I am a 35-year-old female wondering if I should get the varicella vaccine. My mother doesn't think I had chickenpox as a child. When I was 24, I had a varicella titer that showed I had "borderline immunity." I have a seven-year-old daughter who has never had the vaccine either. I work in a patient-care area of a hospital as a secretary. Do you think I should get a varicella vaccine? Since I'm an adult, could I have a reaction to the vaccine that might be just as severe as getting the disease? I am a little hesitant because when I received the rubella vaccine at age 20 I became quite ill with a fever and swollen lymph nodes. My doctor says it doesn't matter whether I get vaccinated, but our pediatrician wants me to. I am very confused.

Maureen

Between 3 million and 4 million people develop varicella (chickenpox) each year in the United States alone. It is usually a harmless childhood disease that gets better on its own. However, the infection can have many important consequences. The varicella virus, reactivating later in life, causes shingles, a painful blistering rash on the trunk or face. In rare cases, children with chickenpox can develop serious complications, including pneumonia, encephalitis (brain infection) or hepatitis (liver infection). Another complication is serious strep infection of the skin developing at the site of one of the blisters. When adults get varicella, the complication rate is much higher. Pneumonia is much more common in adults and can be especially deadly in pregnant women. In addition, if a woman develops varicella near the time of delivery, she may pass it to her newborn, who then has a high risk of serious, even fatal disease.

In addition to the medical complications, the virus causes a great financial burden. As many as half a million physician visits each year are due to the disease. The amount of lost wages for the parents of ill children is staggering. Because of the economic implications and the occasional complications, researchers developed a vaccine to prevent varicella. This vaccine contains weakened but still "living" virus, and it is very effective, somewhat more so in children than in adults. It is approved for use in all children, and most babies today receive it.

There is still some controversy regarding the vaccine, however. Some feel that if the vaccine is given to every baby, and if its effectiveness wanes over the years, then many adults of that generation will be susceptible to the virus. Since the disease is much more severe in adults than in children, that would lead to more-serious infections in the long run.

What should you do? I think you should definitely consider the vaccine. Since you work in a hospital, you will be exposed to the virus and are at risk of exposing others, including the immune-compromised, who are particularly susceptible to the infection. (The only contraindication to the vaccine is if you have a serious immune deficiency such as AIDS.) If I were you, I would first be tested again to look for antibody to varicella. If the test is positive, then you have had chickenpox and are immune to further infection. In that case, you would not need the vaccine. If your test is negative, I would get the shot. (In fact, I was in this situation, as I had never had chickenpox either. I chose to get vaccinated.)

I would not worry too much about the side effects of the vaccine. I do not know why you may have had a reaction to the rubella vaccine, but I don't think it puts you at increased risk for reactions to this vaccine. You certainly should not expect a reaction to be anywhere near as severe as getting varicella. The most common side effects are fever and a few small blisters on the skin.