Jan. 10, 2000 (Baltimore) -- Although the vaccine against varicella, or chickenpox, has been in use for some time, a large number of children aren't immunized and should be, says a document released by the American Academy of Pediatrics (AAP) updating their recommendations on the vaccine. The update appears in the January issue of the journal Pediatrics.
"There are really three things that are important in this document," says Michael Gerber, MD, member of the committee on infectious diseases of the AAP, in an interview with WebMD. "First is the recognition that although the recommendation for universal use of the varicella vaccine was made in 1995, a large number of eligible children remain unimmunized. Second, the Academy [AAP] is now strongly encouraging pediatricians to support public health officials in the development and implementation of varicella vaccine requirements for daycare and school entry. And third is that the vaccine has been shown to be safe in certain patients who are HIV positive and should be administered to them."
Gerber says that some pediatricians and parents are resistant to the idea of vaccinating all eligible children for chickenpox. "Although they are decreasing in number, there are still some people who are not convinced the vaccine is safe and effective," he says. "I think much of the resistance among pediatricians is a reflection of the resistance on the part of parents."
The update cites many studies showing the vaccine is safe and effective. One new study has just been published in the December issue of the Pediatric Infectious Disease Journal. This study looked at the vaccine effectiveness in 11 day care centers serving between 1,100 and 1,500 children in North Carolina. Comparing the number of chickenpox cases in vaccinated and unvaccinated children, the vaccine effectiveness in this study was found to be 83%.
"Basically, what we saw is that as children are vaccinated, there is less varicella disease, even among those who haven't been vaccinated," Christine Bland, RN, a research nurse at the Duke Vaccine Unit at Duke University in Durham, N.C., and one of the authors of the study, tells WebMD. "We're hoping that one day the vaccine will be made mandatory and we can avoid any outbreaks of varicella. This is especially important as more children who are immunocompromised attend day care and school. For these kids, the infection can be quite deadly."
Gerber makes the point that the AAP is also recommending use of varicella vaccine in children who have recently been exposed to chickenpox. "We now have ample data to show that if the vaccine is given within three days of [chickenpox] exposure it will prevent or modify disease. This is another way to reduce or eliminate outbreaks of varicella in school and day care settings."
"Children 12 months of age or older without documentation of varicella immunization or infection who do not have a contraindication should receive a dose of varicella vaccine immediately," the update states. "In addition, special emphasis should be placed on immunization of susceptible older children and adults, because the likelihood of severe infection increases with increasing age."
- Although the American Academy of Pediatrics began recommending universal administration of the chickenpox vaccine in 1995, a large number of eligible children aren't immunized.
- All children over age 12 months should receive immunization, although both pediatricians and parents can be resistant to the idea of vaccinating all children.
- Special emphasis should be placed on older patients, because the risk of severe infection increases with age.