Playing Chicken Health: Getting pox as a child grants immunization for life from the more dangerous adult form. An expensive shot can't promise the same. So, parents of XTC never-infected youngsters face a tough choice.

THE BALTIMORE SUN

Wanted: Someone with a case of chicken pox bad enough to pierce 12-year-old Danny Mroz's healthy armor.

He and a 10-year-old sister, Emilee, have ducked the common childhood disease for years despite what their mom, Sandy, estimates were six known exposures and thousands of possible carriers in playgroups, classrooms and soccer fields.

"I've been trying to expose him to it since he was 5," she says.

With only a year before Danny turns 13, when a case of chicken pox can be more serious than one endured in early childhood, Mrs. Mroz is torn over whether to hold out a few more months or give him the new chicken pox vaccine that arrived in doctors' offices across the country a year ago.

To vax or not to vax. That is the question for the doctors and parents of nearly 4 million children born this year following the introduction of a vaccine that could put chicken pox in the same category as German measles: obsolete.

On the one hand, chicken pox is a big problem -- 4 million children a year get it and the American Medical Association estimates it costs $384 million every year in missed work for parents and hospitalizations.

On the other hand, do children need a vaccine for what is usually a mild disease? Will the protection last into adulthood? If immunity wanes and a person catches the disease later in life, it can be more serious.

World experts in chicken pox, including Neal Halsey, pediatrics professor at the Johns Hopkins School of Hygiene and Public Health, strongly support the vaccine for all children beginning at age 1.

"Children with chicken pox do suffer," says Dr. Halsey, a member of the American Academy of Pediatrics' committee on infectious diseases. "It's the child suffering and it's the serious complications" that beg for the vaccine, he says. "If we can prevent 50 to 100 deaths a year, it's worth it."

Between 5,000 and 10,000 children and adults are hospitalized annually because of the disease and its secondary effects, including the strep virus, pneumonia, and brain damage from encephalitis. "That is probably an underestimation of the true complications that occur," Dr. Halsey says.

Recently in California, researchers found an increased link between varicella, the chicken pox virus, and group A strep, after studying cases including the 1994 deaths of eight children within three weeks from strep. All of them had also suffered from chicken pox.

The vaccine's manufacturer, Merck & Co., is expected to sign a contract with the Centers for Disease Control and Prevention in the next few weeks to provide the vaccine for children in public immunization programs. They represent about 60 percent of the eligible population.

But the vaccine isn't taking off in private doctors' offices the way some expected -- despite strong stands by the American Academy of Pediatrics and the CDC in favor of universal immunization. Many doctors -- about half those in Maryland -- are recommending the vaccine only gingerly for younger children -- babies though pre-teens.

The reasons include its cost, about $60, the relatively mild nature of childhood chicken pox and questions about whether the vaccine will provide the same lifetime immunity afforded by the natural strain of the disease.

"The concern is, it works, but it doesn't last," says Leonard Raucher, a family doctor in Ellicott City. Real chicken pox, he says, makes you immune for life. "I'd hate to see it happen that we take a whole generation of kids to adulthood without the natural immunities."

In early childhood the disease is often considered more irritating than serious. Its first sign is a high fever, followed by quick outbursts of anywhere from 10 to 500 lesions. As the lesions break open and form scabs, they can be severely itchy.

Since May 1995, more than 2.3 million doses of the vaccine have been ordered by doctors' offices, according to Merck. A Merck spokeswoman says the orders represent about the same initial acceptance rate, about 50 percent of those born every year, that greeted the measles vaccine when it was launched in 1963. In contrast, the acceptance rate for hepatitis B, introduced in 1991, is only about 20 percent.

But some of the sales may be to doctors who are pushing the new vaccine not for babies but for 11- and 12-year-olds like Danny Mroz and for adults who've never been exposed. Doctors pretty much agree that teen-agers and adults who haven't already had a natural case of chicken pox should get the vaccine. At that age, complications from chicken pox are more common and more serious.

A tough call

Paul Bodnar, a Towson pediatrician, normally finds himself helping the Maryland Department of Health and Mental Hygiene educate doctors to improve proper immunizations. But when it comes to the chicken pox vaccine, the state health department and the state's doctors are running in two different directions, he says. Maryland doctors are split on the question of whether to vaccinate, he says. "The trouble comes in ages 1-11, when the odds of having a complication are very, very small. It is true it is an illness that affects parents' employment a fair bit. It keeps kids out of school for a week or more. But as far as the children's health is concerned, the odds of complications are quite small," Dr. Bodnar says.

Many people rely on their doctors' advice, and in Dr. Bodner's office, most patients have decided to wait it out.

A mile away in Stephen R. Feldman's practice, two-thirds of children who haven't had chicken pox are opting to get the vaccine. Initially neutral on the new vaccine, Dr. Feldman is now recommending it.

"It is a safe vaccine, it is effective, and I don't think a child should have a sickness that I can prevent," Dr. Feldman says. "The only remaining issue is lifelong immunity," he says, adding that a booster may be needed to prevent adult complications.

Boosters have been required for measles, mumps and rubella since 1989 -- it took more than 25 years to find out that the measles vaccine doesn't always take and a booster is needed.

The chicken pox vaccine lasts at least six to 10 years and perhaps a lifetime -- the longest study is 20 years in Japan, where the vaccine originated. There are no signs yet that a booster will be needed, says Sandra J. Holmes, an expert in infectious diseases at the Center for Pediatric Research at the Eastern Virginia Medical School in Norfolk.

She and others warn that if only part of the population is vaccinated, reducing the wild disease by half, those who aren't vaccinated could get the disease at a later age when it is more serious.

This is also the concern of Barry Trostel, chief of immunization for the Maryland health department, which like the CDC, recommends the vaccine for all babies beginning at 12 months. He remembers when the same concerns about lifelong immunity were raised about polio, measles and rubella. "The only way to find out is to try it," he says. "My point is, how long are we going to wait?"

For some parents, whether to vaccinate has more to do with economics than medicine. Although most parents who get information about the vaccine in his office "are opting to wait and see if they get the illness by kindergarten," James Brayton, chief of pediatrics at Franklin Square Hospital, says some families where both husband and wife have jobs are getting the vaccine earlier so they won't miss work.

Some parents also are relying on memories of oatmeal baths and miserable children to decide whether to get the vaccine.

Carolyn Fewster, 42, says she would have welcomed the vaccine in exchange for what her daughter Emily went through six years ago. Emily's case was so severe that she was home for school for two weeks -- the same two weeks workmen were drilling through brick walls to renovate their house. The family kept sane by taking Emily to visit children who already had the disease.

With Emily's experience and Mrs. Fewster's own case of mumps at age 21, she is taking no chances that her husband will contract chicken pox. She says she is bringing him back for the vaccine because he has never had the disease.

A test of patience

In the Mroz household, Mrs. Mroz and husband Robert continue to search for a prospective carrier willing to sit near their son -- she has even asked the school nurse at Pinewood Elementary to be on the lookout. But Mrs. Mroz says she's adamantly opposed to it for her youngest -- 6-year-old Cyndee and 18-month-old Kylee.

"This is a mild disease that all children get. Other diseases that have been wiped out with a vaccine, such as German measles and scarlet fever, all have severe side effects. This one, the worst you can get is scars. But there is medication on the market to reduce itching," she says.

She could be trying for many more years to expose her younger children. Cyndee recently played with her best friend one day before the friend's chicken pox erupted. But her mom says she got "not a thing."

Pub Date: 4/09/96

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