When childcare centres, schools, and colleges in the United States reopen after the summer break, attendees will need to prove that they have been immunised against the varicella zoster virus—which causes varicella (chickenpox) and herpes zoster (shingles)—or to demonstrate naturally acquired immunity.1 In the United Kingdom (and most of Europe), the debate intensifies as to whether we should follow suit and instigate universal childhood immunisation against this virus.

Immunisation has reduced the incidence of varicella in the US since the first vaccine became available in 1995.2 3 4 So why have more countries not adopted universal immunisation?

Firstly, there is a concern that childhood immunisation for varicella zoster virus may shift the burden of disease to adults. Most children get varicella at some time, and in most cases the consequences are not life threatening. Getting varicella as an adult, when pregnant, or when immunologically compromised generally leads to more severe complications. Adults are 23-29 times more likely to die from primary infection.5 Once a high proportion of children are routinely immunised it is increasingly difficult for non-immunised children to contract varicella naturally, which exposes them …