One more school prerequisite: A second shot for chickenpox

The look on Alena Tikalsky's face said it all: Needles hurt.

Alena, 5, couldn't help crying when a nurse gave her four shots during a check-up in Burnsville. But she came out of the clinic with four Bugs Bunny Band-Aids and a sticker, as well as the vaccinations she'll need to start kindergarten.

One of them, for chickenpox, is a new requirement for all Minnesota students entering kindergarten and seventh grade who don't have a legal exemption. Starting this year, they must show they've had two doses -- not just one -- in order to go to school.

For childless adults who grew up before the vaccine, it can be a surprise to learn that chickenpox, which can be deadly, is no longer a rite of passage for American kids. But since the Food and Drug Administration licensed the first chickenpox vaccine in 1995, the disease has become far less common than it was in the days when parents threw chickenpox parties in an attempt to get the ordeal over with for their children.

Even so, about 15 to 20 percent of people who have gotten one dose of the vaccine still get chickenpox if they're exposed to the virus that causes it, according to the Centers for Disease Control and Prevention. Medical experts say the second shot will cut down on those "breakthrough" cases.

"With any vaccine, once the vaccine is licensed and used, that's not the end of the story," said Kristen Ehresmann, director of the infectious disease division at the state Department of Health. "There's additional evaluation and assessment to look at its continued effectiveness ... out in the real world."

Breakthrough cases are usually mild, with fewer of the telltale itchy spots, but kids can still spread the disease and end up missing several days of school, often keeping parents home from work along with them, Ehresmann said.

A few Minnesota schools have had runs of chickenpox recently, including Pinewood Elementary in Eagan, which had more than 30 cases this year.

When the vaccine first became available, many parents questioned whether it was necessary to immunize their children against a disease that most survive.

"I don't think that people really consider that kids can die from chickenpox, but they can," said Ellen De Vries, a pediatrician at the Park Nicollet clinic in Burnsville.

For some people, chickenpox leads to serious complications such as bacterial infections, viral pneumonia, brain infections or even death. Before the vaccine, about 10,600 people were hospitalized and 100 to 150 died in the United States every year as a result of chickenpox, according to the CDC.

The federal Advisory Council on Immunization Practices has recommended a second dose of the vaccine since 2006, but the state Health Department has held off requiring it for Minnesota students until now because of a vaccine shortage, Ehresmann said.

The delay has given schools extra time to notify parents, and many clinics have already begun offering the second dose as a routine part of pediatric check-ups. That means many students have already gotten it, though several school nurses encouraged families to double-check their children's immunization records before clinics fill up with back-to-school appointments.

State law requires students be immunized against a host of diseases, from measles to polio to hepatitis B. The law allows kids to get a physician-signed exemption for medical reasons, and families who don't want their children immunized can instead submit a notarized conscientious objector statement. Students who have already had chickenpox don't need to get the vaccine, but they must document that they've had the disease.

Several metro-area school nurses said they don't expect an unusually large number of kids to show up on the first day of school without proper immunization forms as a result of the new requirement. Still, school districts such as Rosemount-Apple Valley-Eagan have redoubled their efforts to get the word out through newsletters and notes home to parents, said Jane Schleisman, the district's lead health services nurse. "I still feel like there are just a lot of people that don't know about it," she said.

Sarah Lemagie • 952-882-9016