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Editor,—I am in complete agreement with Dr Aebi that strategies for delivering varicella vaccine effectively are critical to the success of immunisation programmes.1 In the USA great efforts are being made in this direction. Nevertheless, despite the licensure of varicella vaccine for routine use in the United States in March 1995, deaths from varicella continue in children and adults.2 (At my hospital, a 37 year old, previously healthy man died recently of varicella pneumonia.) The US Centers for Disease Control and Prevention has set goals for eventual vaccine coverage rates of over 90% within the next decade. Since morbidity and mortality continue to occur in the USA, it is very difficult for me to believe that there is little problem with varicella in Europe. It may be that studies so far have not been large enough or have not been truly representative sampling. Varicella is clearly a disease associated with many complications.3 It should also be remembered that varicella vaccine provides protection against herpes zoster as well as against chickenpox.
In the USA, the best approach to ensure vaccine delivery has been to require immunisation before school entry. This rationale may or may not be useful for all countries. As the efficacy of antimicrobials continues to decrease due to resistant organisms, it is likely that the world will become more dependent on vaccines to protect the populace from infections. Society must be prepared to develop effective means and strategies to protect its children from infectious diseases.
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