Lack of reduction in hospitalizations and emergency department visits for varicella in the first 2 years post-vaccine licensure

Objectives: To describe and compare the incidence and spectrum of complicat ions of varicella pre-vaccine and post-vaccine Licensure. Methods: We performed a retrospective chart review of children under age 21 gears either treated in the emergency department (ED) or admitted to the h ospital with varicella at Children's Hospital, Boston, from January to Dece mber 1994 (pre-licensure) and from January 1996 to December 1997 (post-lice nsure). Results: We identified 937 children who made a visit to the ED for varicell a and 270 children hospitalized for varicella during the 3-year study perio d, The ratio of varicella-related visits to the ED to total visits (0.67%) did not vary significantly from the post-vaccine ratio (0.60%). The most co mmon reasons for a visit were cellulitis in immunocompetent patients and tr eatment with varicella tester immune globulin (VZIG) in children with immun osuppression, Similarly, the ratio of varicella-related hospitalizations to total hospitalizations did not vary in the pre-vaccine (0.53%) and post-va ccine (0.47%) eras. The most common complications in hospitalized patients were cellulitis in previously healthy children (37%) and uncomplicated vari cella in immunocompromised patients (36%). The distribution of diagnoses in the ED and complications among hospitalized children did not differ signif icantly in the pre-vaccine and post-vaccine eras. Conclusions: Despite licensure of the varicella vaccine, varicella-related hospitalizations and ED visits have not changed significantly. Further effo rts are needed to increase utilization of the varicella vaccine.