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ARTICLE |

Public Health Policy on Varicella Infection

Stephen T. Green, MD, MRCP; Dilip Nathwani, MRCP; David J. Goldberg, MRCP; John C. P. Kingdom, MRCP, DCH
JAMA. 1990;263(11):1495. doi:10.1001/jama.1990.03440110057023.
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To the Editor.—  Dr Johnson1 suggested that early return of varicella-infected children to school would increase herd immunity and decrease the eventual incidence of varicella in adults. However, while Dr Bass'1 reply stressed the potential risk to community-based immunosuppressed individuals of contracting chickenpox by secondary exposure, the failure to mention nonimmune pregnant women was a significant omission, as both mother and fetus are at risk of serious morbidity and mortality.2 A maternal mortality rate of 40% has been reported,3 and varicella, like any febrile condition, may lead to spontaneous abortion,4 while a fetal varicella-related syndrome is recognized.5Pneumonitis is the main danger, especially among tobacco smokers,6 and can progress to respiratory failure over a matter of hours.2 Should pulmonary involvement be suspected, early recourse to high-dose intravenous acyclovir therapy (15 to 20 mg/kg of body weight three times daily)7 and high-flow

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