Immunization levels of young children are now rapidly increasing. Unlike for other vaccine-preventable diseases of childhood against which vaccination is routinely recommended, most states do not have systematic surveillance to evaluate the ongoing impact of vaccination on varicella morbidity, nor is there a timely and sensitive national surveillance system for varicella morbidity. Recent investigations of the use of varicella vaccine to control outbreaks have been promising, although further studies are needed. No guidance yet exists for state and local immunization programs on the aggressiveness with which reported outbreaks should be investigated and controlled. Allowing such outbreaks to run their natural course is no longer acceptable and is inconsistent with the principles underlying the recommendations to routinely vaccinate all infants and susceptible children and high-risk adults.
Guidance is needed and publicly funded vaccine needs to be available to support control.
Such outbreaks are preventable with systematic vaccination of DCC and school enterers, yet few states have begun a process to require DCC and school entry vaccination against varicella. Although states are encouraged to eventually establish individual case reporting systems, current resources may limit the potential to do so at this time. As soon as it is operationally feasible, each state adopt an individual or statewide aggregate varicella case reporting system. CDC-NIP work with CSTE to develop varicella surveillance guidelines for the implementation of individual case reporting by states and to identify associated funding needs. CDC, in collaboration with CSTE and state immunization programs, should develop and disseminate recommendations for varicella outbreak response and control in day care centers, schools and other institutional settings and model educational materials that could be used as part of an outbreak response.