Background Varicella zoster virus causes chickenpox, usually a mild self-limiting illness of childhood. However, complications occur in 1% with 4200 deaths annually. Since the first vaccination was developed in the 1970’s, many countries have introduced universal mass immunisation (UMI) but the UK only routinely immunises ‘at-risk’ populations.

Aims To review the reasons for why the UK is yet to adopt UMI for varicella in healthy children

Methods A literature review was performed on OVID Medline and Embase with the following criteria:

Chickenpox OR varicella AND

Immuni?* OR vaccin* AND

Child* OR p?ediatric* OR infan* AND

Systematic review OR meta-analysis

All articles were reviewed and further references found from manual review of bibliographies.

Results 10 studies were found assessing vaccine effectiveness showing reduced incidence, hospitalisation and mortality. There was also high seroconversion and immunogenic profile with a 2dose schedule superior to 1-dose. 17 studies assessed safety showing a good safety profile with fever, rash and injection site redness the commonest complaints. 4 cost-effectiveness studies showed UMI was cost-effective if societal savings were included. Modelling based on an increased incidence of herpes zoster due to varicella UMI made it less or not cost-effective.

Conclusions Varicella immunisation has a good safety profile and reduces incidence, morbidity and mortality. Further longitudinal studies are required to investigate the impact on herpes zoster and elucidate cost-effectiveness.