Varicella disease has declined dramatically in surveillance areas with moderate vaccine coverage. Continued implementation of existing vaccine policies should lead to further reductions of varicella disease in these communities and throughout the United States.

Highlights► In 2000, varicella incidence dramatically declined to 70% of the prevaccine rate. ► HZ reports significantly increased among adults aged 20–69 years from 2000 to 2001. ► Children with a prior history of varicella demonstrated HZ rates similar to adults. ► By 2002, the efficacy of the varicella vaccination had declined well below 80%. ► HZ morbidity costs have exceeded the cost savings from varicella-disease reductions.

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Clinical varicella reinfections may occur more commonly than previously thought. Additional studies of the predictive value of a positive varicella history and laboratory studies of reported reinfections are indicated to guide varicella vaccination policy.