Robin, an eighteen-year-old, came in for her college entrance physical examination. Mom had all of the paperwork ready--one of the forms wanted documentation of her immunizations. “I’m sure that she is all up to date,” mom said. “I fought them all the way, but my husband convinced me that she should have the immunizations. I sure didn’t like the idea.”
As I looked at her record chart I realized that Robin was missing one vaccine. It was her second Varivax, or chicken pox vaccine. I knew that this was not going to go over well with mom.
The Varivax was first licensed in the United States in 1995. The next year it became the standard of care to give the vaccine between 12 to 18 months of age. The vaccine was very successful in greatly decreasing the incidence of chicken pox in the United States. It had very little side effects. Robin was born in 1992. When it was time for her to enter kindergarten at five years of age it was required for school entrance. Her mom was very resistant. However, her dad talked her into it so that Robin could register for school. The youngster got the vaccine and did just fine.
Subsequent studies of the efficacy of the vaccine showed that, for those initial patients who received the vaccine, 79 percent were fully protected. The Japanese literature verified that with one vaccine the protection lasts 20 years. The United States literature suggested that the protection lasted for around 10 years. Because of this data, in 2005-to-2006 the Advisory Committee of Immunization Practices which sets the immunization policies for the United States revised their recommendations.
The new endorsement calls for two Varivax shots. The first is to be given between 12-to-18 month of age, and the second one between 4-to-5 years of age. The second vaccine is to pick up those who were not fully protected with the first. It was also recommended to give a second vaccine to anyone who had received only one regardless of the age. Robin fell into this category. She did get the first vaccine for kindergarten entrance in 1997, but was already in school when the revised recommendations were made in 2006.
Needless to say, Robin’s mom was less than thrilled when I explained this. “No way,” she emphatically said. “I’ll take my chances that she is in the 79% group that is protected. These are pretty good odds.”
There was just one problem. The form that Robin had for college wanted documentation that she had received two Varivax shots, or verification that she had actual chicken pox.
Sensing that giving Robin another Varivax shot would be a less than popular choice, or at best a hard sell, I told mom that we had two options. We could give her another Varivax and be done with the whole matter, or we could do a blood test to see if she was fully protected. I explained to them that there is a blood test that measures the antibodies against the chicken pox virus. When one gets chicken pox, or receives the vaccine and is protected, the level of IgG immunoglobulin in the body is elevated. It is this immunoglobulin that protects one from getting the virus again. This required a simple blood draw, and the actual cost of the test is less than the vaccine itself. I asked Robin what she would like to do. She was not particularly thrilled about either option but at the urging of mom, she opted for the blood test.
The results came back in two days. It showed that Robin had an elevated IgG and was fully protected, I filled out her paperwork and both Robin and mom were pleased.
The vaccine has been very successful in preventing chicken pox. People often ask about the contraindications to the vaccine. In other words, who should NOT RECEIVE THE VACCINE? These are very few and include people with a compromised immune system, pregnant women, people with allergies to gelatin or Neomycin, people on steroids, cancer patients who are receiving chemotherapy, or people who have received blood products within the previous five months.