Adult susceptibility to varicella in the tropics is a rural phenomenon due to the lack of previous exposure

In the industrialized countries of the West, varicella is largely a childhood disease, whereas reports from tropical countries indicate a significant incidence of varicella among adults. High ambient temperature, epidemiologic interference from other viruses, and race have been blamed. We tested our hypothesis that less exposure to varicella-zoster virus (VZV) during childhood in rural areas accounts for the reported greater frequency of varicella in adults in tropical climates by comparing rates of VZV seropositivity among urban and rural adult Bengalee populations living in identical climatic conditions in India. Only 5 (3.4%) of 153 urban adults were seronegative compared with 74 (31.1%) of 246 rural adults. Ninety-six percent of urban adults were immune by the age of 25, compared with 42% in the rural group. The results suggest that higher adult susceptibility to varicella is seen only in rural areas of the Tropics and is due to reduced transmission of VZV.