Commentary: The Case for Universal Varicella Immunization

Abstract

The article in this month’s issue on immunity to the varicella-zoster virus (VZV) in France highlights the fact that varicella is primarily a childhood disease and that prevention of varicella and its attendant morbidity and mortality require the universal vaccination of children. Yet despite the availability of a safe and effective vaccine, many countries in Europe and the industrialized world, at present, have not included varicella vaccine in their routine immunization programs. 1 Considered by many physicians to be a benign disease, varicella can result in serious complications, sequelae and death. In the United States, before use of varicella vaccine, there were an average of 4 million cases of varicella that resulted in 10,500 –15,000 hospitalizations and 100 –150 deaths every year. 2– 6 Although the risk of severe disease was higher in adults, children bore the brunt of the health burden with 90% of varicella cases, 67% of the varicella hospitalizations and one-half the varicella deaths occurring in this age group. 2– 4 It was recognition of this health burden and the knowledge that children were the primary transmitters of infection that led the United States to adopt a program of universal vaccination of children in 1995. Germany is the only country in Europe with routine childhood immunization. Varicella vaccine was incorporated into the routine immunization schedule in July 2004, as a