We examined varicella deaths in the United States during the 25 years before vaccine licensure and identified 2262 people who died with varicella as the underlying cause of death. From 1970 to 1994, varicella mortality declined, followed by an increase. Mortality rates were highest among children; however, adult varicella deaths more than doubled in number, proportion, and rate per million population. Despite declining fatality rates, in 1990-1994, adults had a risk 25 times greater and infants had a risk 4 times greater of dying from varicella than did children 1-4 years old, and most people who died of varicella were previously healthy. Varicella deaths are now preventable by vaccine. Investigation and reporting of all varicella deaths in the United States is needed to accurately document deaths due to varicella, to improve prevention efforts, and to evaluate the vaccine's impact on mortality.