Thanks!

I saw a kid with chickenpox. This isn’t that unusual, as I’m a pediatrician and an infectious diseases specialist. Pediatricians have been coming home and saying “I saw a kid with chickenpox,” to their spouses for a long, long time. It’s less common now, because we have a safe, effective vaccine that prevents infection with varicella, the virus that causes chickenpox. Children get two shots — the first at 12 months and the second at least three months later. In exchange for this, they get lifelong immunity against a disease that used to affect essentially all kids.

There are a reasonable number of people, some pediatricians included, who think that the varicella vaccine is superfluous. Why give a shot to prevent something that we all had as kids? After all, it didn’t kill us, right? Well, before the vaccine was licensed in the United States, there were about 11,000 hospitalizations and 100 deaths per year due to chickenpox. These are relatively small numbers when compared to the size of any year’s birth cohort, though that calculus changes pretty drastically if your kid is one of the 100. The vaccine has drastically decreased these numbers, though there are still cases, including severe ones. These may occur among immune compromised people, children who are too young to have received the vaccine, or those whose parents or pediatrician decided to forgo this protection.

Which brings us to the kid I saw. She was a beautiful two year-old with the classic dots of chicken pox studding her pale skin. They had passed the “dew drop on a rose petal” phase and were crusted over already, indicating that her immune system had the virus pretty well under control. What was less under control was the Streptococcus bacteria that had taken advantage of her damaged skin barrier to invade first the soft tissues of her neck and later her bloodstream. That’s why we met in the intensive care unit, where a ventilator did her breathing, where Sharpie lines on her skin demarcated the spread of her infection since her arrival, and where her father told me that she was up to date on her vaccines. It was just that her pediatrician didn’t give her the chickenpox shot at the 1 year-old visit.

When you sign up to be a pediatrician, you agree to sometimes argue with parents, to push and cajole and manipulate so that parents trust that, yes, even though the grandmother says to put the newborn baby on her stomach to sleep that it really truly is safer on the back. We ask questions about car seats and smoke alarms and guns in the house, all in the name of preventing tragedy. There are so many things that we can’t vaccinate our patients against. If I had a child abuse vaccine, a car crash vaccine, a heartbreak vaccine — I would use them all. It turns out that we only have a handful. So why, then, was I picking up the pieces of this family whose daughter was fighting bravely against one of the few things that we actually know how to prevent?