Varicella (Chickenpox) Deaths

Reportable by Providers

About this Reportable Disease

Infectious agent:  Varicella-zoster virus

Description of illness:  Deaths due to primary infection with varicella zoster virus (VZV), or chickenpox, are extremely rare in the United States due to high rates of routine childhood immunization. Although people with weakened immune systems are at highest risk of fatal infection, death can occur in healthy, unvaccinated children or adults. A primary infection of varicella may start with a 1-2 days of fever and malaise prior to rash onset in adults. In children, the first sign of disease is rash. The rash, which is composed of crops or waves of itchy, blister-like lesions that crust over as they resolve, usually starts on the head and descends to the trunk and extremities. A person can spread varicella 1-2 days prior to rash onset until all blisters have dried and scabbed-over (usually 5-7 days). Primary varicella in previously vaccinated persons is usually much milder, and may have fewer than 50 lesions. Deaths may result from primary varicella infection of the brain (encephalitis), pneumonia, or secondary bacterial infections.

Individual cases of varicella are not reportable in Tennessee: only varicella outbreaks or deaths associated with primary varicella infection are reportable. Deaths related to reactivation of latent infection (herpes zoster/shingles) are not reportable – herpes zoster is most likely to occur in the elderly, but can occur in any person who has ever had chickenpox.

Laboratory Reporting for this Disease

Varicella, Zoster Virus

TEST NAME Varicella - Zoster Virus (VZV)
DISEASE/DISORDER Chickenpox / Shingles
ALTERNATE NAME(S) VZV
METHODOLOGY LRN-B Varicella-Zoster PCR/7500DX
SPECIAL INSTRUCTIONS
  • Specimen Submission 
  • REQUIRED PRIOR CONSULTATION WITH EPIDEMIOLOGY REQUIRED 
  • Contact CEDEP prior to submission
ORDERING INFORMATION TDH DLS Requisition: PH-4263 - Clinical Select Agent Rule-Out Submission Requisition

Specimen Requirements

Patient Preparation None
Specimen Collection
  • Acceptable Specimen Sounces/Type(s) for Submission

-Vesicle swab

- Scab
Specimen Labeling Specimen must be labeled with at least two unique patient identifiers and match accompanying PH-4263 Clinical Select Agent Rule-Out Submission Requistions.
Specimen Processing Contact Bioterrorism lab prior to shipment.
Specimen Storage and Preservation Contact Bioterrorism lab prior to shipment.
Specimen Transport Contact Bioterrorism lab prior to shipment.
Specimen Acceptability and Rejection Contact Bioterrorism lab prior to shipment.
Testing Location
  • Nashville
  • Knoxville

Laboratory Reporting

Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.

Information about this Reportable Disease for Healthcare Providers

Clinical Summary

  • Varicella (chickenpox) deaths result from primary infection with varicella-zoster virus (VZV), not herpes zoster (shingles). Deaths are rare in the United States due to routine vaccination, but can occur, particularly among unvaccinated individuals and those who are immunocompromised. Transmission occurs through airborne spread and direct contact with vesicular fluid. Individuals are contagious from 1–2 days before rash onset until all lesions have crusted, typically 5–7 days. Vaccinated persons with non-crusting lesions are considered contagious until no new lesions appear for 24 hours.
  • Clinical illness in adults often begins with a brief prodrome of fever and malaise 1–2 days before rash onset, while children may present with rash as the initial symptom. The rash is generalized, pruritic, and appears in successive crops, progressing from macules to papules to vesicles and crusts. Severe complications that may lead to death include pneumonia, encephalitis or cerebellar ataxia, secondary bacterial infections (including invasive Group A Streptococcus), sepsis, hemorrhagic complications, and dehydration.
  • Populations at increased risk for severe disease or death include immunocompromised persons without evidence of immunity, pregnant women without immunity, newborns whose mothers develop varicella 5 days before to 2 days after delivery, premature infants exposed to VZV, and adults without evidence of immunity. In healthcare settings, standard, airborne, and contact precautions are recommended, ideally in a negative airflow room, and should be maintained until lesions are dry and crusted.
  • Varicella deaths are nationally notifiable and should be investigated to assess risk factors and missed vaccination opportunities. In Tennessee, individual varicella cases are not reportable; however, outbreaks and deaths associated with primary varicella infection are reportable. Prevention relies on routine 2-dose varicella vaccination, recommended at 12–15 months and 4–6 years of age, with two doses also recommended for older children, adolescents, and adults without evidence of immunity.

Healthcare Provider Reporting

Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.

Providers must report cases of all diseases and conditions listed through one of these methods:

• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857

• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.

• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting. 

• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link. 

Information about this Reportable Disease for the Public

What It Is

Chickenpox is an illness caused by a virus called varicella-zoster virus (VZV). It usually causes an itchy rash with blisters. 

How It Spreads

Chickenpox spreads easily from person to person.

  • A person can spread it 1–2 days before the rash starts and until all blisters have dried and scabbed over (often 5–7 days).
  • People who were vaccinated can still get chickenpox, but it’s often milder. They can still spread it.

Who Is at Higher Risk

People more likely to have severe illness include:

  • People with a weakened immune system
  • Pregnant women who are not  immune
  • Newborns (especially around the time of delivery)
  • Premature infants exposed to the virus

Prevention

Vaccination is the best protection.
CDC’s routine schedule is:

  • 1st dose: 12–15 months
  • 2nd dose: 4–6 years

Older children, teens, and adults who are not immune also need 2 doses. 

Tennessee Reporting Note

In Tennessee, TDH indicates that single cases of chickenpox are not reportable, but outbreaks and deaths from primary chickenpox infection are reportable. 

This Page Last Updated: March 25, 2026 at 8:53 PM