To the Editor.
—Considering the limited experience with the manufacturer's strain of varicella vaccine (only approximately 6000 doses given since 19811) and the relatively benign character of the natural disease, I find many of the assumptions and the convenient denial of possible long-term consequences of such a program by Lieu et al2 very disturbing. The risk to the 5% to 10% of vaccinees who don't respond or to those children who are not vaccinated in the catch-up program and enter adulthood unknowingly susceptible to varicella is ignored. Similarly, the definite possibility of waning immunity is summarily disregarded with the statement, "Considerable uncertainty exists about several of the key assumptions in this model."2 Since this vaccine will not eradicate the varicellazoster virus,3 this program may transform varicella from a mild disease of childhood to a severe disease of adulthood.No amount of reduction in work-loss costs is
Smukler M. Routine Childhood Varicella Vaccination. JAMA. 1994;271(24):1906. doi:10.1001/jama.1994.03510480030021