Varicella Death of an Unvaccinated, Previously Healthy Adolescent — Ohio, 2009

Varicella usually is a self-limited disease but sometimes can result in severe complications and death. Although infants, adults, and immunocompromised persons are at increased risk for severe disease, before varicella vaccine was introduced in 1995, the majority of hospitalizations and deaths from varicella occurred among healthy persons aged <20 years. Introduction of varicella vaccine has substantially decreased varicella incidence, hospitalizations, and deaths in the United States. This report describes a varicella death in an unvaccinated, previously healthy adolescent aged 15 years. In April 2012, as part of the routine review of vital statistics records, the Ohio Department of Health identified a 2009 death with the International Classification of Diseases, 10th Revision code for varicella as the underlying cause. Because varicella deaths are nationally reportable, the Ohio Department of Health conducted an investigation to validate that the coding was accurate. Investigators learned that, on March 12, 2009, the adolescent girl was admitted to a hospital with a 3-day history of a rash consistent with varicella and a 1-day history of fever and shortness of breath. The patient was started on intravenous acyclovir (on day 4 of illness) and broad-spectrum antibiotics and antifungals, but she died 3 weeks later. The case underscores the importance of varicella vaccination, including catch-up vaccination of older children and adolescents, to prevent varicella and its serious complications.