Physicians and health officials agree: It's a good idea to get your child immunized against chicken pox, even though researchers don't yet know how long the vaccine will be effective.
But getting access to the year-old vaccine is proving to be a problem for parents in the Augusta area.
None of the health departments in Aiken, Burke, Columbia or Richmond counties offers the vaccine, and getting the shot through a private doctor's office can be expensive. After factoring in the cost of an office visit and an "injection fee," a single dose can cost as much as $100, an expense most insurance companies don't cover.
"I suspect that there are a lot of parents out there who would get their child vaccinated, but just don't know where to go or can't afford it," said Carol Heebner, a pediatrician and an assistant professor at the University of South Carolina School of Medicine in Columbia.
Varicella, the medical name for the common childhood disease, has long been treated as little more than a nuisance by many parents. In fact, some parents have deliberately exposed their children to an infected child to "go ahead and get it over with." After a week of rashes, fever, lethargy and itchiness, most children recover quickly, never to suffer from the disease again.
But out of the estimated 4 million annual cases of chicken pox in the United States, about 4,500 children develop complications serious enough to require a hospital stay and about 100 children die from the disease, according to the Atlanta-based Centers for Disease Control and Prevention.
Although the disease is its own immunization for most people, it can come back to haunt its victims later in life. About 400,000 adults each year develop zoster, or "shingles," a recurring, painful skin rash.
The disease is particularly dangerous to people whose immune systems are compromised, such as people with AIDS, cancer, or any other serious illness. It can also impair the development of an unborn baby if its mother is exposed to an infected person.
The vaccine, which has been used in a slightly altered form in Europe and Japan for more than a decade, is designed to prevent those complications, as well as avoiding the need for a parent to miss a week of work to tend to a feverish, itchy child.
But although the Food and Drug Administration approved the vaccine a year ago, it has only recently been listed on the federal register for immunizations, which provides for low-cost or free immunizations for diseases such as polio, tetanus, rubella and mumps.
That is one of the reasons area health departments - which immunize most school children - do not carry the vaccine.
"It's not on the (federal and state list), so we would have to pay for it out of pocket," said Leslie Mills, who supervises the immunization program for Richmond and 12 other counties.
Another problem for health departments is storage and transportation. The vaccine must be shipped on dry ice and stored below 5 degrees Fahrenheit. The vaccine comes in one-dose vials that must be injected within 30 minutes after being thawed. Because not all health departments have freezers that can store the vaccine, some counties will not offer the vaccine when it is added to the state list at the beginning of next year.
"It's a difficult vaccine to work with for the health departments, who like to do things on a large scale. It just doesn't lend itself to mass vaccinations like oral polio or other vaccines," said William S. Foshee, a pediatrician with University Hospital and Medical College of Georgia.
Some parents might continue to eschew the vaccine, even when it does become available at a lower cost, because long-term research hasn't been completed.
Researchers say it is possible the vaccine could lose its effectiveness as the immunized children reach adulthood, exposing them to the risk of contracting the disease then. Adults who have not had the disease when they were young often have a stronger, sometimes fatal, reaction.
"It may turn out that we will have to develop some sort of booster down the road, but that's not a big problem," Dr. Foshee said. "I would give it to my children."
Varivax, the chicken pox vaccine approved by the FDA last year, contains a weakened form of the live varicella virus. Ideally, the vaccine causes an extremely mild case of the disease without side effects, although some children will develop a rash and fever for a few days.
The Medical College of Georgia, University Hospital and a few private doctors' offices carry the vaccine. It will be available on a limited basis in public health clinics beginning next year, but will not be required for school admission.