Should health care workers in the tropics be immunized against varicella?

In tropical regions, chickenpox affects both adults and children. Therefore , healthcare workers in the tropics are vulnerable to hospital-acquired var icella infection and they may transmit infection to susceptible hospitalize d individuals. Although the varicella vaccine is safe and effective, its co st is a deterrent to its use in routine immunization programmes. In order t o assess whether vaccination of susceptible healthcare workers to prevent h ospital-acquired transmission may be justified, we have documented the freq uency of varicella among healthcare workers in our hospital. There were 96 admissions for varicella during the 1993-1997 period; staff and student nur ses accounted for 76%. The peak season of admission was from February to Ap ril. The attack rate in staff and student nurses was 0.78 and 1.54 per 100 person-years, respectively. While community outbreaks of varicella occur in this region once in 4-5 years, hospital outbreaks of varicella occurred ev ery year. This poses the risk of transmission to hospitalized patients, wit h serious consequences among immunocompromized individuals. Therefore, we r ecommend systematic selective vaccination of susceptible healthcare workers to break this cycle of annual varicella outbreaks among hospital personnel . (C) 2001 The Hospital infection Society.