Update on trends in varicella mortality during the varicella vaccine era-United States, 1990-2016

We reported previously that the annual average mortality rate in the United States in 2008-2011 for varicella listed as the underlying cause declined 87% compared with the prevaccine period (1990-1994). Here, we update the analysis with five additional years of data. We used varicella death data from the 2012-2016 Mortality Multiple Cause-of Death records to calculate mortality rates during 2012-2016 and trends since the prevaccine period and end of 1-dose vaccination program (2005-2007). The annual average age-adjusted mortality rate for varicella as the underlying cause was 0.03 per million population during 2012-2016, a 94% reduction from prevaccine years and a 47% reduction from 2005-2007. Varicella deaths continue to decline due to the varicella vaccination program in the United States.

Trends in varicella mortality in the United States: Data from vital statistics and the national surveillance system

This manuscript describes trends in US varicella mortality using national vital statistics system data for 2008-2011, the first years of the routine 2-dose varicella vaccination program, and characteristics of varicella deaths reported to CDC during 1996-2013. We obtained data on deaths with varicella as underlying or contributing cause from the 2008-2011 Mortality Multiple Cause-of Death records and calculated rates to compare with the prevaccine and mature 1-dose varicella vaccination program eras. We also reviewed available records of varicella deaths reported to CDC through the national varicella death surveillance. The annual average age-adjusted mortality rate for varicella as the underlying cause was 0.05 per million population during 2008-2011, an 87% reduction from the prevaccine years. Varicella deaths among persons aged <20 y declined by 99% in 2008-2011 compared with prevaccine years. There was a 70% decline in varicella mortality rates among those <20 y in 2008-2011 compared to 2005-2007. Among the 83 deaths reported to CDC during 1996-2013 classified as likely due to varicella, 24 (29%) were among immunocompromised individuals. Five were among persons previously vaccinated with 1 dose of varicella vaccine. In conclusion, although the US varicella vaccination program has significantly reduced varicella disease burden, there are still opportunities to prevent varicella and its associated morbidity and mortality through routine varicella vaccination, catch-up vaccination, and ensuring that household contacts of immunocompromised persons have evidence of immunity.