England’s 2025 varicella surveillance captures the pre-vaccine burden in children
England’s 2025 varicella surveillance provides a baseline portrait of chickenpox before routine childhood vaccination entered the national schedule on 1 January 2026. The report spans children and adolescents under 18 years and draws on four surveillance streams: GP consultations, clinical reports to UKHSA health protection teams, absences from sentinel educational settings, and hospital admissions. In practical terms, it sets the reference point against which the new combined MMRV vaccine programme will be judged in the years ahead.
The infection still moved with a predictable seasonal rhythm. Higher activity clustered in spring and early summer, then eased later in the year, a pattern visible across primary care, school absence, and hospital data. For clinicians, that seasonality matters because chickenpox is often encountered in bursts rather than as a flat, year-round problem; for public health teams, it provides a useful marker for whether transmission is shrinking after vaccination reaches children at 12 and 18 months.
One sentence captures the burden plainly: young children carried most of it.
Primary care consultations peaked in late June
GP consultation data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre covered around 2,000 practices and more than 19 million registered patients across England. In 2025, there were 15,099 varicella GP consultations among people under 18 years old, an annual rate of 626.0 per 100,000. The weekly consultation rate reached its highest point at 21.2 per 100,000 in week 26, covering 23 June to 30 June. By contrast, the highest five-year average rate was 28.9 per 100,000 in week 23, and the lowest rate in 2025 fell to 4.0 per 100,000 in week 35.
The age distribution followed the biology of first exposure. Consultation rates were highest in children aged 1 to 4 years, with a peak of 51.0 consultations per 100,000 in week 14. Infants younger than 1 year peaked at 48.7 per 100,000 in week 26. Older children had progressively lower rates, with 5 to 11 year olds peaking at 22.9 per 100,000 in week 26 and 12 to 17 year olds reaching a maximum of just 4.5 per 100,000 in week 18. In a disease transmitted easily in households and childcare settings, those patterns are unsurprising; toddlers and preschool children remain the most visible clinical reservoir because they mix closely, are not yet protected by routine vaccination in this pre-programme period, and often present when rash illness spreads through a classroom or nursery.
Notifiable case reports were concentrated in the youngest children
From 6 April, when varicella became a notifiable disease, through 31 December 2025, 5,954 clinical varicella reports were received for people under 18 years of age. The monthly curve tracked the same seasonality seen in GP consultations, with a peak in June of 1,278 reports and the lowest monthly count in September at 302.
Age skew was stark. Most reports, 71.3% or 4,248 cases, were in children aged 5 years and under. Children aged 1 year accounted for the single largest share, 15.7% or 932 reports. The highest reporting rate occurred in 1-year-olds at 157 per 100,000. At the other end of the age scale, 16- and 17-year-olds had the lowest rates, 3.5 and 3.7 per 100,000, respectively. Those numbers fit the expected natural history of chickenpox before universal vaccination: the disease is most common soon after maternal antibody protection wanes and before systematic immunisation can interrupt spread.
Regional differences were present but did not alter the overall picture. The North East recorded the highest rate of clinical reports at 68.2 per 100,000, followed by London at 61.4 per 100,000. The East of England and South West had the lowest rates, 33.5 and 31.1 per 100,000 respectively. London accounted for the largest absolute number of reports, 1,177 cases, followed by the West Midlands at 818, the South East at 784, and the North West at 778.
School and nursery absences echoed community transmission
The educational-setting surveillance stream covered 439 nurseries and primary schools in England and focused on children under 12 years old. In 2025, 4,117 varicella-related absences were recorded, producing an annual rate of 6,353 per 100,000. The highest weekly absence rate reached 152 per 100,000 in week 9, spanning 24 February to 2 March.
Age-specific absence data showed the heaviest burden in 1 to 4 year olds, who reached a peak of 342 per 100,000 in week 9. Among 5 to 11 year olds, the peak came in the same week but at a lower rate of 115 per 100,000. These absences are more than a classroom inconvenience. Varicella can spread quickly through early years settings, and even when illness is uncomplicated, it disrupts attendance for children, families, and staff. In infectious disease surveillance, school absence data often acts as an early community pulse, and here it followed the same seasonal rise and fall seen in clinical care.
Hospitalisations stayed within historical expectations
Hospital admissions due to varicella were also tracked in NHS England’s Secondary Uses Service using ICD-10 code B01.X, with concurrent B01.X and B02.X codes removed. The report states that in 2025 there were 3,037 hospitalisations for varicella among people under 18 years old, an annual rate of 24.9 per 100,000. Across the surveillance systems, observed rates were consistent with historical means.
Hospitalisation is the clearest marker of severe disease burden because it captures complications and the downstream pressure on paediatric services. Even in a condition often considered routine, admission data remind clinicians that chickenpox can still generate meaningful acute-care demand, especially among very young children.
The surveillance picture is, therefore, straightforward but consequential. England entered routine MMRV vaccination with a well-described pre-vaccine baseline: seasonal circulation, heavy concentration in children five and under, visible school and nursery disruption, and hospital use that remained in line with prior years. The next task is not to speculate about future impact but to measure it against this reference point with the same surveillance discipline now established across primary care, notifications, education, and hospital care.