Your questions about the varicella, or chicken pox, vaccine are a hot topic both among parents and pediatricians. In coming to a decision on whether to immunize your child against this, you must weigh the pros and cons.

First, I must tell you that the American Academy of Pediatrics has recommended that all children 15 months and older who have not gotten chicken pox receive the varicella vaccine. With that said, let me give you pros, cons, and my opinion:

PROS: While chicken pox is a relatively benign infection for most, there are children who develop complications from this. Occasionally, because of the pox being open to dirt and the scratching associated with them, the pox may become infected requiring anything from simple antibiotics by mouth to hospitalization for serious infections. In addition, rarely children get what is called post-varicella encephalitis which is infection of the brain requiring medication by vein and observation in the hospital. Some argue that although these complications are uncommon, they could be eliminated with the vaccine. The other aspect of this infection is financial. Fever and malaise last a few days, but the pox are considered infectious until they crust over. This means the child must stay out of daycare or school for a week or more. This can be quite a financial burden to some families when a parent has to stay at home to take care of the child.

CONS: This vaccine has been used for about the last ten years in Japan, and we now know those people are still immune to chicken pox. However, this does not guarantee immunity for life. Adults who get chicken pox have a much more severe course. Many end up in the hospital with severe pneumonia, and the risk of death due to these complications is much greater as an adult. Many pediatricians wonder if we're passing the burden of this disease to our internal medicine colleagues who will have a harder time fighting this infection. The company marketing the vaccine is following many patients closely to see if booster immunizations will be necessary, but getting adults in to be immunized has historically been much more difficult than children.

MY OPINION: If you, as a parent, would like to have your child immunized, I whole heartedly back your decision (and so does the American Academy of Pediatrics). My strategy, however, is to immunize any child who has not gotten chicken pox by 10 years of age. Under that age, if the child gets chicken pox, she will most likely not have complications and be immune for life. At age 10, however, her risk of complications is increasing, and I recommend immunization at that point. But you must keep in mind that those individuals will need to keep informed of possible need for revaccination as an adult. Ultimately, however, the chicken pox vaccine may be linked into a combined vaccine with the MMR (MMR-V) which will make it more difficult to abstain from this immunization.

The debate on this will continue among physicians, so I am sure you may get differing opinions from different individuals.