Decline in Mortality with Varicella Vaccination

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Abstract
Nguyen et al. (Feb. 3 issue)1 report on the effect of the U.S. varicella vaccination program on disease-related mortality. The effectiveness of such programs also includes reducing severe varicella-associated complications. In Italy, from 1995 to 2003, when no universal childhood varicella vaccination program was in effect, we documented 303 admissions (median age of patients, 4.2 years; range, 0 to 15) to a children's research hospital for varicella for a total of 2420 days of hospitalization. Thirty-nine patients (13 percent) had varicella-associated complications (1.2 percent of admissions for varicella), including 13 with central nervous system involvement and 7 with severe bacterial superinfections. No patient died, but stroke occurred in four children (age range, 6 months to 6 years) ( Figure 1 ), with hemiparesis, facial paralysis, or both 2 to 30 days after the onset of exanthema, as previously described.2,3 All four patients had severe sequelae. Universal varicella vaccination not only reduces mortality but also provides an effective means of limiting severe and incapacitating disease-related complications.

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