What You Need to Know:
Kentucky Governor and father, Matt Bevin made headlines last week when he stated in an interview that he purposely chose to expose all nine of his children to varicella-zoster (chickenpox) for natural immunity, rather than having them vaccinated. Governor Bevin is not alone in his choice to avoid the vaccine. The percentage of children aged two and under who are unvaccinated has quadrupled over the past 17 years. Currently, 18 states permit parents to decline immunizations for their children, which has lead to an increase in preventable disease outbreaks, including chickenpox. Data from 2017 also demonstrates an increase in the number of kindergarteners who were exempt from immunizations (2.2%) based on nonmedical (religious or philosophical), or medical reasons, which is raising concern among health officials, clinicians, and school districts.
Prior to the availability of varicella vaccine in the U.S., there were approximately 100 deaths and 11,000 hospitalizations annually, which are now preventable. Yet, there is a subset of the population that does not have their children immunized for a variety of reasons. One of the main reasons cited for not vaccinating children is concern over the vaccine's safety profile. The varicella-zoster vaccine has been proven safe, even in high risk groups, including pediatric and juvenile patients with autoimmune diseases, HIV, and organ transplantation. Another possible barrier to vaccination is lack of knowledge about the free Vaccines for Children program in the U.S. for those who are uninsured and/or unable to pay. Others may choose not to vaccinate their children because they believe the government should not mandate such actions, or they believe natural immunity is preferable to acquired immunity. Some consciously choose to abstain from vaccines based on religious convictions.
Motivations for Vaccination
There are three main reasons to get vaccinated and avoid chickenpox altogether. First, anyone who contracts chickenpox may be at risk for serious complications including dehydration, bacterial infections of the bones, joints, bloodstream, soft tissues, and skin, pneumonia, encephalitis, toxic shock syndrome, Reye’s syndrome, and death. High risk groups such as infants, elderly, and persons with weakened immune systems are even more likely to develop life-threatening complications. Second, chickenpox is highly contagious and is easily spread in the community by direct or droplet contact. Persons who are not immunized are at greater risk of contracting chickenpox. Third, when a person recovers from chickenpox the virus remains dormant in nerve cells and may reappear as the person ages and the immune system weakens, in the form of herpes zoster (shingles). Shingles causes a painful rash that can appear anywhere on the body and may have complications such as postherpetic neuralgia, vision loss, pneumonia, hearing difficulty, encephalitis, or death.
Read more about Varicella-Zoster (Chickenpox):
Harrison’s Principles of Internal Medicine, 20e: Chapter 188. Varicella-Zoster Virus Infections
The Color Atlas and Synopsis of Family Medicine, 3e: Chapter 129. Chickenpox
Hazzard’s Geriatric Medicine and Gerontology, 7e: Chapter 3. Immunology of Aging