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In 1996 the USA introduced a programme of mass varicella vaccination for children aged 12–18 months. This measure has resulted in a fall in the annual incidence of varicella in the USA by over 70 % and a reduction in associated hospital admission rates (Seward et al. 2002). Clinical studies in Japan, the USA and Europe have shown the vaccine to be effective. Ninety five per cent of healthy children seroconvert after one dose of the vaccine (White et al., 1991; Kuter et al., 1991; Weibel et al., 1984), while leukaemic children immunized during maintenance therapy, and healthy adults, require two doses to achieve 90 % seroconversion (LaRussa et al., 1996; Hardy et al., 1991). Clinical protection against subsequent (breakthrough) varicella appears to be good, although estimates of protection within the first 10 years vary between 65 and 97 % depending on the potency of the vaccine preparation used (Varis & Veskari, 1996; Weibel et al., 1984). In a study of 4042 healthy children and adolescents, protection appeared to correlate with the titre of varicella-zoster virus (VZV)-specific antibody at 6 weeks post-vaccination (White et al., 1991).

Live attenuated vaccine for the prevention of varicella-zoster virus infection: does it work, is it safe and do we really need it in the UK?