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 varicella infection and they may transmit infection to susceptible hospitalized individuals. Although the varicella vaccine is safe and effective, its cost is a deterrent to its use in routine immunization programmes. In order to assess whether vaccination of susceptible healthcare workers to prevent hospital-acquired transmission may be justified, we have documented the frequency of varicella among healthcare workers in our hospital. There were 96 admissions for varicella during the 1993-1997 period; staff and student nurses accounted for 76%. The peak season of admission was from February to April. 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 every year. This poses the risk of transmission to hospitalized patients, with serious consequences among immunocompromized individuals. Therefore, we recommend systematic selective vaccination of susceptible healthcare workers to break this cycle of annual varicella outbreaks among hospital personnel.