Public Health Policy on Varicella Infection

To the Editor.— Dr Johnson¹ suggested that early return of varicella-infected children to school would increase herd immunity and decrease the eventual incidence of varicella in adults. However, while Dr Bass'¹ reply stressed the potential risk to community-based immunosuppressed individuals of contracting chickenpox by secondary exposure, the failure to mention nonimmune pregnant women was a significant omission, as both mother and fetus are at risk of serious morbidity and mortality.² A maternal mortality rate of 40% has been reported,³ and varicella, like any febrile condition, may lead to spontaneous abortion,⁴ while a fetal varicella-related syndrome is recognized.⁵

Pneumonitis is the main danger, especially among tobacco smokers,⁶ and can progress to respiratory failure over a matter of hours.² Should pulmonary involvement be suspected, early recourse to high-dose intravenous acyclovir therapy (15 to 20 mg/kg of body weight three times daily)⁷ and high-flow