Chickenpox: To Vaccinate or Not?

MOTHERING

DR. GREENE

KIDSHEALTH.ORG

CENTER FOR DISEASE CONTROL

CBS

• 

  ANTI VACCINE: Mothering "Chickenpox Party: Developing Natural Varicella Immunity"

  "Whoopee!" When word got out that little George's cousin Natalie had chickenpox, the playgroup phone tree lit up with the jubilant consensus: "Chickenpox party!"

  It sounds cruel and unusual to subject one's child to a biological sneak attack. But [....] we'd done our homework. On the kitchen table was a stack of clinical studies citing the pros, cons, dos, and don'ts of catching wild chickenpox in the company of friends. Admittedly, we mommies and daddies were not caught in the mainstream with this somewhat rebellious act. Today's conventional wisdom says to go with the shot, which many parents do "to be on the safe side."

  Varivax, the varicella vaccine manufactured by Merck, was approved by the FDA in 1995. The latest Centers for Disease Control (CDC) reports estimate that 75 percent of the nation's children have been vaccinated with it. They credit the vaccine with a significant statistical drop in the number of chickenpox cases reported, and they have stacks of studies to back up their claim.

  While the CDC estimates the vaccine to be 86 percent effective in children, a 2001 CDC study showed that that effectiveness might actually be as low as 40 percent.

  Nor, perhaps, is the vaccine as safe as advertised. ...read the full article

  "Whoopee!" When word got out that little George's cousin Natalie had chickenpox, the playgroup phone tree lit up with the jubilant consensus: "Chickenpox party!"

  It sounds cruel and unusual to subject one's child to a biological sneak attack. But [....] we'd done our homework. On the kitchen table was a stack of clinical studies citing the pros, cons, dos, and don'ts of catching wild chickenpox in the company of friends. Admittedly, we mommies and daddies were not caught in the mainstream with this somewhat rebellious act. Today's conventional wisdom says to go with the shot, which many parents do "to be on the safe side."

  Varivax, the varicella vaccine manufactured by Merck, was approved by the FDA in 1995. The latest Centers for Disease Control (CDC) reports estimate that 75 percent of the nation's children have been vaccinated with it. They credit the vaccine with a significant statistical drop in the number of chickenpox cases reported, and they have stacks of studies to back up their claim.

  While the CDC estimates the vaccine to be 86 percent effective in children, a 2001 CDC study showed that that effectiveness might actually be as low as 40 percent.

  Nor, perhaps, is the vaccine as safe as advertised.

  This is not to say that wild chickenpox is entirely benign. The CDC estimates that the 4 million annual cases result in 11,000 hospitalizations and 100 deaths every year. The risk of death from chickenpox complications in healthy children is quite minimal. However, the CDC contends that chickenpox is the leading "vaccine-preventable" killer of children, and many clinical studies have been published attesting to the vaccine's safety and efficacy.

  Critics of vaccines say that catching the wild version can mean the difference between temporary and lifelong immunity. According to Merck's literature, "the duration of protection of Varivax is unknown at present."

  Dr. Arthur Lavin, a pediatrician at St. Luke's Medical Center in Cleveland , agrees, writing in The Lancet that routine varicella vaccination in healthy children might pose a "grave danger of advancing the age of onset of chickenpox into adulthood." We were able to witness this firsthand. Luka's uncle Damir, 32, caught chickenpox in the wake of our party. While all the kids had mild responses, Damir got the worst case his doctor had ever seen: hundreds of lesions, even in his mouth and down his throat; headache; and tender kidneys.

  But we at the party knew [of all the potential risks]. Our children were all healthy. None had asthma or leukemia (that we knew of), and no one was on steroids. Nor were we planning to give anyone Tylenol, aspirin, or NSAIDS of any kind. It was our belief that, given the correct circumstances, what we were doing was acceptably safe, rationally prudent, and would give our children a lifetime of immunity to a disease that could be dangerous in adulthood. click to close

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  MIDDLE GROUND: Dr. Greene "Chickenpox Vaccine"

  When deciding upon any immunization, it is wise to consider both the risks versus benefits of the vaccine and the risks versus benefits of not receiving the vaccine. Children who do not get the vaccine are likely to develop chickenpox. This common viral infection is usually mild and not life-threatening. Although these children may be miserable for several days, and miss a week of school or day care (stranding parents at home), they will likely recover from the 250-500 itchy blisters with nothing more to show for it than a few small scars. Each year, however, about 200,000 of the millions of people who contract chickenpox become seriously ill with complications such as pneumonia or encephalitis (inflammation of the brain). About 2,000 of these die. Those who are at higher risk for complications include those with an already weak immune system, those with eczema or other skin conditions, adolescents, and adults.

