The rubber-gloved health-care workers who inject kids with disease-halting immunizations may have only themselves to blame.
Vaccines have proved so successful in eliminating their target diseases that some parents of school-aged children have gotten a bit lax about completing the complicated battery of injections. Not a good idea, say public health officials, because even relatively minor childhood infections such as chickenpox sometimes result in severe illness.
It's hard to believe, but not so long ago, parents used to organize gatherings to expose their children to the varicella zoster virus, thinking chickenpox was just a benign childhood disease, and that it was best for kids to get it over with.
"People thought it was a rite of passage," says Dr. Mary Glode, a professor of pediatric infectious disease and an infectious disease specialist at Denver's Children's Hospital. "There used to be chickenpox parties."
Sad to say, even five years after the varicella vaccine hit the market, the Denver hospital sees a child a day with chickenpox complications. One such youngster had been a healthy 8-year-old before contracting the illness, which normally runs its course in four days. The child was hospitalized for four months, comatose and paralyzed by a spinal-cord infection, a rare complication.
According to the U.S. Centers for Disease Control (CDC), before the varicella vaccine was available, some 4 million people got chickenpox annually -- mostly children under age 6. Some 11,000 required hospitalization, and 100 died each year.
"They're big numbers," says Dr. Glode. "Even though, as a parent, you may have only seen the neighbors' children and they may have done fine, at a national level, we don't like this disease."
Will the 'Cure' Give Me the Disease?
Considering the potentially severe consequences of childhood illnesses, and the toll in lost school and work days, most parents are eager to get their kids immunized. But some shun vaccines like the plague, fearing the shots will give their kids the diseases they aim to prevent.
"Every vaccine has potential side effects," says Dr. Benjamin Estrada, an assistant professor at the University of South Alabama's division of pediatric infectious diseases, "but the benefits of getting them outweigh the risks by a large percentage."
And some older vaccines have been changed to lessen the chance of side effects and improve overall safety. A newer polio vaccine, for example, will eventually eliminate any chance of infants getting the disease via immunization. And U.S. Food and Drug Administration worries that a hepatitis-B vaccine exposed children to too much mercury prompted creation of a mercury-free version, notes Dr. Estrada.
Never Too Late to Be Up to Date
Even if you abided by immunization deadlines when your child was younger, you may still have catch-up work because of new vaccines.
"Early on, when immunizations became available ... (parents) were flocking to clinics to get shots for their kids. But as vaccines have been more and more successful -- and there is less direct memory in parents of how bad these diseases are -- it's dropped a little bit on the priority list," says Dr. David W. Fleming, of the Oregon Health Division in Portland.
The chickenpox vaccine, for example, has been on the market since May 1995 and recommended by the CDC since '96. Yet varicella has remained the leading cause of vaccine-preventable deaths in this country, according to Dr. Estrada. And immunization rates in some regions are still as low as 25%, according to the CDC.
Hepatitis B is another case in point. The disease occurs primarily in older children and young adults. Pediatricians have been less enthusiastic in giving those immunizations.
According to Dr. Fleming, who is also a member of the Advisory Committee on Immunization Practices (ACIP), health-care providers tend to be more jazzed about newer immunizations if they prevent childhood ailments the doctor has treated. "I think we're seeing the same phenomenon with parents," he adds.
Don't Forget Your Middle-Schooler
There is slight variation by state, but generally, 11- to 12-year-olds need vaccines against hepatitis B, measles, mumps, rubella and varicella, if previously recommended doses were missed or given earlier than the recommended minimum age.
In May 1999, the ACIP recommended that all states require varicella vaccination, or evidence of immunity, for children entering child care and elementary school.
And there is talk of adding chickenpox to the existing measles, mumps and rubella vaccine to pack a quadruple wallop into a single needle stick. But that product won't be developed right away, Dr. Fleming says, and will mainly aid younger children who now face 13 separate injections by age 6.
A Td shot -- tetanus and diphtheria toxoids -- is recommended at 11 to 12 years of age if more than five years have elapsed since the last dose of DTP, DTaP or DT. Routine Td boosters are recommended every decade.
Dr. Fleming, himself the father of children in the immunization age range, says it helps to talk to children about the need for the shots. Children recall being sick, or having a friend who was sick, and can understand the shot as a "trade-off" to prevent future sickness.
"I'm not above bribery and combining a visit to the ice-cream store," admits Dr. Fleming, "so the child has a short-term reason to want to get their shot."