The only maternal death I recall from my residency was a pregnant woman who died from chicken pox pneumonia. Back then, there were no anti-viral drugs to give her, and she, and the baby she was carrying, died. I don’t remember how she got chicken pox, but I suspect it was from a toddler, maybe her own, who passed on the gift of the varicella, or chicken pox, virus.
By the time the varicella vaccine became available in 1995, my kids had already weathered the ravages of chicken pox, and come out none the worse for it. It was kind of a rite of passage, I figured, and I wondered why it was necessary to vaccinate for a disease that was pretty benign. But then I remembered that woman and her baby. Chicken pox may be benign for a toddler, but it can be deadly for adults and for infants younger than 1 year old.
The varicella vaccine is now recommended for all children between the ages of 12 and 18 months. Researchers at the Center for Disease Control set out to find what impact the vaccine has had on health care utilization, and published their results last week in the Journal of the American Medical Association. They collected data from a huge database that included enrollees from more than 100 health care plans. They combined the data for 1994 and 1995 and used that as their baseline. Then they looked at the trends in hospitalizations and office visits for chicken pox among people from birth to age 49 up through 2002 and compared it to their baseline data.
By 2002, 81 percent of children between the ages of 19 and 35 months had received the vaccine. Looking at the data for hospital admissions in all age groups, the researchers found a decrease of 88 percent. Even more impressive to this mother’s heart was the data for infants younger than 12 months old, who weren’t even eligible for the vaccine. Their admissions dropped 100 percent – from 45 per 100,000 at baseline to none in 2002.
Looking at office visits, they found a 59 percent decrease. And again, the largest drop was in infants, down 90 percent.
So, infants who didn’t get the vaccine, and adults who presumably missed the joy of chicken pox when they were kids, had dramatically fewer office visits and hospitalizations. What’s going on here?
In the parlance of epidemiologists, this is called “herd immunity.” Putting aside the reference to all of us as a “herd,” this means that if those who are most likely to get chicken pox (kids) are vaccinated, there will be fewer cases of chicken pox to spread around. Even though the mother who died during my residency was not immune to chicken pox, if the children she was near had been vaccinated, she wouldn’t have been exposed to chicken pox, and she wouldn’t have become sick. She’d be around today, maybe even bragging about her grandkids.
This study also has good news for those who are wringing their hands over health care costs in the United States. Based on their data, the researchers estimated the annual expenditures for hospitalizations and office visits. They calculated the costs in 1994 to be $84.9 million. By 2002 the cost was 74 percent lower, $22.1 million. This doesn’t count the time lost from work or school by the person with the itchy rash or the mom or dad who is taking care of the sick one. It also doesn’t count the endless bottles of children’s Tylenol and Aveeno oatmeal bath.
There are some parents who are leery of vaccinations, who don’t want their child to face the very rare associated risks, figuring their kids will do just fine if they get the German measles, mumps or whooping cough. And they might. But the rare child got terribly ill from these diseases, and some died. And the infants and adults (who generally get much sicker) will be much safer if we immunize our children.
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