Varicella: to vaccinate or not to vaccinate?

Despite the fact that live attenuated varicella vaccine was developed about 25 years ago,1 many questions remain about its use, the major, recurring one being whether it is worthwhile. Varicella is often perceived as a mild ailment. However, not only is varicella not necessarily a benign disease, but it is usually not possible to predict in advance whether an individual will develop a severe illness. In the United States, where varicella vaccine has been licensed for the past two years, utilisation rates vary across the country. The Centers for Disease Control and Prevention (CDC) has been alarmed by recent reports of deaths from varicella in healthy unvaccinated young women as well as in unvaccinated children. Currently in the United States, varicella is the leading cause of deaths that are preventable by vaccination.2 3

Complications of varicella include those described in this issue by Jaeggi and colleagues,4 and involve the central nervous system, bacterial superinfections, and severe infections in immunocompromised patients and adults. Although they concluded that the rate of complications in the population studied was low, one cannot assume that this will continue to be the case. For example, in the United States, invasive group A β haemolytic streptococcal infections as a complication of varicella have …