National Perspective : PUBLIC HEALTH: Chickenpox in Retreat?
Beginning this month, a vaccine is available for chickenpox, a disease that strikes nearly 4 million people a year in the United States. Though more of a nuisance than a danger, chickenpox nonetheless kills 100 Americans a year. Here is a look at how the Varivax vaccine works and a review of how other major vaccines have performed:
Q & A
What is chickenpox?
A disease characterized by an itchy rash on the face, scalp and upper body that forms blisters that dry and become scabs in two to four days. Other symptoms include fever, tiredness, loss of appetite and headache.
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How is it transmitted?
By inhaling air contaminated by coughing or sneezing of someone infected by chickenpox or through direct contact with a chickenpox blister.
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Who gets it?
There are an estimated 4 million cases of chickenpox a year. More than 95% of Americans get chickenpox by adulthood.
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How long does it take to develop?
Within 10-21 days after infection.
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Can it be life threatening?
Yes. Up to 100 persons die from complications of chickenpox in the United States each year, most of them young children.
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What is the vaccine?
It is made from a live, weakened form of the varicella virus that causes chickenpox.
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How many shots are needed?
The company recommends a single injection for children 12 months to 12 years of age who have never had chickenpox. Those 13 and older and adults who have never had chickenpox should receive two injections four to eight weeks apart.
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When should the shots be given?
At the same time as the combination shot for measles, mumps and rubella in the case of the 1pyear-olds.
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Does the vaccine have side effects?
Possible side effects are pain, redness, swelling, rash, and stiffness at the site of the injection. Fever among nearly 15% of those who underwent testing.
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How much does the vaccine cost?
It costs doctors and other health care providers $39 a dose. Final price for a visit and injection will vary by provider.
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Is the United States the first nation to develop a chickenpox vaccine?
No. The Japanese developed a vaccine in the early 1970’s which is licensed in Japan and several other countries. The U.S. vaccine is based on the same strain of the virus as the Japanese vaccine.
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Who shouldn’t receive the vaccine?
* Children under age 1
* Pregnant women
* People who have had chickenpox before
* Anyone with suppressed immune systems
* People allergic to the drug neomycin
How all immunizations work
Vaccines trick the body into thinking that it is actually being attacked by the disease.
1) A weakened form of the disease germ is injected into body.
2) The body manufactures antibodies to fight the invaders.
3) If germs from disease later attack body, antibodies will be there to destroy them.
Immunization Rates Proportion of children fully immunized by kindergarten: 96% Proportion of 2-year-old who have received recommended shots: 67% Top States Percentage of 2-year-olds immunized:
1. Tennessee: 72.0% 2. Minnesota: 71.4% 3. Massachusetts: 70.8% 4. Vermont: 70.4% 5. Connecticut: 70.3% Bottom States 50. Michigan: 42.1% 49. New Jersey: 45.1% 48. Texas: 45.8% 47. Utah: 49.3% 46. Ohio: 50.0% California’s rate is 57.2% *
Prices of Vaccines
Some health insurers cover the cost of vaccines. HMOs often cover immunizations and they are free at public health clinics or are given for a small fee.
Doses Public Private Polio 4 $2.21 $10.47 Measles, mumps, rubella 2 $15.71 $25.87 Diptheria, tetanus, pertussis 2 $9.81 $16.09 Hepatitus B 3 $7.09 $16.17 H. influenzae type B 1 $4.17 $15.13
Voices
“Getting children properly immunized is one of the most important things every parent and caring adult can do to ensure that all our children get a healthy start in life. Not only is vaccinating children the right thing to do, it also saves money. Every dollar spent to immunize a child saves $14 on the other end in health care costs.”
--Marian Wright Edelman, president, Children’s Defense Fund
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“I have been extremely concerned about the unacceptably low levels of immunization among America’s children. Immunization may be our most cost effective way to prevent disease.”
--David Satcher, director, Centers for Disease Control and Prevention
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“We can only relax our guard once disease is completely conquered.”
--James R. Allen, vice president for Science, Technology and Public Health American Medical Assn.
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“Immunization is one of the smartest, wisest things we can do as we address medical crisis in the U.S. and keep it under control.”
--Lawton (Bud) Chiles III, national director, Hope for Kids Immunization Outreach program
Success Rates
Figures show the drop in number of cases in peak years compared to the 1993 figures, the most recent available.
Disease Number of cases 1993 % change Diphtheria 206,939 (1921) 0 -100 Measles 894,134 (1941) 277 -99.9 Mumps 152,209 (1968) 1,630 -98.9 Whooping cough (Pertussis) 265,269 (1934) 6,132 -97.7 Polio (paralytic) 21,269 (1952) 0 -100 Rubella (German measles) 57,686 (1969) 188 -99.7 Tetanus 1,500 (1923) 9 -99.4
Vaccine Timeline
When vaccinations were developed or licensed:
1800: First smallpox vaccination in the United States
1923: Diphtheria vaccine developed
1925: Tetanus vaccine introduced
1940s: Whooping cough (Pertussis) vaccine available
1955: Inactivated polio vaccine licensed
1963: Live measles vaccine licensed; oral polio vaccine licensed
1968: Mumps vaccine licensed
1969: Rubella vaccine licensed
1975: Smallpox eradicated from the Americas
1989: Haemophilus influenzae type B vaccine licensed
1990: Hepatitis B vaccine licensed
1995: Chickenpox (varicella) vaccine licensed
Sources: Centers for Disease Control and Prevention; Merck Vaccine Division, Merck & Co.; Massachusetts Department of Health; National Vaccine Advisory Committee Report; Public Health Service; U.S. Department of Health and Human Services
Researched by ANNA M. VIRTUE / Los Angeles Times
