Varicella-related deaths in children and adolescents - Germany 2003-2004

Aim: Although varicella is acknowledged as a rare cause of death in children there are few, comprehensive data with respect to the clinical course leading to death. Methods: A nationwide, active surveillance was carried out in Germany for children up to age 17 years who were admitted to a paediatric hospital for varicella or associated complications, including deaths. Results: A total of 10 children with varicella-associated death were reported over period of 2 years, yielding a mortality rate of 0.4/1 000 000 children per year. Three deaths occurred in children diagnosed with acute lymphocytic leukaemia and disseminated varicella, two shortly after diagnosis of leukaemia and therefore not preventable, and one during remission with an untypical presentation. Two children died with a congenital varicella syndrome. There was no death in children with neonatal varicella. Four other cases were related to varicella pneumonia or septicaemia and one to myocarditis. Conclusion: In a population with no general varicella vaccination programme, varicella accounted for a small but not negligible risk for death in immunocompetent and immunocompromised children. Together these data point to the importance of a thoroughly implemented, general varicella vaccination programme.