Varicella: Fatal Cases Despite Vaccine Availability

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Varicella: Fatal Cases Despite Vaccine Availability

Tamar Barlam, Dennis L. Kasper

[Copyright © 1998, 1999, 2000 by The McGraw-Hill Companies, Inc. Reproduced

with permission of The McGraw-Hill Companies.]

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A recent article in Morbidity and Mortality Weekly Report (Guerra et al,

1998) summarizes three fatal cases of varicella reported by Texas and Iowa

health authorities to the Centers for Disease Control and Prevention in the

first quarter of 1998. All three children involved died during 1997, and all

three were unvaccinated. Two of the children acquired varicella from

unvaccinated siblings. One child was 5 years old; the other two were <2 years

old. The respective causes of death in the three cases were varicella with

hemorrhagic complications; group A streptococcal septicemia, pneumonia, and

pleural effusion complicating varicella; and refractive heart failure

secondary to staphylococcal endocarditis following varicella.

An accompanying editorial note reviews recent statistics on fatal varicella.

In 1990-1994, this disease was the underlying cause of death in an average of

43 children (<15 years of age) each year, and in 1988-1995, as many as 10,000

children were hospitalized annually for varicella or its complications.

Moreover, 90 percent of children with fatal cases had no preexisting risk

factors for severe varicella.

Thus, " healthy children continue to die from complications of varicella, a

disease that is preventable through vaccination. " In fact, this disease is

the foremost cause of vaccine-preventable deaths among children in the United

States. National varicella vaccine coverage levels for children 19-35 months

of age had increased to 25 percent as of March-June 1997. Health care

providers and the public must be educated about the potential for severe

complications and death due to varicella, the lack of validity of perceptions

that currently impede vaccination, and the effectiveness of the recommended

vaccination strategy (vaccination of children at 12-18 months of age and of

susceptible older children and adolescents).

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Reference

Guerra FA et al: Varicella-related deaths among children--United States,

1997. Morb Mortal Wkly Rep 47(18):365, 1998 [PMID 9603627]