States Mandate Varicella Vaccine

N E W   Y O R K, Aug. 1, 2000 -- Robert Wack knew about the vaccine to preventchickenpox, but he opted against giving it to his infant son.

The result: His son, Michael, developed chickenpox in 1998 whenhe was 2.

Wack, a Westminster, Md., pediatrician, did not think thedisease warranted the vaccination — although it can be serious andeven fatal in a small number of cases.

He considered the disease a sort of childhood rite of passage.“It is more of a nuisance disease compared to pertussis (whoopingcough) and measles,” Wack said.

Resisting the Varicella Vaccine

Wack’s resistance to the chickenpox immunization, also known asthe varicella vaccine, highlights the difficulty public healthofficials have faced building support for the shot. But graduallythat resistance is fading among parents and doctors due to publicawareness campaigns by the vaccine’s manufacturer, Merck & Co., andgovernment health agencies.

Also helping the trend is the growing list of states thatrequire the vaccination for entrance into public school or daycare. While still not as widely given as other childhoodimmunizations such as those for polio and measles, the chickenpoxvaccine is closing the gap.

The vaccine is already required for day care or public school orboth in the District of Columbia and seven states: Massachusetts,Michigan, Oklahoma, Pennsylvania, Rhode Island, Tennessee andVirginia. In the 2000-01 school year, 11 more states will mandatethe vaccine: Alabama, Arkansas, Colorado, Connecticut, Georgia,Maryland, New Mexico, Oregon, South Carolina, South Dakota andTexas.

And between the fall of 2001 and 2003, the vaccine will also berequired in Alaska, Florida, New York and Louisiana.

The requirements have had an effect. The immunization rates forthe chickenpox vaccine, first available in 1995, hit 59 percent oftoddlers last year, up from 43.2 percent in 1998 and 37 percent in1997.

In comparison, the vaccine rate for thediptheria-pertussis-tetanus shot last year was 95.9 percent,according to the U.S. Centers for Disease Control and Prevention.

Parents Follow Mandates“The mandates have been a significant factor,” said Dr.Leonard Weiner, director of pediatric infectious diseases at theState University of New York’s Upstate Medical Center in Syracuse.

Before the state mandates helped change their view, somedoctors’ skepticism of the new vaccine led parents to decideagainst having their children immunized.

Some doctors did not think chickenpox was all that serious. Andsome doctors feared the vaccine would wear off and leave patientsvulnerable to catching the disease later in life, when chickenpoxcan be a much more serious condition, causing possiblecomplications such as infections.

But those worries have decreased amid reassurances about thevaccine’s effectiveness from the CDC and Merck.

“There is an increased awareness on the part of doctors andparents that chickenpox is no longer a rite of childhood,” saidDr. Margaret Fisher, a Philadelphia pediatrician. “Now, it’s knownthis is a disease that kills children each year, and it is adisease worth preventing. That’s not the perception there was fiveyears ago.”

85 Percent Effective

In studies, the vaccine has proven to be 85 percent effectivefor preventing all cases of chickenpox and almost 100 percenteffective in preventing severe cases. The vaccine can also workwhen administered within three days of exposure to chickenpox.

Side effects from the shot are rare and mild, and includesoreness and swelling at the injection site.

Most healthy children who get chickenpox won’t have anycomplications from the disease. However, each year in the UnitedStates, about 9,000 people are hospitalized for chickenpox andabout 90 die from the disease, according to the American Academy ofPediatrics. The academy recommends immunizing kids between 12 and18 months of age.

A person with chickenpox is contagious from one to two days beforethe rash starts and for up to 5 days after the rash appears. Achild will have to stay home from child care or school until he orshe is no longer contagious.

Before the vaccine became available, there were about 4 millioncases of chickenpox in the United States each year. It occurs mostfrequently in children age 6 to 10, but it can be contracted at anyage.

Troubling News?

Wack said he is troubled by states requiring the shot. Withoutthe mandate, he would tell parents about the vaccine and leave thechoice up to them. Now, with many states including Marylandrequiring shots, his advice matters less to parents.

“I feel like I am being squeezed because of the mandates,”said Wack, who is chief of pediatrics at Carroll County GeneralHospital.

But Wack said he has no plans to immunize his next child,expected to be born later this month, unless the child fails to getthe disease before age 10.

Dr. Robert Steele, a Springfield, Mo., pediatrician, saidthere’s been a clear shift in doctors becoming advocates for thechickenpox vaccine. He credits the CDC for educating doctors aboutsome dangerous side effects of the chickenpox.

Steele was not a proponent of the vaccine after its approval.“I am not anti-varicella vaccine or pro. I just say it should bean informed decision,” he said.

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