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To the Editor: Dr Seward and colleagues¹ report that the incidence of varicella in the United States decreased following the introduction of vaccination. It is unclear, however, how varicella vaccination will affect the incidence of herpes zoster (HZ). It has been suggested that exposure to varicella can boost specific immunity to varicella zoster virus (VZV) and thus reduce the risk of reactivation.² If this is the case, reduction of circulating VZV due to varicella vaccination would increase the overall incidence of HZ; unvaccinated adults would be most at risk. This potential danger was recognized by the Food and Drug Administration at the time the varicella vaccine was licensed,³ and the Centers for Disease Control and Prevention (CDC) were recommended to conduct surveillance of both chickenpox and HZ cases after widespread use of the vaccine.⁴

Mathematical models have suggested that the greater the reduction in the incidence of varicella, the greater . . . [Full Text of this Article]

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Varicella Disease After Introduction of Varicella Vaccine in the United States, 1995-2000
Jane F. Seward, Barbara M. Watson, Carol L. Peterson, Laurene Mascola, Jan W. Pelosi, John X. Zhang, Teresa J. Maupin, Gary S. Goldman, Laura J. Tabony, Kimberly G. Brodovicz, Aisha O. Jumaan, and Melinda Wharton
JAMA. 2002;287(5):606-611.
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