  Adults who get chicken pox usually have a much more severe, prolonged case than children. Pneumonia is common. The rate of hospitalization for chickenpox is almost 900 percent higher in adults than in children. Adults are more than 20 times more likely to die from this disease. Pregnant women face the additional fear of serious, even fatal, damage to the baby developing within. Clearly it is beneficial to prevent chickenpox in adults. ...read the full article

  When deciding upon any immunization, it is wise to consider both the risks versus benefits of the vaccine and the risks versus benefits of not receiving the vaccine. Children who do not get the vaccine are likely to develop chickenpox. This common viral infection is usually mild and not life-threatening. Although these children may be miserable for several days, and miss a week of school or day care (stranding parents at home), they will likely recover from the 250-500 itchy blisters with nothing more to show for it than a few small scars. Each year, however, about 200,000 of the millions of people who contract chickenpox become seriously ill with complications such as pneumonia or encephalitis (inflammation of the brain). About 2,000 of these die. Those who are at higher risk for complications include those with an already weak immune system, those with eczema or other skin conditions, adolescents, and adults.

  Adults who get chicken pox usually have a much more severe, prolonged case than children. Pneumonia is common. The rate of hospitalization for chickenpox is almost 900 percent higher in adults than in children. Adults are more than 20 times more likely to die from this disease. Pregnant women face the additional fear of serious, even fatal, damage to the baby developing within. Clearly it is beneficial to prevent chickenpox in adults.

  In the recent past, the primary benefit of getting chickenpox as a child was the likelihood of attaining lifetime immunity. [...] This may now be changing in areas where the chickenpox vaccine is common. In the past, multiple re-exposures helped to keep people's immunity high. Since the vaccine is now standard in the United States, the frequency of the natural disease should decline. Those who have had chickenpox as children will not be re-exposed as often, if at all. Their immunity may wane over time, making shingles and adult chickenpox even more common than they are now. Studies are currently underway to look for any evidence of waning immunity with the chickenpox vaccine.

  The main benefit of the chickenpox vaccine to individuals is long-lasting immunity to chickenpox. All other common vaccines require a booster dose to maintain immunity. The chickenpox vaccine lasts so long that a booster dose has not yet been recommended, although it probably will be at some time in the future. To date, those who have received the vaccine have a much lower incidence of shingles than those who actually had chickenpox over the same time period.

  [...]

  For the environment, the risks increase the more effective the vaccine. If chickenpox — an old, familiar opponent with which we have developed a stable relationship — were eliminated, this might create a niche in the microscopic environment for a new, unknown, more virulent, human virus.

  The bottom line: While I remain unconvinced of the long-term wisdom of immunizing everyone against this generally mild disease, the benefits of the vaccine seem to me to outweigh the risks for:

  1. children with eczema (or other chronic skin conditions), asthma (or other chronic lung conditions), or a strong family history of allergic conditions;

  2. adolescents or adults who have not yet had chickenpox; and

  3. those who live in areas where immunization is widespread. click to close

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  PRO VACCINE: Kidshealth.org "Chickenpox"

  Preventing Chickenpox: Doctors recommend that kids receive the chickenpox vaccine when they are 12 to 18 months old. The vaccine is about 70 to 85 percent effective at preventing mild infection, and more than 95 percent effective in preventing moderate to severe forms of the infection. Although the vaccine works pretty well, some kids who are immunized still will get chickenpox. Those who do, though, will have much milder symptoms than those who haven't had the vaccine and become infected. Healthy children who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness. ...read the full article

  Preventing Chickenpox: Doctors recommend that kids receive the chickenpox vaccine when they are 12 to 18 months old. The vaccine is about 70 to 85 percent effective at preventing mild infection, and more than 95 percent effective in preventing moderate to severe forms of the infection. Although the vaccine works pretty well, some kids who are immunized still will get chickenpox. Those who do, though, will have much milder symptoms than those who haven't had the vaccine and become infected. Healthy children who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness.

  Treating Chickenpox

  A virus causes chickenpox, so your child's doctor won't prescribe antibiotics. However, antibiotics may be required if the sores become infected by bacteria. This is pretty common among kids because they often scratch and pick at the blisters.

  The antiviral medicine acyclovir may be prescribed for people with chickenpox who are at risk for complications. The drug, which can make the infection less severe, must be given within the first 24 hours after the rash appears. Acyclovir can have significant side effects, so it is only given when necessary. Your doctor can tell you if the medication is right for your child. click to close

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  PRO VACCINE: Centers for Disease Control and Prevention "Chickenpox Vaccine: What you need to know"

  A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of chickenpox vaccine causing serious harm, or death, is extremely small. Getting chickenpox vaccine is much safer than getting chickenpox disease. Most people who get chickenpox vaccine do not have any problems with it. ...read the full article

  A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of chickenpox vaccine causing serious harm, or death, is extremely small. Getting chickenpox vaccine is much safer than getting chickenpox disease. Most people who get chickenpox vaccine do not have any problems with it.

