The Pox

When I was an intern, a family from Ireland who had given birth prematurely and were readying themselves to go home with their now fat and happy new baby, asked why we give the Hepatitis B shot at birth. It's a good question, since if a mother is not infected with the virus there is no harm in waiting to vaccinate the infant during the routine 2 month shots. But some women will catch Hepatitis B during pregnancy and after their screening labs were done. For these infants, the chance of chronic liver disease from the infection is 90%, which brings with it the danger of liver cancer and death, a horrible future for an infant who could have been entirely healthy. So the default in the U.S is to immunize.

In Ireland, they wait until 2 months of age for the first Hepatitis B vaccine, but at birth infants receive immunization against tuberculosis in the form of the BCG vaccine. This vaccine isn't used at all in the U.S., since the rates of tuberculosis are currently so low that the monetary costs of universal vaccination are not thought to be worth while.

There are several other differences as well. Infants in Ireland are routinely immunized (or immunised) against bacterial meningitis during infancy, a measure currently being debated here in the U.S. Hopefully we will follow suit since, having seen pus drain directly from a spinal needle placed in an infant's back, I can tell you that bacterial meningitis is absolutely not something you want your brand new babe to get.

But what about chickenpox? We vaccinate here against varicella but they don't necessarily do so in Ireland. Years ago my husband found himself embroiled in an online debate on the benefits of vaccines. Routine vaccination against chickenpox was only just beginning and there was, of course, objection to the addition of one more jab to the early childhood immunization schedule. Those opposed to vaccination protested that only about a hundred people die from chickenpox every year of the 4 million who contract the disease in the U.S.

My husband was agast. Surely, he protested, if two school buses filled with children were driven off the edge of a ravine and one hundred young and healthy kids losts their lives needlessly, you would think this was a tragedy. How is it different if they instead die horribly painful deaths in the hospital after their organs shut down from infection? And isn't it, in fact, worse to have a tool that could have saved them and decide not to use it?

But we are using it. Children are getting the vaccine and, as a result, the number of chickenpox cases ws down to 400,000 in 2005. More importantly, deaths in children and adolescents from chickenpox are down 97% here in the U.S. Canada and Australia have begun to adopt the vaccine. Perhaps soon Ireland will follow.

In the meantime, for those parents trying to avoid vaccination and considering the "chickenpox party" as a way to get your kids exposed early, good luck. I'll keep my fingers crossed that none of the kids at your party end up driving into the ravine.