~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This message is from PedTalk! To reply to the group, use "" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This discussion is really going off track. The issue is not just one of money, although the costs of varicella are incredible. I used to argue that it was better for small children to get varicella than older kids, because missing a week of preschool is no big deal. I have changed my mind after reviewing the facts. On the lesser issue of financial costs, children who have varicella require a caretaker. That often must be a parent who has to take time off work -- costing them money or sick leave, and costing their employer productivity. The money adds up quickly. I know this from personal experience as well. My child had varicella twice, once at 9 months and once at 2 years, both times while I was in residency and money was tight. (Incidentally, it is not unusual for a child to have a second attack when the first came prior to their first birthday.) The larger issue, though, is the disease. The risks are not minimal. Children do get bacterial superinfections, varicella pneumonia, and even die from the disease. The 1997 Red Book does not recommend the vaccine based solely on money: "Vaccine for universal use in early childhood and immunization in susceptible older children and adolescents is recomended based on the frequency of serious complications and deaths after infection with wild varicella, the excess cost to the family and society incurred by varicella infection, and the efficacy and safety of the live-attenuated varicella vaccine." (Committee on Infectious Diseases, American Academy of Pediatrics, 1997 Red Book, 582.) The CID is not always right, but it's important at least to give them credit for looking at the whole issue. Andrew M. Eisen, MD Assistant Professor of Pediatrics University of Nevada School of Medicine