As chair of the AAP Committee on Infectious Diseases (COID), I appreciate your support for childhood immunizations and your concerns regarding the need to assure the availability of resources to address other problems affecting children including injuries, guns, prematurity, etc. You note that the majority of children who become infected with rotavirus or varicella do not suffer serious consequences from these infections. However, these infections are not "harmless to the overwhelming majority" of children. Children with varicella develop an average of 300 skin lesions and are sick for five to seven days. Prior to the availability of vaccine, 150,000 to 250,000 complications occurred annually. Secondary bacterial infections of the skin occur commonly. Other more serious complications, including bacterial sepsis, necrotizing fasciitis, septic arthritis and encephalitis, result in approximately 10,000 hospitalizations each year in the United States. The risk of serious complications increases in adults where 1 in every 10 to 50 persons develops complications including severe pneumonia. Before the vaccine was available, about 100 deaths occurred each year in this country due to varicella. There is no predictor to identify which children with varicella will develop one of these complications.
The letter from Dr. Barry expresses some of the controversy that the Committee on Infectious Diseases had to reconcile in determining the role of acyclovir for the therapy of varicella in the otherwise healthy child. We indeed acknowledged the proven benefit of acyclovir therapy regarding a day less of fever and a decrease in the number of skin lesions in children treated within 24 hours of onset.