To the Editor.—The Editorial by Drs Shapiro and LaRussa1 argues for universal varicella immunization without a clear understanding of the concerns of those against that strategy. We agree with several points.
Varicella causes morbidity and mortality especially among adults. Universal immunization is difficult to achieve, and adults rarely comply with immunization recommendations. Immunization programs targeted at children, especially those coupled with school-required physical examinations, have greater compliance rates. The duration of immunity from varicella virus vaccine in a world without natural boosting from exposure to wild disease is unknown (despite the suggestion from 1 study2 that it may be long-lasting). Less than universal childhood immunization for varicella may increase adult morbidity and mortality.
For example, let us consider the risks, benefits, and possible outcomes of 2 strategies:
1. Immunization of high-risk children (those with severe eczema, probable future steroid use, and so on) and anyone aged 10 years or . . . [Full Text of this Article]
