Chickenpox has traditionally been viewed as an irritating but inevitable infection to be endured during childhood, a rite of passage during the preschool years. This benign view persists despite evidence that certain groups, including neonates, adults, pregnant women and the immunocompromised, have higher risk of severe disease. Few data on the incidence of severe complications and death in children are available; however, such information might change our view of the disease, especially considering that such morbidity and mortality may now be regarded as vaccine preventable.

Population incidence is approximately 13–16 cases per 1000 with substantial year-to-year variation with 2–5-yearly epidemics.1 Recently, incidence in pre-school children has risen relative to primary school age children, possibly due to the increased mixing at child-care centres and playgroups.2 3 For every 1000 cases of varicella, between two and five will require hospital admission,2 4^–6 with the majority being children, reflecting higher childhood incidence.

Secondary bacterial infections, usually affecting skin and soft tissue, are the most common complications.7 8 However, as the vast majority are presumably treated in primary care without hospital attendance, the true incidence is uncertain. Skin lesions also provide a portal of entry for more invasive infections including arthritis, osteomyelitis, necrotising fasciitis, sepsis and other deep-seated infections caused mainly by Group A β-haemolytic Streptococci and Staphylococcus aureus …