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Varicella-Zoster Infections
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PEDIATRICS Vol. 109 No. 6 June 2002, pp. 1068-1073

Second Varicella Infections: Are They More Common Than Previously Thought?

Susan Hall, MSt, MS*, Teresa Maupin, RN, MA{ddagger}, Jane Seward, MBBS, MPH§, Aisha O. Jumaan, PhD, MPH§, Carol Peterson, MD, MPH{ddagger}, Gary Goldman, PhD{ddagger}, Laurene Mascola, MD, MPH{ddagger} and Melinda Wharton, MD, MPH§

* Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
{ddagger} Child Vaccine Preventable Disease Control Branch, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
§ Los Angeles County Department of Health Services, Los Angeles, California

--> Objective. To describe the epidemiology and clinical characteristics of varicella reinfections reported to a surveillance project.

Methods. We investigated varicella cases reported to a surveillance project between January 1, 1995, and December 31, 1999—with more extensive investigation of cases reporting previous varicella with onset between January 1, 1998, and September 30, 1998—to provide a more detailed description of first and second varicella infections. A simple decision tree was used to assess the likelihood that reported first and second infections were varicella.

Results. Among varicella cases reported to the surveillance project, 4.5% of cases in 1995 and 13.3% of cases in 1999 reported previous varicella. More than 95% of first infections were physician diagnosed, epidemiologically linked to another case, or had a rash description consistent with varicella; the same was true for reported second infections. People who reported reinfections were generally healthy. There was a family history of repeat infections in 45% of people who reported reinfections.

Conclusions. Clinical varicella reinfections may occur more commonly than previously thought. Additional studies of the predictive value of a positive varicella history and laboratory studies of reported reinfections are indicated to guide varicella vaccination policy.

Key Words: varicella • reinfection • surveillance • vaccination • immunity

Abbreviations: VZV, varicella-zoster virus

Received for publication Oct 1, 2001; Accepted Jan 29, 2002.


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