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"Protecting the health and informed consent rights of children since 1982."

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BL Fisher Note: The expense of trying to "eradicate" chickenpox with a
universal second dose of vaccine must be accurately evaluated by taking into
consideration  the fact that the live virus vaccine itself can cause vaccine
strain infection. Also, the increase in shingles in our child and adult
population is a result of mass vaccination policies which do not allow those
who have recovered naturally from the disease with a qualitatively superior
immunity (99.99 percent) to be naturally boosted by coming into contact with
the natural disease. Chicken pox never has been a serious, life threatening
disease for 99.9 plus percent of the population. The better route would have
been to find ways to help those who get chicken pox naturally recover
without sequelae.


http://www.dailynews.com/Stories/0,1413,200~20954~2642466,00.html
Los Angeles Daily News


Eradicating chickenpox worth price?
Cost of second shot for kids weighed
By Susan FitzGerald The Philadelphia Inquirer


Saturday, January 08, 2005 - PHILADELPHIA -- Nearly a decade after a new
chickenpox vaccine began driving down the number of children getting the
itchy red spots, the federal government now has an ambitious goal: to try to
eliminate the disease from this country.

Health officials want chickenpox, which afflicts an estimated 600,000 people
a year, to go the way of other illnesses such as measles and mumps that were
once a routine part of childhood.

But to get there, it might mean giving children a second shot of the
chickenpox vaccine.

That would be good news for the vaccine's maker, Merck & Co. But some
doctors say it's not clear whether it would be worth the cost and effort
involved in adding another shot to a crowded lineup of childhood
immunizations.

A large federally funded study in Philadelphia is allowing health officials
to measure the effectiveness of the one-dose regimen, and decide whether a
second dose is warranted.

"We would like to try to eliminate varicella," the virus that causes
chickenpox, said Dr. Jane Seward, head of the viral vaccine branch at the
federal Centers for Disease Control and Prevention. "The basic goal of any
program should be decreasing disease to the lowest extent possible if that's
not an undue burden on society."

Introduced in 1995, the vaccine was not intended to wipe out chickenpox, but
to significantly lessen the toll of the disease.

About 4 million people a year in this country, predominantly children, used
to get chickenpox, a highly infectious viral disease that spreads from
person to person by direct contact or through airborne droplets from
coughing and sneezing.

Most weather the discomfort -- fever and sometimes hundreds of blisters that
scab over -- without much trouble. But about 100 people died and 11,000 were
hospitalized annually with complications such as pneumonia and encephalitis,
a potentially deadly brain inflammation.

Right now children receive a single dose of vaccine between the ages of 1
year and 18 months. But some children who get the shot come down with
so-called breakthrough cases of chickenpox that are usually milder.

"It's been a very successful program to date," Seward said. "But can we do
even better? ... Ten years into the program is it still acceptable for
children to get 20 lesions and miss three or four days of school?"

CDC officials decided in the fall to pursue the goal of eliminating the
transmission of chickenpox in the United States. It would still crop up from
time to time, in the same way measles do, but "you don't have a case going
to a case going to a case," Seward said.

The CDC is doing a cost-benefit analysis of a second shot, she said, but no
decision has been made on whether it is warranted.

Adding another shot to the lineup of childhood immunizations would not be
done lightly, in part because children already get as many as 22 shots by
the age of 2.

Money is also an issue. The chickenpox vaccine used in this country, Merck's
Varivax, has a wholesale price of $65.09 per dose, though it usually sells
for less.

Dr. Robert Baltimore, a Yale University pediatrician and infectious-disease
specialist who serves on the American Academy of Pediatrics' infectious
disease committee, said the question that needs to be considered is whether
a second dose would provide "sufficient impact to have a public health
benefit."

"It's not good for kids to get sick," he said. But on the other hand, there
is cost and office time involved in giving another shot, and there may be "a
limit on the number of vaccines the public is willing to accept," he said.

Dr. Mark Warner of Drexel Hill Pediatrics said that from his perspective the
one-dose approach is very effective.

"I'm not seeing a whole lot of breakthrough cases, and the ones I do see are
not so sick," he said.

"It's not like doctors are begging" to add another shot, Warner said.

Merck in August submitted an application to the Food and Drug Administration
for a four-prong vaccine, called ProQuad, against measles, mumps, rubella
and chickenpox. If the vaccine is approved, the decision to add a second
dose of chickenpox vaccine could be easier since a second
measles-mumps-rubella (MMR) shot is already given.

The Philadelphia study, in the meantime, is giving the CDC a wealth of data
on the status of chickenpox in the vaccine era. A network of hospitals,
doctors offices and other sites reports suspicious rashes to the city health
department, which then investigates.

One evening in November, nurse Karl Heath went to the home of LaShona Moment
in the city's Wynnefield neighborhood. When her 8-year-old twins broke out
in red spots in October, Moment suspected they had chickenpox, even though
one had the vaccine and the other had the disease as a baby.

"We want to know if children who got the vaccine are getting chickenpox,"
said Heath, who pricked the index fingers of Malik and his sister Maliyah.

It's not always easy to identify chickenpox since a mild case can resemble
bug bites. As it turned out, the repeat blood tests on the Moment twins
ruled out chickenpox.

The Philadelphia study shows that vaccinated children still have about a 2
percent chance per year of getting chickenpox, though these breakthrough
cases have far fewer lesions, said Dr. Barbara Watson, medical specialist
with the city's immunization program.

The study is also documenting the steep decline of the disease. In 1995,
there were 1,197 reported cases of chickenpox in west Philadelphia; in 2003,
there were 130.

This time of year is the start of chickenpox season. The health department
is investigating nine cases at a northeast Philadelphia school -- a mere
shadow of former outbreaks.

"In the old days, you'd have 600 kids out of school at any point during an
outbreak," said Watson, a consultant for Merck.

Still, not all children respond to the current vaccine. "With one dose, if
you're a vaccinated child in school and have very close exposure, you have a
one-in-five chance of developing disease," Seward said. "We should
anticipate that after two doses, that risk would be 7 percent."

But even if a second dose of chickenpox vaccine is recommended, it doesn't
mean that the virus will fade away.

After the active stage of infection, the chickenpox virus, called
varicella-zoster, lies dormant in nerves along the spinal cord and can
re-emerge years later as a painful rash called shingles. Shingles provide
another route for the spread of chickenpox. A person with shingles can
infect someone with chickenpox if they lack immunity to the virus.

Merck is testing a shingles vaccine that is aimed at preventing the rash in
older people. The vaccine might by extension help lower the incidence of
chickenpox because "it may be able to reduce shingles as a source of
transmission of the varicella-zoster virus," said Michael Oxman, an
infectious-disease doctor at the VA Medical Center in San Diego who is
heading a nationwide trial of the shingles vaccine.

But, he said, as long as people harbor the virus, chickenpox can't be
completely wiped out.

Starting this year, the CDC is making chickenpox reportable, which will
allow health officials to better track the disease's remaining hold.

Watson said she senses a shift in parental attitudes since the chickenpox
vaccine became available almost a decade ago.

Skeptical parents used to reason, "'I had chickenpox and I survived. What's
the big deal?"' she said. "Now there's been enough education for parents to
know that 100 kids dying and 11,000 being hospitalized is a big deal."




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