Luckily, we have a fantastic following of local politics in my community. We have many bloggers on nebraska politics, pretty good local news, a pretty poor local paper, and a terrific local radio station (1110 KFAB) that keeps me in the loop on the issues that matter to me at the local level (from our mayor's latest gaffe to a traffic accident that will slow my morning commute). Since I've been on my 2.5 month break from the world of medicine, I've spent a good many hours listening to KFAB and getting my fill of local issues and humor.
What does this have to do with chickenpox you might ask? Almost nothing, except that my favorite radio personality, Scott Voorhees, spent a good 20 minutes talking about a recent bill that passed our unicameral (our state, just like the "pool-only" members at the country club, has only one house). The bill requires that all school-aged children get a second dose of the chickenpox (varicella) vaccine before entering kindergarten. Here is my take, in question-answer format:
Question: The chickenpox, come on! Rub some calamine lotion on your pox and get over it!
Answer: Yes, the chickenpox is a common childhood disease and 20 years ago every "lucky" family played host to a pox-party where they infected half the neighborhood kids with chickenpox. There are certainly worse diseases that are much more worthy of vaccinations (measles, mumps, rubella, polio, etc.) but we have a vaccine, it works, and it saves money to society (see below). Chickenpox isn't always a benign scratch-fest. In 1995, before the vaccine became available, there were 13,000 hospitalizations due to chickenpox and around 150 deaths each year due to complications of chickenpox.
Question: Okay, so chickenpox can be serious. Is the vaccine any good?
Answer: Yep, it's actually a very good vaccine. The rate of chickenpox dropped in the 10 years after the vaccine (the one-dose version) by more than 80%, the hospitalization rate dropped 88% and the death rate dropped 92%. Those numbers were all with the one-dose version. Additionally, when kids do get chickenpox despite getting the vaccine, their disease is much more mild (~50 pox lesions versus >250 in the unimmunized, shorter course of disease, and fewer complications). In adults who had the chickenpox as children, there is a risk of developing shingles. 20-30% of adults that had chickenpox will have a case of shingles and that can have complications too (it's also very painful, so I've been told!). Data suggests the risk of shingles later in life is reduced by immunization, too. Vaccines cost money to the patient and to society, so it's important to look at the numbers and see how vaccination affects society's bottom line. Single and double dose chickenpox vaccination SAVE MONEY for society by preventing expensive medical care related to severe disease and complications.
Question: Why do we need TWO doses then??
Answer: Although the numbers above are dramatic, one-dose immunized kids still get chickenpox about 10% of the time. Some kids just don't quite respond to the one dose with a vigorous enough immune response. However, with two doses the chance of getting chickenpox is reduced down to around 2%. Two doses makes a big difference at preventing breakthrough chickenpox and thus preventing the spread of chickenpox. Even though kids that have one dose of vaccine have milder disease, they can still pass chickenpox on to their unvaccinated colleagues who experience the "normal" full-throttle version of the chickenpox since they aren't immunized at all.
Question: Okay, I'll buy that the two dose regimen works, but I again argue that kids these days are weenies and could use a little scratching and discomfort!
Answer: Kids today are weenies. I'm a big advocate for letting kids fall down (from low to moderate heights, of course) and scrape their knees, bump their elbows, and bruise their foreheads. At our church, the child area has rough stone floors and all of Jane's skinned knees just help make her less of a weenie! With that said, I do think the vaccination against chickenpox is worthwhile. Even if your child has the normal course of the chickenpox and recovers, they have the opportunity to spread the disease to children that may not be so lucky.
We live in a large medical community. There are a number of vulnerable patients who could get very sick if exposed to the chickenpox. In addition to newborns and pregnant mommas who can have serious complications from the chickenpox, we have some special populations in our community. We are lucky to have a strong transplant program at our local university - children receiving bone marrow transplants for cancer treatment, liver transplants, etc. are all at risk of having severe and deadly complications from seemingly benign diseases in the community. Kids with congenital heart disease, lung disease, prematurity, and many others are at a higher risk of having worse complications from chickenpox, too. These kids aren't all in the hospital either - there are plenty of kiddos on immunosuppressants for transplants, kids with serious heart disease, and many others who are at the grocery store, mall, etc. living a mostly normal life in the community.
Question: Fine, but why does the unicameral get to tell ME how to take care of my kids?
Answer: This is my biggest gripe with the issue as well. I'm not a fan of the idea of the "nanny state" and think that parents should be able to make choices about how their children are cared for. I don't know what made the legislature decide to take up this issue, especially since double dosing has been a recommendation of the AAP for more than 4 years. The intent seems to be to mainstream the concept of double-dosing and help doctors offices convince parents that they need to double dose to get their kiddo into kindergarten. However, objectors to getting the immunization CAN sign a waiver and their children will be allowed into school without the immunization.
Long post and I'd love to hear your take on the issue, too. Please comment below.
p.s. Scott Vorhees is on 1110 KFAB from 9-11am weekdays and can be heard on anywhere in the world via the iHeartRadio app!
- Posted using BlogPress from my iPad 2
I'm no doctor but our pro-life doctor down here informed us that this chicken pox vaccine is made from aborted babies. I defer to you but isn't that a pretty strong reason to avoid this vaccine?
ReplyDeleteInteresting question, John. The short answer the chickenpox vaccine is absollutely NOT made from aborted babies. The long answer is the same, but here's how this idea came about. 40 years ago, the original cell lines used to develop MMR vaccines came from the cells of an aborted fetus. The cells were harvested and regrown over and over for m any years to provide a growth medium for the viruses cells that then could be used in the vaccines. Since then, the MMR and other vaccines have been made independently without the use of the cell lines and have even no historical relation to aborted fetuses. The chickenpox vaccine is still developed from this original cell line, so there is a very distant historical association but that is all. It is absolutely NOT made from aborted fetuses. I did some research and even the catholic church does not oppose vaccination with the chickenpox vaccine or any other vaccine that is from this historical cell line. There is no moral obligation to refuse chickenpox vaccine. Here is my source for this: http://www.ncbcenter.org/NetCommunity/Page.aspx?pid=434
ReplyDeleteThanks for the question!
Sorry for the spelling mistakes and typos - that reply was typed on my iPhone! Feel free to share the above info with your pediatrician - maybe they will reconsider their position and get more kids protected against chickenpox!
ReplyDeleteThanks for the good read Phil!
ReplyDeleteA lot of the parents in the school district that I taught at the last three years are anti-vaccines. (Very frustrating for me as I'm very pro-vaccine) We had two outbreaks of chicken pox in the 8th grade this year, both while I was there pregnant with Evan. Lucky for me I had the chicken pox as a child and I didn't have a reason to worry. One comment I heard: "The FDA says they have a higher chance of dying from the vaccine than having chicken pox." I'm glad you're going into Peds and can educate the parents!
In general, I like the idea that vaccines are mandated because kiddos who are low income can get their shots at free or reduced prices. Even if I don't agree with the way some of my students' parents spend their money, it is nice to know that the kids' health does not always have to suffer because of it. -Char
ReplyDeleteThat's a great point, Char. Mandating vaccines does ensure that even low-income families will have access to the services. Thanks for bringing that up!
ReplyDelete