Few of us are inclined to buck the wisdom of conventional medicine when it comes to vaccinating our kids against polio, diphtheria, measles, mumps and other illnesses. These diseases can be debilitating, even deadly; the shots prevent them. End of issue. But the decision can be more difficult when it comes to Varivax, the chickenpox vaccine.
Many of us remember getting chickenpox as children, and for most of us — some 4 million annually before 1995, when the vaccine became available — the week or so of itchy sores, fever and fatigue were mostly an annoyance. But according to the Centers for Disease Control and Prevention, 9,000 people are hospitalized in the United States each year because of complications such as streptococcal infection, pneumonia and encephalitis; up to 100 die. While children account for 90 percent of the cases, half of the deaths occur in adults, in whom the disease is usually more severe.
“If you can prevent that with a safe vaccine, it’s hard to see why one wouldn’t want to,” says pediatrician Cody Meissner, M.D., head of the pediatric infectious disease division at New England Medical Center in Boston and a member of the American Academy of Pediatrics’ committee on infectious diseases. Two decades of testing show that the vaccine — made up of a live, weakened version of the disease-causing varicella-zoster virus — wards off chickenpox in 85 percent of all cases and is effective at preventing serious cases almost 100 percent of the time. Sounds like a good argument, doesn’t it? But not everybody thinks so.
Vaccination pros and cons
The AAP recommends that children be vaccinated between 12 months and 18 months of age; older children (and adults) who have never had chickenpox should be vaccinated also. Not all physicians agree with the guidelines, however. Jonathan Benjamin, M.D., a pediatrician in Newton Centre, Mass., would like to see children over the age of 9 and adults who have avoided a bout get vaccinated (provided the adults are not immune) — but not babies. “My concern is that if we mass-immunize infants, in 30 or 40 or 50 years we may find that these adults may no longer be immune to the disease,” he says.
Jay Gordon, M.D., a pediatrician in Santa Monica, Calif., agrees. “The chickenpox is a relatively benign disease in childhood,” he says, “but if immunity doesn’t last and people get it when they’re adults, the disease can cause complications and potential damage to fetuses in pregnant women.”
Gordon makes another point often overlooked in the vaccine controversy: “Getting the chickenpox is good for you, and the number of complications in children is quite small,” he says. “Getting the disease itself gives you a different level of antibodies and, for all we know, different types of antibodies are worth getting because they build the immune system.” Gordon does add, however, that if a child hasn’t contracted the disease by age 10 to 12, the vaccine is in order.
The immunity issue also troubles Barbara Loe Fisher, president of the National Vaccine Information Center, based in Vienna, Va. “A lot of parents would rather that their children get chickenpox naturally and get permanent immunity,” she says.
Meissner says the concern is unwarranted. “There is no evidence to suggest that a young child who is vaccinated against chickenpox is at risk of developing the disease as an adult.”
But the vaccination itself isn’t without drawbacks. According to the AAP, 3 to 5 percent of children who are vaccinated suffer a localized skin reaction to the shot, 15 percent develop a fever of 102? F or greater, and 3 to 5 percent get a small number of chickenpox sores.