Varicella, or chickenpox, is a highly communicable infectious disease which, in the prevaccine era, contributed to significant morbidity and mortality among the general population, as well as resulted in substantial costs to society. Following US vaccine licensure in 1995, a significant decline in disease, hospitalizations, and deaths began and has continued. The Healthy People 2010 goal related to varicella is disease reduction; in contrast, the goal of the CDC is disease elimination. State and national vaccination rates have steadily risen since 1995, with a current national rate of 85%. Although significant decreases in disease are evident and vaccination rates have increased, cases of disease, hospitalizations, and deaths still occur. Surveillance is a necessary component of vaccination programs in order to monitor impact, identify factors that allow cases to continue to occur, and to guide state policy. The Council of State and Territorial Epidemiologists ( CSTE) recommended that each state institute an ongoing surveillance system to monitor the impact of varicella vaccination on the incidence of varicella by 2005. In response to this recommendation, North Carolina implemented a sentinel ED surveillance system. The system, although efficient, has limitations, but the resulting data demonstrate a low incidence of disease in the Emergency Department setting with minimal burden on North Carolina emergency healthcare systems.