Despite the cost, the painful jab and the continuing debate over whether it's even necessary, the new chickenpox vaccine seems to be a hit among private pediatric practices in the Los Angeles area after just one month in circulation.
An informal polling shows that many doctors throughout Southern California are offering Varivax, approved in March by the Food and Drug Administration. At one busy Long Beach group practice, more than 300 children have been immunized.
But the vaccine won't land at Los Angeles County health clinics until at least the beginning of 1996, as officials clear several hurdles before offering the vaccine, which will be free to eligible children.
For now, families without affordable access to the vaccine "will have to hang tight," says Ed Boes, director of the L.A. County Department of Health Services Immunization Program. "This is typical of what happens when a new vaccine is licensed," he says. "There's a lag time."
Private physicians, meanwhile, are doing a brisk business.
The vaccine's popularity comes despite the fact that pediatricians are charging $55 to $80 for the injection--which costs them $39. Insurance coverage varies.
"Plans that cover other routine immunizations will probably cover this one as well," says Kathy Worthington of Aetna Health Plans, which recently announced plans to do so. At Kaiser Permanente, which expects to have the vaccine at all its health centers by month's end, members will be charged the usual co-payment, spokeswoman Kathleen Barco says.
The new vaccine is also covered by Medi-Cal, says Scott Lewis, spokesman for the California Department of Health Services.
But the vaccine's arrival is delayed at L.A. County health centers because the county must wait for the federal Centers for Disease Control and Prevention to issue policy guidelines on the vaccine, says Dr. Carol Peterson, a medical epidemiologist at the L.A. County Department of Health Services.
The vaccine is administered by the county through the Federal Vaccines for Children Program, which provides free immunizations to children without insurance coverage, those eligible for Medicaid, and Native Americans.
The recommendations are expected to be announced later this month by the CDC's Advisory Committee on Immunization Practices. But it may take six more months for the vaccine to reach the clinics because government officials have to first evaluate their needs and negotiate with the manufacturer, Merck Vaccine Division, Merck & Co. Inc.
Depending on the specific CDC recommendations, the potential pool of children 18 and younger who are eligible for the new vaccine could be about 5 million in California alone, estimates Lewis of the state health department.
In May, the American Academy of Pediatrics recommended the vaccine "for universal use in early childhood, and for immunization in susceptible older children and adolescents." Excluded from the recommendation are patients with compromised immune systems, children on steroid medication and other individuals.
According to the recommendations, a single dose should routinely be given between 12 and 18 months of age, at the same time as the child's first measles, mumps and rubella vaccination. Older children who have not had chickenpox may receive the vaccine "at the earliest convenient opportunity," according to the guidelines. (When the CDC advisory committee meets later this month, Dr. Jeffrey Davis, committee chairman, says he expects the recommendation to be "very similar" to the academy's.)
Chickenpox is highly contagious and is spread by direct contact or through the air. It is caused by varicella zoster virus.
Because chickenpox is usually mild and not life-threatening, some experts question whether it's better to be vaccinated--which might not result in lifelong immunity--or to let a child get chickenpox and have lifelong immunity.
Barbara Loe Fisher, director of the Virginia-based National Vaccine Information Center/Dissatisfied Parents Together, says, "Parents should be able to choose whether or not they want their children to be vaccinated and get a temporary immunity, which will probably require booster vaccinations throughout life, or have the natural disease and get permanent immunity for life."
Adds Dr. Antonio Arrieta, associate director of pediatric infectious diseases at Childrens Hospital of Orange County in Orange: "I abide by the recommendations [of the academy], but I have some concerns," he says. "By eradicating natural infection, we will be eradicating the natural ongoing booster [provided by repeated exposure within the community]."
If people who received the vaccine experienced decreased immunity over time, he says, "they would have a risk of being exposed at a later time, when it could be more serious."