Decline in mortality due to varicella after implementation of varicella vaccination in the United States

BACKGROUND: Varicella disease has been preventable in the United States since 1995. Starting in 1999, active and passive surveillance data showed sharp decreases in varicella disease. We reviewed national death records to assess the effect of the vaccination program on mortality associated with varicella. METHODS: Data on deaths for which varicella was listed as an underlying or contributing cause were obtained from National Center for Health Statistics Multiple Cause-of-Death Mortality Data for 1990 through 2001. We calculated the numbers and rates of death due to varicella according to age, sex, race, ethnic background, and birthplace. RESULTS: The rate of death due to varicella fluctuated from 1990 through 1998 and then declined sharply. For the interval from 1990 through 1994, the average number of varicella-related deaths was 145 per year (varicella was listed as the underlying cause in 105 deaths and as a contributing cause in 40); it then declined to 66 per year during 1999 through 2001. For deaths for which varicella was listed as the underlying cause, age-adjusted mortality rates dropped by 66 percent, from an average of 0.41 death per 1 million population during 1990 through 1994 to 0.14 during 1999 through 2001 (P<0.001). This decline was observed in all age groups under 50 years, with the greatest reduction (92 percent) among children 1 to 4 years of age. In addition, by the period from 1999 through 2001, the average rates of mortality due to varicella among all racial and ethnic groups were below 0.15 per 1 million population, as compared with rates ranging from 0.37 per 1 million for whites to 0.66 per 1 million for other races in the period from 1990 through 1994. CONCLUSIONS: The program of universal childhood vaccination against varicella in the United States has resulted in a sharp decline in the rate of death due to varicella.