Varicella Vaccine: Still at the Crossroads

¹ From the Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, NY

Dr Saul Krugman was and continues to be a teacher, mentor, and inspiration to many in the field of infectious diseases, particularly with regard to viral infections and immunizations. It is therefore a great privilege to play a role in celebrating his 80th birthday, and it also seems appropriate to honor him with a presentation concerning live attenuated varicella vaccine. Dr Krugman was greatly responsible for bringing about clinical trials with varicella vaccine in the United States, and in fact, without his input it is unlikely that this vaccine would ever have been tested here. His recognition, in the 1950s, of the potential severity of varicella in adults was a landmark paper in the realization that varicella is not always a benign disease and is worth preventing.¹ The conventional wisdom, however, has been that there was no need for a varicella vaccine because the disease is too mild to warrant immunization. There are, nevertheless, numerous well-recognized complications of varicella. The most common is bacterial superinfection which may be local and mild but on occasion may be systemic and even fatal (such as staphylococcal pneumonia). In 1984, Preblud and his colleagues² estimated that each year in the United States, as the result of chickenpox, 56 otherwise healthy children die, 46 develop encephalitis, more than a quarter of a million children visit a physician, and physicians write a similar number of prescriptions for antipruritics and antibiotics. Moreover, children at high risk to develop severe or chronic forms of chickenpox, such as leukemics, those who have had organ transplants, and those with human immunodeficiency virus infection, are often denied such activities as attending school and social functions for fear of an unrecognized exposure to varicella.

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