Correspondence

Decline in Mortality with Varicella Vaccination

N Engl J Med 2005; 352:1819April 28, 2005

Article

To the Editor:

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 1Figure 1Cerebral Magnetic Resonance Image Showing Ischemic Hemorrhagic Lesions (Panel A, Arrow) and Hypovascularization with Occlusion of the Middle Cerebral Artery (Panel B, Arrow).), 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.

Raffaella Giacchino, M.D.
Giuseppe Losurdo, M.D.
Elio Castagnola, M.D.
G. Gaslini Children's Hospital, 16147 Genoa, Italy
raffaellagiacchino@ospedale-gaslini.ge.it

3 References

1. 1

   Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med 2005;352:450-458
   Full Text | Web of Science | Medline

2. 2

   Askalan R, Laughlin S, Mayank S, et al. Chickenpox and stroke in childhood: a study of frequency and causation. Stroke 2001;32:1257-1262
   CrossRef | Web of Science | Medline

3. 3

   Moriuchi H, Rodriguez W. Role of varicella-zoster in stroke syndromes. Pediatr Infect Dis J 2000;19:648-653
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   Paolo Bonanni, Sara Boccalini, Angela Bechini, Kurt Banz. (2008) Economic evaluation of varicella vaccination in Italian children and adolescents according to different intervention strategies: The burden of uncomplicated hospitalised cases. Vaccine 26:44, 5619-5626
   CrossRef