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Although most cases of varicella or zoster are clinically unambiguous, serology may be occasionally useful in the differential diagnosis of other blistering illnesses or when infection shows an unusual complication, such as hepatitis. It may also be important to establish whether an individual is susceptible when clinical history is unclear, or when varicella immune globulin may be needed, as in the immunocompromised host or cancer patient on toxic chemotherapy. Zoster is more common with aging and may occur in the face of significant antibody titers, demonstrating that cell-mediated immunity is also significant.