What is varicella?
Varicella or chickenpox is a highly contagious disease with peak age at 5-9 years leading to rash. It is a self-limiting disease and occasionally leads to fever, pneumonia, liver damage and brain infection. Chicken pox can be very severe in immunocompromised patients e.g. in patients with cancer and can even lead to death.

If it occurs during pregnancy, there are 25% chances of transmission of the virus to fetus. If it occurs in first half of pregnancy it will lead to fetal varicella syndrome characterized by scarred skin, limb defects and eye defects. If it occurs in 2nd half of pregnancy, the child has chances of developing herpes zoster at an early age.

If it occurs within 21 days of delivery, there are 25% chances of newborn developing chicken pox.

Which high- risk group should receive Varicella vaccine and why?
Varicella vaccine is definitely indicated in certain high-risk groups:

• Immuno-compromised host: Varicella can be very severe in immunocompromised host as seen before. Hence such children should be immunized irrespective of age. One needs to give 2 doses of injections. Care should be taken to stop chemotherapy/steroids for at least 2 weeks before and after vaccination or at least for the first dose of vaccination.
  
• Healthy adults and adolescents (>13 yrs. old): Those with no definite history of chicken pox in the past can be assumed to be susceptible, as subclinical cases of varicella are rare. Such patients have high morbidity and occasional mortality if they develop chicken pox. Ideally all such adults should be vaccinated but specially the following high risk groups:
  
  i) Non-pregnant women of childbearing age.
  ii) Adults in contact with children who are at high risk of complications of chicken pox e.g. family members of a child with leukemia.
  iii) Those at high risk of exposure to chickenpox like teachers of young children, college students, day-care nursery workers, military personnel etc.
  iv) Health personnel.

What about normal children? Who should be given the varicella vaccine?
Universal vaccination of all children at 15-18 months of age has been advocated in some countries including USA of late.

A normal child who develops chickenpox suffers for 1-2 weeks of disease. The complications are rare and mortality even more rare. But there are occasional cases of complications like encephalitis, pneumonia and even death in normal children. More important, it leads to social problems like the child missing school or even final exams as it usually occurs in months of Jan- March every year. Even the parents will have to take leave and lose wages for 7-14 days.

On the other hand, the vaccine is very costly. The cost is approximately Rs. 1250/- per dose. There are 2-3% chances of developing vaccine induced rash immediately after vaccination and 2-8% chances of breakthrough varicella at a later age. Both these problems are mild and without any complications.


The parents must be explained the pros and cons of giving or not giving the varicella vaccine. The choice is then left to the parents whether they would want to give the vaccine to their child or not.

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