Return to Main Menu

Advisory committee urges double dose of vaccination The Advisory Committee on Immunization Practices (ACIP) to the U.S. Centers for Disease Control and Prevention (CDC) recommended a second dose of varicella (chickenpox) vaccine be administered to children 4 to 6 years old to increase protection against the disease. The first dose of varicella vaccine is recommended at 12 to 15 months of age.   Fifteen percent to 20 percent of children who have received one dose of the vaccine are not fully protected and may develop chickenpox after coming in contact with varicella zoster virus, ACIP said. Additionally, one dose of the vaccine may not continue to provide protection into adulthood when a chickenpox outbreak is more severe. A second dose of varicella vaccine provides increased protection against varicella disease, compared with one dose. The ACIP also recommended that children, adolescents and adults who previously received one dose should receive a second dose.   “We have made great progress in reducing chickenpox during the past 10 years,” said Anne Schuchat, M.D., director of CDC’s National Center for Immunization and Respiratory Diseases. “This recommendation will further reduce outbreaks of chickenpox and provide better individual protection.”   Before licensure of the varicella vaccine in 1995, about four million cases of varicella—with 13,500 hospitalizations and 150 deaths — occurred each year. Cases of varicella have steadily declined 80 percent to 85 percent in surveillance sites since the licensure. From 1995 to 2001, varicella hospitalizations declined by 72 percent, and deaths, among those 50 years old and younger, decreased by 75 percent or more, CDC said.   However, in recent years varicella outbreaks have continued among vaccinated school children. During these chickenpox outbreaks, up to 17 percent of vaccinated children developed varicella. Varicella in vaccinated children is usually mild, but the children are contagious and can transmit the virus to others, including their parents who are at higher risk of severe disease, the panel warned.   ACIP, consisting of 15 members appointed by the U.S. Secretary of the Department of Health and Human Services (HHS), advises the director of CDC and secretary of HHS on control of vaccine-preventable disease and vaccine usage. Recommendations of the ACIP become CDC policy when they are accepted by the director of CDC and are published in CDC’s Morbidity and Mortality Weekly Report (MMWR). No federal laws require the immunization of children. All school and daycare entry laws are state laws and vary from state to state. Vaccination report card (Source: National Partnership for Immunization) Since 1995, 38 states have enacted mandates requiring varicella immunization for entry into day care, preschool or Head Start programs, including daycare, kindergarten, elementary school and/or middle school. Of the 38 states that mandate use of the varicella vaccine, 34 (89.4 percent) require it for day care entry, 34 (89.4 percent) for elementary school entry, and 18 (47.4 percent) for middle school entry.   Four states (10.5 percent)—Arizona, Indiana, Missouri and West Virginia—have mandates only for children entering day care.   Similarly, four states (10.5 percent) —Maine, Nevada, South Dakota and Utah—require varicella immunization only for children entering elementary school. Varicella immunization is required for both day care and elementary school entry in 12 states (31.6 percent), including South Carolina.   Eighteen (47.4 percent) states require varicella immunization for entry into day care, elementary school and middle school.   Only a few states require varicella vaccinations for older children. This is important, because chickenpox is a disease that becomes more dangerous as children age.   Among adolescents 15 to 19 years of age, the varicella-related mortality rate is 2.7 per 100,000 cases of disease. In adults, varicella can be more severe, with the risks of complications and death due to infection being 10 or more times greater than among children.   Despite evidence that the varicella vaccine can reduce the incidence and public health impact of chickenpox, 13 states have yet to enact any mandates requiring the vaccination for school-aged children. Those states are Arizona, Idaho, Iowa, Kansas, Minnesota, Montana, Nebraska, New Jersey, North Dakota, Ohio, Vermont, Washington and Wyoming.   For more information about states that require varicella vaccinations, visit http://www.partnersforimmunization.org/chickenpoxreportcard/summary.html.   For more information, visit http://www.cdc.gov.     Friday, Sept. 1, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.