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The varicella zoster virus (VZV) is a DNA virus belonging to the herpes family of viruses. VZV is the cause of the primary illness that is commonly called chicken pox, a highly contagious disease transmitted via direct contact with a patient's skin lesions or oral secretions and, somewhat less commonly, through airborne routes. The disease manifests in the following ways:
- One will begin to see the familiar skin rash
- The rash will concentrate around the trunk, scalp, and face.
- Soon after rash develops, symptoms such as fever, upper respiratory tract infection, and malaise set in
History of Chicken Pox
In many parts of the world, chicken pox is something of a childhood rite of passage: some four million American children once contracted the disease each year. The lifetime risk of infection with VZV is approximately 95 percent. The illness was once so widespread that almost all adults in the United States were immune as a result being infected at a young age. In the overwhelming majority-90 percent-of childhood cases, the disease runs its course in about one week and the most frequent complications are infections resulting from continual scratching of one or more of hundreds of small red spots that appear on the surface of the skin. Chicken pox often also leaves permanent scars about the face and other parts of the body. In the United States, the most serious cases resulted in some 9,000 hospitalizations each year and as many as 100 deaths from complications associated with the disease.
Nonetheless, although chicken pox is a relatively mild childhood illness, VZV can produce severe complications among adults. Acute complications with chicken pox are:
- Superimposed skin infections
In Canada, for instance, although adult patients make up only about 5% of all yearly infections, in the decade between 1987 and 1996, they accounted for some 70 percent of all reported VZV-related deaths. In addition, the virus may lie dormant for decades in the sensory nerve ganglia, becoming active again only later in life when it can produce herpes zoster-the illness commonly known as shingles. The most dangerous consequences of chicken pox are often observed in pregnant women with the disease: during the first two trimesters of pregnancy it can result in severe birth defects, while in the final trimester it can produce neonatal chicken pox, which is associated with a mortality rate during the first month of life as high as 30 percent among infected infants.
The Chicken Pox Vaccine - Pros and Cons
During the early 1970s, a live, attenuated vaccine called the Oka strain was developed in Japan. In 1995 the U.S. Food and Drug administration approved a similar varicella virus vaccine, known as Varivax. That same year, the American Academy of Pediatrics and, with somewhat more muted enthusiasm, the Immunization Practices Advisory Committee of the US Centers for Disease Control and Prevention recommended routine vaccination for all children at 12-18 months of age, that all children under should 13 years receive should 1 dose the of vaccine, and that older individuals susceptible to varicella should be offered 2 doses 4-8 weeks apart.The Canadian National Advisory Committee on Immunization also recommends vaccination for all potentially susceptible individuals aged 12 months or more, with dose regimens similar to those applied in the United States
Some feel that the vaccine is a viable tool in counteracting a dangerous illness and should be mandatory. Varifax does appear to be highly effective at countering varicella. Ulmer and Liu utilize statistics to support their supposition that around the globe, various vaccines have saved millions of lives and reduced immense suffering. Furthermore, they appeal to reliable authorities on the subject and cite other studies that assert vaccination is the only form of medical intervention that has effectively eliminated any disease. Siegel-Itzkovich use the logic of analogy in stating that attenuated-virus vaccine has been a component of routine immunization programs in Japan for more than two decades and in the United States since 1995. This is a viable analogy due to the similarity of the two vaccines. Likewise, a study in CMAJ uses analogy to point out that several studies have shown that breakthrough infections of VZV and herpes zoster infections are rather infrequent and, when they do occur, manifest in rather mild forms. Furthermore, transmission of VZV from the vaccine has been found to be considerably more rare than natural transmission of VZV, while research does not support the hypothetical concern that immunization may lead to higher incidences of herpes zoster. In additional, although immunization may increase the average age at which varicella infection occurs, the general decrease in the number of adult cases should compensate for this shift.
Reports also suggest that extensive use of the vaccine will be economically beneficial. Globally, vaccines are outstanding among medical interventions in their cost-effectiveness. Although the relative mildness of the disease leads to underestimation of the costs associated with it, chicken pox can be a rather expensive disease. It is a highly contagious illness, which, even when uncomplicated, can cost hundreds of millions of dollars annually, including direct medical costs-which account for only about one-tenth of the total economic burden-and productivity declines resulting from caregivers' lost work days, which account for the bulk of all economic costs. An article by Carpi appeals to intuition as it sites that, considering costs associated with work-loss and medical expenses, mass immunization should save $5 for every $1 that it costs.
However, some feel that the potential dangers associated with the vaccine outweigh the potential benefits. Despite the oft-cited promises of the vaccine against chicken pox, there are many serious potential problems with employing it universally and many pediatricians remain concerned about the risks incurred in immunizing against a relatively mild childhood disease in which serious complications are comparatively rare and for which there is rather high degree of natural immunity. Siegel-Itzkovich point to a case study of soldiers in the Israeli Defense Forces which found that some 98 percent of a representative sample was naturally immune to chicken pox, although somewhat lower rates of immunity were found among soldiers who had recently immigrated from the former Soviet Union . However, the case analogy may not be applicable due to the risks involved in universal employment of the vaccine. Despite these considerable risks, medical officials rushed to apply universal vaccination, failed to adequately evaluate Varivax for its carcinogenicity or mutagenicity or for its long-term impacts on fertility.
Although the vaccine has already been in use for a few years with few negative side effects, negative impacts may materialize in the not-too-distant future. Serious problems may involve those children who, as historical experience demonstrates, are inevitably missed in any immunization campaign. Carpi cites statistical information from the Centers for Disease Control, a reliable and well-documented source, to support that vaccination procedure. For instance, the Centers for Disease Control and Prevention reported recently that, while as a result of immunization campaigns the incidence of measles had declined to an unprecedented of 948 in 1994, children who did not receive vaccinations accounted for 98 percent of infections. About one percent of all children-a proportion that amounts to hundreds of thousands of young Americans each year-are not vaccinated, primarily because their parents are opposed to vaccination on philosophical or religious grounds. Only two of the states do not permit exemptions from vaccination based on religious preferences, while in 17 states a simple note from a parent stating philosophical opposition is sufficient to exempt a child from vaccination.
Furthermore, even where vaccination is compulsory, important minorities of children go unvaccinated.
The biggest uncertainties with the anti-chicken pox vaccine may lie in the possibility that, as the disease becomes more rare among children, unvaccinated individuals increase their chances for acquiring the infection as adults. And, as was noted earlier, the risks associated with contracting varicella later in life are especially dangerous. Carpi's study imparts emotionalism in its appeal to intuition through common sense in stating that there may now be hundreds of thousands of children in America who, without vaccination, might have gained immunity from natural exposure to the relatively mild chicken pox disease, but who now face the possibility of acquiring a dangerous infection later in their lives.