  People should not get chickenpox vaccine if they have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or (for those needing a second dose) a previous dose of chickenpox vaccine.

  · People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting chickenpox vaccine.

  · Pregnant women should wait to get chickenpox vaccine until after they have given birth. Women should not get pregnant for 1 month after getting chickenpox vaccine.

  · Some people should check with their doctor about whether they should get chickenpox vaccine, including anyone who:

  - Has HIV/AIDS or another disease that affects the immune system

  - Is being treated with drugs that affect the immune system, such as steroids, for 2 weeks or longer

  - Has any kind of cancer

  - Is taking cancer treatment with x-rays or drugs

  · People who recently had a transfusion or were given other blood products should ask their doctor when they may get chickenpox vaccine. Ask your doctor or nurse for more information. People who do not get the vaccine until 13 years of age or older should get 2 doses, 4-8 weeks apart. Ask your doctor or nurse for details. Chickenpox vaccine may be given at the same time as other vaccines.

  Mild Problems

  · Soreness or swelling where the shot was given (about 1 out of 5 children and up to 1 out of 3 adolescents and adults)

  · Fever (1 person out of 10, or less)

  · Mild rash, up to a month after vaccination (1 person out of 20, or less). It is possible for these people to infect other members of their household, but this is extremely rare.

  Moderate Problems

  · Seizure (jerking or staring) caused by fever (less than 1 person out of 1,000).

  Severe Problems

  · Pneumonia (very rare)

  Other serious problems, including severe brain reactions and low blood count, have been reported after chickenpox vaccination. These happen so rarely experts cannot tell whether they are caused by the vaccine or not. If they are, it is extremely rare. click to close

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  PRO VACCINE: CBS Health Watch "Docs Pan 'Pox Parties'"

  Would you deliberately infect your kids with chicken pox by taking them to "pox parties"?

  A safe and effective chicken pox vaccine is part of the recommended childhood vaccination series. It keeps 85 percent of vaccinated kids from ever getting the illness, says chicken pox virus expert Anne A. Gershon, MD, director of the division of pediatric infectious diseases at New York's Columbia University.

  "In a time when we have the chicken pox vaccine available — one of the safest vaccines we have ever had, and one that works very well — there is no point in exposing your child to the natural infection," Gershon tells WebMD.

  Surprisingly, pox parties are popping up in neighborhoods in several U.S. cities. On Internet bulletin boards and blogs, rumors spread that the chicken pox vaccine is somehow unsafe or ineffective. Parents worried by these rumors join email rings. When one of these parents' children gets chicken pox, the parents invite others in the community to a pox party.

  A "natural mothering" web site gives a recipe for spreading varicella zoster virus — the chicken pox germ. It advises parents to pass a whistle from the infected child to other children.

  "It is absolute lunacy," UCLA infectious disease specialist Peter Katona, MD, tells WebMD. ...read the full article

  Would you deliberately infect your kids with chicken pox by taking them to "pox parties"?

  A safe and effective chicken pox vaccine is part of the recommended childhood vaccination series. It keeps 85 percent of vaccinated kids from ever getting the illness, says chicken pox virus expert Anne A. Gershon, MD, director of the division of pediatric infectious diseases at New York's Columbia University.

  "In a time when we have the chicken pox vaccine available — one of the safest vaccines we have ever had, and one that works very well — there is no point in exposing your child to the natural infection," Gershon tells WebMD.

  Surprisingly, pox parties are popping up in neighborhoods in several U.S. cities. On Internet bulletin boards and blogs, rumors spread that the chicken pox vaccine is somehow unsafe or ineffective. Parents worried by these rumors join email rings. When one of these parents' children gets chicken pox, the parents invite others in the community to a pox party.

  A "natural mothering" web site gives a recipe for spreading varicella zoster virus — the chicken pox germ. It advises parents to pass a whistle from the infected child to other children.

  "It is absolute lunacy," UCLA infectious disease specialist Peter Katona, MD, tells WebMD.

  "Imagine losing a child because you were dumb enough to bring him to a pox party," Gershon says.

  Gershon, in fact, favors giving kids a second chicken pox vaccination. That, she says, would ensure that virtually all kids would safely develop immunity. And it would prevent waning immunity after a first shot, which sometimes happens in the 15 percent of kids who don't get full immunity from the recommended vaccination at age 12-15 months.

  A growing body of evidence, Gershon says, suggests that childhood chicken pox vaccination prevents adult shingles.

  If you've already had chicken pox, there's still hope. A new, high-dose chicken pox vaccine shows promise for preventing shingles in the elderly. click to close

ADDITIONAL LINKS

• American Academy of Pediatrics "Immunizations/Vaccine"

• Salon "Disease Parties"

• Medline "Chickenpox—Vaccine"

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