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Varicella outbreaks remain common and occur increasingly in highly vaccinated populations. Breakthrough varicella in vaccinated individuals is characteristically mild, typically with fewer lesions that frequently do not progress to a vesicular stage. As such, the laboratory diagnosis of varicella has grown increasingly important, particularly in outbreak settings. In this review the impact of varicella vaccine on varicella-zoster virus (VZV) disease, arising complications in the effective diagnosis and monitoring of VZV transmission, and the relative strengths and limitations of currently available laboratory diagnostic techniques are all addressed. Since disease symptoms often resolve in outbreak settings before suitable test specimens can be obtained, the need to develop new diagnostic approaches that rely on alternative patient samples is also discussed.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/cmr.00031-09","type":"journal-article","created":{"date-parts":[[2010,1,12]],"date-time":"2010-01-12T00:22:47Z","timestamp":1263255767000},"page":"202-217","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":110,"title":["Impact of Varicella Vaccine on Varicella-Zoster Virus Dynamics"],"prefix":"10.1128","volume":"23","author":[{"given":"D. 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