—We thank Dr Lebel and note that another recent study1 found a 2% risk of embryopathy in maternal varicella infection in the first 20 weeks of pregnancy. We disagree with Dr Smukler's numbers and his assertions that our analysis ignored the potential long-term risks of a vaccination program. The manufacturer's most recent data show that 9454 healthy children aged 12 years or younger and 1648 adults and adolescents in the United States have received varicella vaccine since 1982.Regarding potential long-term risks, we embarked on this study and its companion study of epidemiologic and morbidity effects of routine varicella immunization2 precisely because of such concerns. The risks to vaccinees with primary vaccine failure, the best estimates of a panel of six national experts regarding waning of immunity, and the fact that adults with chickenpox have a higher case complication rate than children were all incorporated in
Lieu TA, Black SB, Shinefield HR, Cochi SL, Holmes SJ, Halloran ME. Routine Childhood Varicella Vaccination-Reply. JAMA. 1994;271(24):1906. doi:10.1001/jama.1994.03510480030022
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