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Many adults remember the itchy spots of chickenpox (varicella) they had as children. They think that varicella is a mild illness and one that does not need to be prevented through vaccination. They wonder why children are not allowed to acquire natural infection. Even some health care providers are not convinced.

But chickenpox can be dangerous and even deadly. Before the introduction of the varicella vaccine in 1995, approximately 4 million cases of the disease were reported annually, including 4,000 to 9,000 hospitalizations and 100 deaths. While varicella is the greatest vaccine-preventable killer of children in the United States, only 26 percent of children ages 19 to 35 months old had received varicella vaccine by 1997.

Ninety percent of all varicella cases and approximately 60 percent of hospital- izations and 40 percent of deaths due to varicella occur in children younger than age 10. Today, the greatest incidence of varicella has shifted to younger children (ages 1 to 4, rather than ages 5 to 9), probably because of earlier exposure in preschool and child care settings.

In the first 3 months of 1998, three fatal cases of varicella in children were reported. All three children were unvaccinated. Failing to vaccinate young children for varicella is also a threat to adults who lack immunity. In 1997, three fatal cases of varicella in young adult women were reported. All three women had not been vaccinated for varicella and were infected by exposure to unvaccinated preschool-age children with the disease. Although fewer than 5 percent of cases of varicella occur in adults ages 20 and older, 55 percent of varicella-related deaths occur in this age group.

Studies have shown that the varicella vaccine is 85 percent effective in pre- venting disease. If a vaccinated person gets varicella, it is usually a very mild disease. The recommended strategy is to vaccinate children routinely at age 12 to 18 months and to provide "catch-up" vaccinations for older children, adolescents, and adults who have not been vaccinated. Studies show that immunity persists for more than 20 years after vaccination.

Furthermore, vaccination for varicella saves money. Cost studies indicate that $5.40 is saved for every $1 spent on varicella vaccination in children. This includes direct medical costs of varicella as well as the cost to society when children miss school and caregivers miss work to care for their sick children.

This week, National Infant Immunization Week, is a good time to focus on the importance of ensuring that all children are protected against chicken pox-as well as 10 other vaccine-preventable diseases: diphtheria, tetanus, pertussis (whooping cough), polio, measles, mumps, rubella, hepatitis B, and Hib meningitis.

Chickenpox, and the other vaccine-preventable diseases need not occur. All parents/caregivers should check with their health care providers to make sure their children's immunizations are up to date. If they do not have a regular health care provider, they can call the National Immunization Hotline at 1-800-232-2522 (English) or 1-800-232-0233 (Spanish) to find out where vaccinations are available.

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