Washington rates last for chickenpox shot

If the states were graded on a curve for chickenpox vaccination rates, Washington would get an F.

It ranks last among all states, with a 66.6 percent vaccination rate among 19- to 35-month-old children. In Spokane, the rate is even lower, with only a quarter of kids getting the vaccine in 2000. Experts say the reasons are numerous, ranging from slow acceptance of the vaccine among parents and doctors, to schools’ not requiring that students get the shot.

Idaho, with a 72.8 percent rate, ranks 37th in the nation. Connecticut held the top spot, with 93.2 percent of young children receiving the chickenpox vaccination.

The most recent figures are from a 2003 study conducted by the Centers for Disease Control and Prevention. The study is among the data compiled by the National Partnership for Immunization in a report card to be released in May. The nonprofit organization also looked at research studies and state statistics.

“We’ve made very rapid progress as a nation,” said David Neumann, executive director of the NPI. “We still have some distance to go.”

The largest factor influencing vaccination rates was whether a state required it for entry into a day care or school.

Washington is one of six states that do not require it, but the state Board of Health is in the process of changing that.

“It’s going to be required,” said Sofia Aragon, legislative liaison at the Washington Department of Health. “The question is how – how is the requirement going to look.”

Public health officials are debating at what level the requirement should be implemented: day care, kindergarten, middle school.

The ideal would be to require it for all ages, Aragon said, but limited resources don’t allow that at this time. The benefit of immunizing younger children is that they are more susceptible to diseases and already receive a host of other vaccinations, to which the varicella vaccine – as the chickenpox vaccine is called – could be added.

The benefit of immunizing middle schoolers is that they are at a higher risk of complications if they contract the disease in their adolescence or adulthood.

Cost is particularly an issue in Washington because the state provides all recommended vaccines free, said Kim Thorburn, health officer with the Spokane Regional Health District. Patients pay for the office visit or administrative fee, typically $10.

“Universal distribution is the best way for Washington to ensure high vaccine coverage rates,” Thorburn said. But, on the other hand, the state can’t afford every newly required vaccine.

Thorburn believes that a way to deal with the budgetary constraints is to prioritize which vaccines the state should fund. If it protects the individual and the public – like the varicella vaccine does – then it should be paid for by public funds. If it protects only the individual – like the tetanus vaccine – then it should be paid for by the individual.

Another reason Washington lags, Thorburn said, is that “there has been both physician and patient resistance to using the vaccine.”

Physicians were slow to accept it because chickenpox was a common disease with only rare complications.

Yet, 10 years after the vaccine made by Merck was introduced, its benefits have been documented, said NPI’s Neumann. Doubts about its effectiveness or whether it simply delays onset have been quelled by recent studies. Researchers are still studying when the best time is to administer the shot.

A CDC report published in February noted that between 1990-1994, there were 145 deaths per year nationally due to chickenpox. From 1999-2001, that number decreased to 66 deaths annually.

“It’s not a trivial number, particularly if it’s your child,” Neumann said. “This vaccine is effective, it’s reducing illness, it’s reducing hospitalizations and it’s saving lives.”

Potential complications of chickenpox include pneumonia; shingles, a blistering rash; and encephalitis, an inflammation of the brain.

Thorburn is not aware of any recent chickenpox-related deaths or hospitalizations in Spokane, but the disease is not among those that require reporting.

Spokane’s rate of chickenpox immunization is much lower than the state average. In 2000, only a quarter of children received the vaccine, Thorburn said. For the required vaccines, however, almost three-quarters of children were up to date with their shots.

Also contributing to the low number is that many Spokane children do not have a regular doctor, Thorburn said, so they fall through the cracks.

In addition, Washington allows for three types of exemptions from getting required or recommended vaccines: medical, religious and philosophical. Most states only allow exemptions based on medical reasons, and some allow for medical and religious.

“The ones that have all three (exemptions) tend to have the lowest immunization coverage rates,” Thorburn said. She attributes this to convenience on the part of parents: it’s easier for them to file a philosophical exemption than take their children to get the recommended shots.

Convenient or not, Neumann recommends that parents make the effort to immunize their children.

“With a safe and effective vaccine,” Neumann said, “there’s no reason for kids to run the risk for acquiring chickenpox and potentially requiring hospitalization.”