Doctors renew push to require vaccination

5/3/2004

Dr. Dwight Powell got a reminder of what can happen in Ohio and other states that don't require childhood chicken pox vaccinations.

He took a call last week from a worried doctor north of Columbus whose patient contracted chicken pox shortly after giving birth. The mother had apparently caught the disease from her 5-year-old, one of many Ohio children who haven't been vaccinated against the disease.

Because chicken pox can be dangerous to infants, the baby was rushed to the children's hospital in Columbus for medication to ward off infection. Dr. Powell, chief of infectious diseases at Columbus Children's Hospital, said he doesn't know how the baby is doing but said it's more evidence of what happens when lax immunization laws and a sometimes dangerous disease mix.

He and other physicians are again pushing a bill introduced recently in an Ohio House of Representatives committee that would require all children entering school to be vaccinated against chicken pox. Ohio is one of seven states that doesn't mandate chicken pox vaccination. All states bordering Ohio require it, though West Virginia only mandates it for children in day care.

"We are a state that's way behind in immunizing against this disease," Dr. Powell said.

The vaccine was approved in 1995 and is recommended by the federal government and the American Academy of Pediatrics. Many children are vaccinated in Ohio and elsewhere, usually between 12 and 18 months of age.

But Ohio's lack of a mandatory vaccination requirement means an estimated 75 percent to 80 percent of Ohio children are now vaccinated, leaving 20 percent unprotected.

Chicken pox - which is extremely contagious - is considered by many parents, and even some physicians, to be a rite of passage during childhood. For most children who get chicken pox, it's nothing more than an annoying problem that keeps them home from school for a week or more.

But in a small number of children, the disease can be deadly. Before vaccinations became widespread, an estimated 100 people died annually from chicken pox in the United States and there were 11,000 hospitalizations. Dr. Powell said severe complications of chicken pox can be "horrific," with bacterial infections resulting, including the "flesh-eating" bacteria. Some of those secondary infections have become resistant to drug treatment.

Complications and deaths have fallen dramatically since 1995, but federal health authorities are investigating six chicken pox-related deaths in children.

The nation's top disease prevention authority, the federal Centers for Disease Control and Prevention, doesn't mince words when it comes to what states should do:

"We think it's particularly important that there be school laws [requiring vaccination]," said Dr. Rafael Harpaz, a chicken pox expert at the CDC.

"Without school entry laws, those 15 or 20 percent [of Ohio children] will grow to adulthood without being vaccinated and not having had the disease. Should any of those kids be exposed as adults, they may be in for a very rough time," he said.

Dr. Christopher Rizzo, a Cleveland pediatrician and president of the Ohio chapter of the American Academy of Pediatrics, agreed. He said Ohio is setting itself up for problems down the road if large numbers of adults grow up never being vaccinated because those who catch chicken pox as adults face a much higher risk of death or complications.

Jay Carey, an Ohio Department of Health spokesman, said the department supports mandatory chicken pox vaccinations "in concept, but we do have concerns about the funding."

Mr. Carey said with tight budgets it would be difficult for the state's safety net system to fund the extra expense of vaccines for children who can't afford them. He said it could cost up to $800,000 annually, an estimate Dr. Rizzo and Dr. Powell argue is a worst-case scenario and the real figure would likely be much lower.

The doctors added that the expense for the state in treating Medicaid patients or others who have chicken pox complications would wipe out any short-term cost savings in not vaccinating. Treating one child with chicken pox complications can run to $100,000 or more, Dr. Rizzo said.

The mandatory vaccination bill, which has been introduced and died in previous sessions, has been introduced this time by Rep. Courtney Combs (R, Hamilton). Mr. Combs said the bill "would bring us into conformity with the rest of the country and protect our children. We're hoping to get 95 percent coverage or better."

He said he hasn't heard any resistance, other than opposition from some groups who oppose all vaccinations out of fear that vaccinations could cause side effects. Dr. Powell said the vaccine is just as safe as the now-mandated measles, mumps, rubella (MMR) vaccine given to Ohio children. Every vaccine carries a slight risk of complications, but he feels it's not enough of a concern to prevent mandatory vaccination.

Rep. Lynn Olman (R, Maumee) said it's too early for him to decide the merits of the bill, but said this time around the bill has more generous "opt out" provisions for parents, meaning those who object to vaccinations for religious or other reasons can choose to not have their children vaccinated.

Contact Luke Shockman at: lshockman@theblade.com or 419-724-6084.