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Should all adults with varicella be prescribed antiviral treatment?

To the Editor: A previously healthy young man with a 1-day history of fever and a rash receives a clinical diagnosis of chickenpox from his general practitioner. Should he be treated with an antiviral drug such as aciclovir?

Following the inclusion of a single dose of varicella vaccine in the National Immunisation Program Schedule in 2005, the incidence of varicella (chickenpox) and its complications appears to be declining, with the total number of hospitalisations per year in Australia probably now around 400–500.1 Similar trends have been observed in the United States. In spite of the immunisation program, around 5%–10% of adults in Australia remain non-immune to varicella infection. The disease may lead to significant morbidity and mortality in otherwise healthy adolescents and adults. The main potentially serious complication is pneumonitis, particularly in people who smoke and pregnant women.

There is anecdotal evidence that otherwise healthy adolescents and adults presenting to emergency departments (EDs) with varicella are likely to receive an antiviral drug, but the same is not true in general practice. In the latest version of Therapeutic guidelines: antibiotic there is no recommendation for early (oral)…