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One of my female patients has never had chicken pox and believes herself to be at risk when her young child inevitably develops the disease. She would like me to immunise her. May I charge her for this?

Department of Health recommendations with regard to active immunisation against varicella were set out on 4/12/03 in a CMO letter. The recommendation covers health care workers only at this stage. Since clinical and sub-clinical infections are very common, only 10 per cent of the population is estimated to be at risk of varicella infection. Blood should therefore be tested for immune status before immunisation.

Varicella infection can be serious in healthy adults, particularly pregnant women and those who smoke, as they are at risk of fulminating varicella pneumonia. For neonates and immuno-suppressed individuals, the risk of disseminated or haemorrhagic varicella is greatly increased. Fetal complications may be severe, particularly if contracted in the early stages of pregnancy or at the time of delivery.

The Green Book: Immunisation against Infectious Diseases contains further information on varicella. It recommends that live attenuated varicella vaccine should be considered for susceptible immuno-suppressed patients at long-term risk. (A new Green Book should be available in the next two to three months with updated advice).

The immunisation of a susceptible individual that you believe to be at high risk would probably be considered as part of your contractual obligation to the patient. The vaccine should then be obtained on an FP10 and administration should be covered under the global sum.

If you believe that the patient is not at high risk of infection, you may be prepared to provide the immunisation, on the basis that she has no demonstrable immunity on blood testing and is planning another pregnancy in the next year or so when her first child would be at high risk of infection. In this particular situation you would be permitted to charge for this as a private service, as it is not a public health measure that is currently recommended for such patients and is not therefore part of the service that a GP would normally be expected to provide under the new contract.

Further information is available in CMO letter annex 1 or from your local public health department.

Dr Christine Dewbury, Wessex LMCs

Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.

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