For many parents and children, vaccines are a routine part of visits to the doctor. The alcohol swab. The shot. The tears. The bandage.

But there are stories about childhood vaccines that are anything but routine. A state legislator and a doctor both have such stories to tell. Each of these stories is about a child who suffered a severe illness, and each illustrates the complexity of an issue now before state health officials: whether to require all Illinois schoolchildren to get the varicella vaccination to ward off chickenpox. Yet this question is just the latest in a much larger debate: whether parents or public officials should have ultimate responsibility for deciding which immunizations children must get.

Dr. N. Akhtar's story speaks to the suffering vaccinations are designed to prevent. It's about a 4-year-old boy who visited her Downers Grove practice a few years ago with a case of chickenpox. The boy had not gotten the varicella vaccination and he had the itchy lumps and fever that mark the disease. But instead of getting better in about a week as most children with chickenpox do, the boy contracted a skin infection, which led in turn to a severe bone infection.

The boy had to be hospitalized for two weeks and endure six weeks of intravenous antibiotics at home. "It was very traumatic for the child," Akhtar says, adding that the resultant scarring likely will be permanent. "You see one of those cases and you feel one is enough. There is no reason for children to go through this. And you never know which child will be the unlucky one who will get sick with horrible complications."

Akhtar has had a private practice for 11 years and is not involved in the public debate over the vaccine. In fact, she says she was skeptical in 1995 when the drug first came out in the United States. "I have the same issues with any new vaccine," she says. "I was a little concerned about how safe it would be, how long the immunity would last and how it would help children. Now it is routine."

Patrick O'Malley, a Republican state senator from Palos Park, has a compelling story, too. It's about his daughter. At six months of age, Brigid received the standard DTP vaccine for diphtheria, tetanus and pertussis (whooping cough). But O'Malley says he and his wife wish the doctor had told them about potential side effects before administering the shot. Brigid later suffered an episode, that O'Malley describes this way: "She stopped breathing and had to be brought back to life." She also suffered violent seizures for the next six years. These complications led to cerebral palsy. And today, Brigid can't speak or care for herself. O'Malley says doctors linked the vaccine to his daughter's illness.

He's a little reluctant to share his story because he doesn't want his daughter, who is now 24, to be pitied, but O'Malley says it's the foundation of his belief that parents should decide whether and when their children are vaccinated. "I'm sorry this happened for Brigid's sake," he says. "She's nothing but goodness and kindness. She gives us so much. She's my inspiration. I know the current system isn't working. I'm for parents making the decisions. I trust loving parents to make responsible decisions about the health of their children."

These two scenarios illustrate the seriousness of the questions Illinois public health officials face this fall as they consider whether to send lawmakers a panel's recommendation to add chickenpox to the list of required childhood vaccinations. If approved, the chickenpox vaccine could be required by the 2001-2002 school year.

Illinois children already are required to get 18 vaccinations against nine diseases: diphtheria, whooping cough, tetanus, polio, measles, mumps, German measles, the haemophilus influenzae type B infections and hepatitis B. Without vaccinations -- or religious or medical exemptions -- children can't enroll in school. And their parents can face neglect charges.

The debate during the mid-'90s over the hepatitis B shot, the last vaccine put on Illinois' mandatory list,

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The chickenpox vaccine is the first the panel has had to consider. In April, it recommended that the drug be required for school-age children. This month, the Illinois Department of Public Health's Board of Health is expected to discuss the vaccine and information gathered during the hearings. Director John Lumpkin will then review the recommendation and decide whether to send it to a joint committee of the legislature. Lumpkin, who has said he favors the vaccine, says he's remaining open-minded on new information. The nod from the legislature would be the final step before the vaccine could be placed on the mandated list.

Proponents argue such a decision would arm public health with a crucial weapon against what can be a deadly disease. "We believe if there is a vaccine that can prevent disease and death among children, it should be a requirement for children to enter school," says state public health spokesman Tom Schafer. "Death and suffering has been tremendously impacted by the immunization program and vaccines have proven to be safe."

The case of polio is a dramatic illustration of his point. Prior to Dr. Jonas Salk's 1954 development of a vaccine, children were struck in epidemic porportions by the crippling and potentially deadly disease. There were 4,000 cases of polio in Illinois in 1952 before the vaccine was distributed. Since 1983, Illinois hasn't had a single case.

As for chickenpox, the number of Illinois cases has dropped dramat-ically since that vaccine became available. State health department figures show there were 24,798 cases of the disease reported in 1995. The number dropped to 13,843 in 1999.

Proponents argue, too, that the risk associated with the chickenpox vaccine is low. In uncontrolled clinical trials of 8,900 healthy children ages 1 to 12 years, 14.7 percent developed a fever. Another 19.3 percent had complaints about the injection site. "As public officials, we have to look at the overall good the vaccines do," says department spokesman Schafer.

