one another may not be as effective. It may be usable in people with HIV infections who have
3417-435: The rate of vaccination decreases. The vaccine 's effectiveness lasts many years. It is unclear if it becomes less effective over time. The vaccine may also protect against measles if given within a couple of days after exposure to measles. The vaccine is generally safe, even for those infected by HIV . Most children do not experience any side effects; those that do occur are usually mild, such as fever, rash, pain at
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#17327762701743484-427: The same virus. The recombinant zoster (shingles) vaccine is recommended for adults aged 50 years and older. The long-term duration of protection from varicella vaccine is unknown, but there are now persons vaccinated twenty years ago with no evidence of waning immunity, while others have become vulnerable in as few as six years. Assessments of duration of immunity are complicated in an environment where natural disease
3551-463: The second as early as four weeks later. Otherwise the first dose is typically given at 12–15 months and the second at 4–6 years. In the UK, the National Health Service (NHS) recommendation is for a first dose at around 13 months of age and the second at three years and four months old. In Canada, Health Canada recommends that children traveling outside North America should receive an MMR vaccine if they are aged six to 12 months. However, after
3618-433: The site of injection, and joint stiffness; and are short-lived. Anaphylaxis has been documented in about 3.5–10 cases per million doses. Rates of Guillain–Barré syndrome , autism and inflammatory bowel disease do not appear to be increased by measles vaccination. The vaccine is available both by itself and in combinations such as the MMR vaccine (a combination with the rubella vaccine and mumps vaccine ) or
3685-452: The skin . Another vaccine, known as zoster vaccine , is used to prevent diseases caused by the same virus – the varicella zoster virus . The World Health Organization (WHO) recommends routine vaccination only if a country can keep more than 80% of people vaccinated. If only 20% to 80% of people are vaccinated it is possible that more people will get the disease at an older age and outcomes overall may worsen. Either one or two doses of
3752-690: The throat; hives ; paleness; weakness; dizziness; a fast heart beat; deafness ; long-term seizures, coma, or lowered consciousness; seizures (jerking or staring) caused by fever; or temporary low platelet count. For children age two and younger, the MMRV vaccine is associated with significantly more adverse events compared to separate administration of MMR and varicella vaccinations on the same day. There are 4.3 additional febrile seizures per 10,000 vaccinated children (95% CI 2.6–5.6), 7.5 additional mostly mild fever episodes per 100 vaccinated children (95% CI, 5.4–9.4) and 1.1 additional measles-like rash per 100 children (95% CI, 0.2–1.8). Febrile seizures caused by
3819-489: The vaccine develop a fever or rash. Adverse reaction reports for the period 1995 to 2005 found no deaths attributed to the vaccine despite approximately 55.7 million doses being delivered. Cases of vaccine-related chickenpox have been reported in patients with a weakened immune system, but no deaths. The literature contains several reports of adverse reactions following varicella vaccination, including vaccine-strain zoster in children and adults. The varicella zoster vaccine
3886-469: The vaccine due to its cost. In the United Kingdom , Varilrix, a live viral vaccine is approved from the age of 12 months, but only recommended for certain at risk groups. Minor side effects may include pain at the site of injection, fever, and rash. Severe side effects are rare and occur mostly in those with poor immune function . Its use in people with HIV/AIDS should be done with care. It
3953-411: The vaccine is recommended. In the United States two doses are recommended starting at twelve to fifteen months of age. As of 2017 , twenty-three countries recommend all non-medically exempt children receive the vaccine, nine recommend it only for high risk groups, three additional countries recommend use in only parts of the country, while other countries make no recommendation. Not all countries provide
4020-424: The vaccine was recommended in the US, the CDC reported as much as a 90% drop in chickenpox cases, a varicella-related hospital admission decline of 71% and a 97% drop in chickenpox deaths among those under 20. Vaccines are less effective among high-risk patients, as well as being more dangerous because they contain attenuated live virus. In a study performed on children with an impaired immune system , 30% had lost
4087-473: The virus after vaccination tend to experience milder cases of chickenpox if they develop the disease. Prior to the widespread introduction of the vaccine in the United States in 1995 (1986 in Japan and 1988 in Korea ), there were around 4,000,000 cases per year in the United States, mostly in children, with typically 10,500–13,000 hospital admissions (range, 8,000–18,000), and 100–150 deaths each year. Most of
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#17327762701744154-422: The virus and show that the disease could be passed on to monkeys inoculated with the material he had collected. Enders was able to use the cultivated virus to develop a measles vaccine in 1963 by attenuation through cultured chicken embryo fibroblasts of the material isolated by Peebles. In the late 1950s and early 1960s, nearly twice as many children died from measles as from polio. The vaccine Enders developed
4221-550: Was approved for medical use in Australia in November 2005, and in Canada in June 2008. Measles vaccine Measles vaccine protects against becoming infected with measles . Nearly all of those who do not develop immunity after a single dose develop it after a second dose. When the rate of vaccination within a population is greater than 92%, outbreaks of measles typically no longer occur; however, they may occur again if
4288-399: Was averted due to high rates of vaccination in the surrounding communities. The vaccine has non specific effects such as preventing respiratory infections, that may be greater than those of measles prevention alone. These benefits are greater when the vaccine is given before one year of age. A high- titre vaccine resulted in worse outcomes in girls, and consequently is not recommended by
4355-657: Was based on the Edmonston strain of attenuated live measles virus, which was named for 11-year-old David Edmonston, the Fay student from whom Peebles had taken the culture that led to the virus's cultivation. In the mid-20th century, measles was particularly devastating in West Africa, where child mortality rate was 50 percent before age five, and the children were struck with the type of rash and other symptoms common prior to 1900 in England and other countries. The first trial of
4422-474: Was considered "as inevitable as death and taxes." In the United States, reported cases of measles fell from 3 to 4 million with 400 to 500 deaths to tens of thousands per year following introduction of two measles vaccines in 1963 (both an inactivated and a live attenuated vaccine (Edmonston B strain) were licensed for use, see chart at right). Increasing uptake of the vaccine following outbreaks in 1971 and 1977 brought this down to thousands of cases per year in
4489-453: Was first licensed in the United States in 1995. Routine vaccination against varicella zoster virus is also performed in the United States, and the incidence of chickenpox has been dramatically reduced there (from four million cases per year in the pre-vaccine era to approximately 390,000 cases per year as of 2014 ). As of 2019 , standalone varicella vaccines are available in all 27 European Union member countries, and 16 countries also offer
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