Stop Normalising Chickenpox: It’s Time Children Got The Full Shot — Dr Musa Mohd Nordin & Dr Zulkifli Ismail

When my neighbour’s healthy five-year-old caught “the usual rash” from a classmate, no one expected a week of high fevers, dehydration, and a frantic drive to the emergency room.

We have been conditioned to believe that varicella (chickenpox) is a harmless rite of passage. But that myth is costing Malaysian children their health, and it is long past time we addressed this with urgency.

For years, the burden of varicella in Malaysia has been dangerously underestimated. A Danish study recently revealed that the true impact of varicella is far higher than previously recorded when you account for primary care visits and indirect suffering.

We have no reason to believe Malaysia is exempt. The virus does not discriminate, but its consequences certainly do.

While many assume varicella is only severe in the immunocompromised, the data tells a different story: serious complications occur primarily in healthy children.

Those red spots can lead to infected sores, pneumonia, and even brain inflammation. And for the child undergoing chemotherapy or living with HIV, exposure to an unvaccinated peer can be lethal.

We are also sitting on a demographic time bomb. Studies show low seroprevalence of varicella antibodies among Malaysian young adults. This means a growing number of adults have never developed natural immunity.

When an infected child brings the virus home, it is the adult parent, who ends up bedridden with viral pneumonia or hepatitis. Varicella in adults is not merely uncomfortable; it is dangerous.

Then, there is the tragedy of Congenital Varicella Syndrome, where infection during pregnancy leads to limb deformities, brain damage, and eye defects in the newborn. This is entirely preventable.

Currently, the varicella vaccine in Malaysia is largely relegated to the private sector. The result? Vaccination is more likely among children whose parents have higher education, higher income, or medical knowledge.

In other words, we have created a two-tiered system where the rich can buy protection against severe disease, while lower-income families are left to “just catch it.”

This is not just a health gap; it is an ethical failure. The Quality Adjusted Life Year (QALY) losses from varicella — the time lost to suffering, scarring, missed school days, and parental leave — are significant.

We measure these costs in economic terms, but the real toll is measured in febrile seizures, sleepless nights, and preventable deaths.

Some worry that mass childhood vaccination might reduce natural boosting in the community, theoretically increasing adult shingles (herpes zoster) decades later.

But is it truly ethical to let millions of children suffer the acute consequences of varicella for 25 more years — including hospitalisations and deaths — based on a theoretical, manageable concern for adults? We have a safe zoster vaccine for the elderly.

What will it take to move the needle? Here are som reminders:

• Reminders for hesitant parents that a day of mild fever from a vaccine is vastly preferable to a week of open sores and the risk of brain swelling.
• Reminders for general practitioners to offer the vaccine at every well-child visit, not just when asked.
• Reminders for the Ministry of Health (MOH) that the World Health Organization (WHO) has long supported routine varicella vaccination where resources allow.

Countries like the United States, Germany, and Australia have dramatically reduced hospitalizations and deaths by making this vaccine routine. They did not wait for varicella to prove itself a killer. Neither should we.

We cannot continue to shrug at chickenpox as “just a childhood illness.” A preventable illness that hospitalises healthy children, devastates pregnant women, and kills immunocompromised kids is not harmless. It is a public health failure.

Let’s stop gambling with our children’s health. Add varicella vaccine to the National Immunisation Programme (NIP).

Until then, every parent who can afford the private shot should ask for it. And every doctor should recommend it, not as an optional luxury, but as the standard of care.

Because no child deserves to suffer from a disease we already know how to prevent.

Dr Musa Mohd Nordin and Dr Zulkifli Ismail are paediatricians.