That theory doesn't wash with O'Malley, whose experience provides another view of vaccinations. "I don't think a compelling argument has been made that some greater social good will happen by forcing every child to get this vaccination," he says. "The idea that this is a lottery game should be repugnant to anyone."

If Illinois makes the chickenpox vaccine a requirement, it will become the 24th state to do so, according to the National Conference of State Legislatures, which tracks state laws and regulations. Among the 23 states, Arkansas, Colorado, Connecticut, Georgia, Oregon, Rhode Island, South Dakota and Texas require the vaccine for entry to school this year. Washington, D.C., also has such a regulation. Overseas, the chickenpox vaccine has been in use for more than 20 years in Japan, where it was developed in 1974, and it is widely used in Europe.

The debate over vaccines in the states most often has centered on finances, says Lisa Speissegger, public health analyst for the policy tracking group. "Once a vaccine is required, you have to provide funding for those who can't pay for it," she says. "Because it is so expensive, we are talking about a significant budget item."

Vaccines are expensive because they must be stored at specific temperatures and kept away from light. Doctors in private practice are likely to pay more for the drugs because they don't buy them in bulk. But the price for public agencies can be steep, too. Government contract prices for vaccines vary from $9 a shot for the hepatitis B vaccine to $37.14 for the chickenpox vaccine, according the Illinois health department.

While federal programs would provide immunizations for the uninsured, the state would have to spend $1.5 million to $2 million to cover the cost of vaccines for underinsured children.

Chickenpox is highly contagious with 95 percent of Americans getting the disease by adulthood. There are about four million cases in the United States each year, according to the Centers for Disease Control and Prevention, a federal agency. The group reports there are 4,000 to 9,000 hospitalizations each year and 100 deaths. Symptoms appear about two weeks after exposure. Because it is contagious two days before the rash appears, children expose each other to the disease before they know they have it.

Symptoms include 300 to 400 itchy lesions, a fever of up to 104 degrees and fatigue. The vaccine, which can be administered after a child turns 1, is 85 percent effective in preventing the disease. Children who do get chickenpox after being inoculated suffer a very light case of it. And those vaccinated shortly after being exposed reduce their risk of contracting the disease or suffer a much milder case.

It is not yet known whether a booster is required -- something that also worries critics because adults who contract chickenpox suffer from more complications than children do. Dr. Mark Rosenberg, a Barrington-based pediatrician for 22 years who sits on the state's advisory committee, says that should not be a reason for people to skip the vaccine. If people need a booster later, they can simply get another shot. The benefits of the vaccine are overwhelming, he says.

"The shots are protecting children from a number of horrible diseases at a time when their immune system is underdeveloped," he says, adding that he believes there would be less debate about the good of vaccines if more

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He also argues the benefits of the chickenpox vaccine for parents and schools. "In this society, roughly two-thirds of families have two working parents," he says. "It is a great benefit to those families to keep from missing a week of work and school."

But Dr. Linda Shelton sees the issue another way. The Evergreen Park pediatrician says that convenience isn't enough reason to force children to have the vaccine. To her, requiring the inoculation tramples on parents' rights to decide what medical care is best. "I don't believe we should suspend our civil rights when chickenpox is a common childhood illness that generally is only an inconvenience to parents. The chance of severe illness doesn't warrant suspending civil rights. This is not a great epidemic," says Shelton, who has been a doctor since 1987.

Although she is opposed to making the vaccine mandatory, she does recommend it to teens who haven't contracted chickenpox and to children, such as those with cancer, who may be more susceptible to complications.

Meanwhile, Barbara Alexander Mullarkey, spokeswoman for the Oak Park-based Illinois Vaccine Awareness Coalition, says doctors should be required to better educate their patients about the side effects of vaccines.

Mullarkey, like Shelton, is critical of the new advisory committee.

Both think more public comment should have been allowed at meetings, where speakers were limited to three minutes. And they believe the group, the makeup of which is determined by state statute, should include more people from outside the medical profession. They would also stipulate that panel members should not be able to profit from their recommendations. They worry, for example, that some committee members could have stock in a drug company that makes the vaccine.

The health department's Schafer responds that, as an advisory committee, the group's recommendation is not the final word. "There is the check and balance of the legislature," he says.

It appears likely the joint legislative group will take up the chickenpox vaccine issue later this year. Once it weighs the financial impact, suggests Speissegger of the National Conference of State Legislatures, Illinois lawmakers are likely to debate what has been the crux of the argument in other states: weighing parents' rights against the need to reduce the disease. It won't be an easy question. "Something like the chickenpox, people see as benign," she says. "On the other hand, kids die of it every year."

Kristy Kennedy is a free-lance writer who previously covered DuPage County for the Daily Herald, a suburban metro newspaper. Her most recent piece for Illinois Issues, "Corporate migration," appeared in April.

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