Thrombolysis in patients with diabetes

and acyclovir.While these children and their parents may desire the increased protection of community immunity, the increased risks that such immunity entails for otherwise healthy children cannot be justified.The costs of chickenpox infection are partly the medical expenses and partly the days of work lost among families.The medical expenses are generally low.Studies have shown that universal chickenpox immunisation is not cost effective in terms of health costs alone.78These studies may even underestimate the costs, because they do not account for the possible increase in costs if universal immunisation delays disease until adulthood.The cost of days of work lost by parents because of their children's chickenpox is substantial, and universal chicken- pox immunisation would probably be cost effective from this angle.89A large part of the cost, however, is due to policies of isolation.We believe that this cost is avoidable; if it was avoided this might tip the balance of the cost-benefit studies against universal chickenpox immunisation.Children should not have to stay home while asymptomatic but still capable of transmitting the disease.This policy, which is justifiable primarily on the basis of its benefit to immunocompromised children, in fact offers such children false security since they are still exposed to children who are presymptomatic but are capable of transmitting the disease.The best way to protect immunocompromised children is to immunise them, not all their peers.A policy of mandatory universal immunisation would be justified only if the benefits of participation for each indivi- dual outweighed the risks and costs.Given the mild course of chickenpox in healthy children, such a policy is not justified.Chickenpox immunisation should be recommended only to families in which one or more members are at high risk of serious infection.