Objective: To evaluate the epidemiology and impact of mortality from chickenpox in England and Wales. Design: Review of death certificates from the Office for National Statistics on which codes for “chickenpox” or “varicella” were mentioned. Further information ascertained from certifying physician. Participants: Those certified as having died from chickenpox in England and Wales, 1995-7. Main outcome measures: Diagnosis and age and sex distributions of deaths from chickenpox. Results: On average, 25 people a year die from chickenpox. Overall case fatality was 9.22 per 100 000 consultations for chickenpox. Adults accounted for 81% of deaths and 19% of consultations. Deaths were twice as common in men as in women. More of those who died were born outside United Kingdom than expected (12% v 4%). Conclusions: Chickenpox is not a mild disease. Deaths in adults are increasing, both in number and proportion. Chickenpox can be fatal, especially in immunosuppressed people and adults The age distribution of cases has been shifting upwards for about 30 years About 80% of deaths certified as due to chickenpox are due to chickenpox Chickenpox accounts for about 25 deaths annually in England and Wales, more than from measles, mumps, pertussis, and Hib meningitis combined Mortality in adults has been increasing for at least 30 years and now 80% of deaths from chickenpox are in adults Deaths were twice as common in men as in women.