To present a review of varicella disease, vaccine development and implementation of universal vaccination, discuss common questions about the vaccine and the epidemiology of the disease since licensure of the varicella vaccine.Review the incidence of complications from varicella disease prior to vaccine licensure, safety of the varicella vaccine from clinical trials and post-marketing surveillance data, the impact of the vaccine on disease incidence where high vaccine coverage has been achieved, and address some barriers to vaccination. Raise issues that developed since 1995.The safety data gathered during the 20-year-gestation period of this vaccine prior to licensure has been confirmed. The vaccine works-in areas where vaccine coverage is over 70%, there has been a decline in disease, most marked in the age group with the best vaccine coverage (the 1-4-year olds), leading to a concern that unexposed susceptible children may reach adulthood and remain susceptible unless better practice of universal vaccination of ALL susceptible is practiced.Varicella disease has declined in areas with moderate vaccine coverage. Continued implementation of existing vaccine policies will lead to further reductions of varicella morbidity and mortality throughout the USA.