Editorials

Immunisation against chickenpox

BMJ 1995; 310 doi: http://dx.doi.org/10.1136/bmj.310.6971.2 (Published 07 January 1995) Cite this as: BMJ 1995;310:2
  1. Lainie Friedman Ross,
  2. John D Lantos
  1. Assistant professor of paediatrics MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois 60637, USA
  2. Associate professor of paediatrics Department of Paediatrics, La Rabida Children's Hospital, Chicago, Illinois 60649, USA

    Better to confine immunisation to those at high risk

    There are three main arguments for universal immunisation against chickenpox in childhood. Firstly, immunisation is good for the children who are immunised; secondly, it is good for immunocompromised children, who will be protected from exposure to children with chickenpox; and, finally, it is cost effective because fewer parents need to take time off to take care of children with chickenpox. In our view, these arguments are not powerful enough to justify universal immunisation.

    The natural course of chickenpox is well defined. Most reported cases occur in children under 10, who usually develop a vesicular rash that erupts in clusters and scabs over one week and causes troublesome itching. It is often associated with mild fever and other systemic symptoms. In older patients pneumonia is the most common complication, but bacterial superinfection, meningoencephalitis, and glomerulonephritis may also occur. Death or long term illness from primary chickenpox in immunocompetent children is exceedingly rare. At present, then, chickenpox is a benign illness.

    Chickenpox in adults may be much more severe. During the first two trimesters of pregnancy it may result in chickenpox embryopathy. In the last trimester it may result in …

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