I’ve recently had a few people ask me for my thoughts on the varicella (or chickenpox) vaccine…. so here goes….
The immunisation has been around since 1995 and is part of routine childhood vaccination regimens in many countries including the USA. In the UK (as in others) vaccination is targeted at specific ‘at risk’ groups only.
So assuming you don’t fall into that category, should you bother forking out to have it done privately?
When thinking about immunisation a good rule of thumb is to consider two things. Number one is; how does it affect me or my child as individuals, and number two; what is the impact on the wider community.
I’m sure you are all very familiar with chickenpox and if you haven’t nursed at least one child through it you are bound to have some childhood recollections of sweet sticky calamine lotion. (For tips and advice on how to deal with the pox have a look at my previous post).
For most children chicken pox is a rite of passage; it is relatively minor and generally done and dusted within a week or so. However, although very rare, there are more serious complications to be aware of, such as pneumonia, brain infections, skin infections and a condition called Reyes Syndrome. It’s tricky to find exact figures for the risks of these individual complications, but around 2-6% of people end up in hospital due to the pox. Mortality from chickenpox is thankfully exceedingly rare, especially in children who tend to come off more lightly than adults. For those of you who like stats, within Europe there are in the region of 0.05 deaths per 100,000 cases of chickenpox. Sobering information, however on balance fairly reassuring. The big issue with chickenpox is that for some people it isn’t necessarily such a benign illness and there is a much greater risk of serious complications; for example those with reduced immune systems (due to illness or chemotherapy) and older adults. During pregnancy chickenpox can have serious effects on both the mother’s health and the developing baby.
(At this point its worth remembering that if you have had chickenpox you are immune to it and therefore in the same position as if you have been vaccinated.)
‘At risk’ groups of people need to be protected from chickenpox and this is where the NHS steps in. If you have a compromised immune system (from chemotherapy for example) you can’t be given a ‘live’ vaccine as there is a risk of it causing full blow chickenpox, which would potentially be very dangerous. So the next best thing is to vaccinate your nearest and dearest to stop them catching it and passing it on.
Likewise Healthcare workers who aren’t immune to varicella should also be vaccinated for the same reason. No one would want to infect vulnerable patients they are caring for.
There are other groups who don’t qualify for the jab on the NHS but may consider it, for example a woman who was pregnant and hadn’t previously had chickenpox. She couldn’t be vaccinated herself (‘live’ vaccines aren’t a great idea in pregnancy) but vaccinating her non-immune children/partner etc. might be a sensible idea. If she were super organised, then getting vaccinated prior to becoming pregnant, would be a smart option.
There are many arguments in favour of vaccination. Evidence tells us the vaccine is very safe. It is also very effective; after 2 doses it gives children around 98% protection from chickenpox and is thought to last for around 10-20 years. As we know the serious complications of chickenpox are thankfully rare, however it is uncomfortable, the kids are miserable and it’s all a bit wretched for everyone.
Added to that there are wider issues to consider. Most childcare providers require infected children to stay away for 5 days. This generally means one parent needs to stay at home with the poorly child. This can be a logistical nightmare (speaking personally) and has broader implications for the country in terms of days-worked lost and so on. So wouldn’t an easy solution be to vaccinate your child and all these problems disappear?
The flip side is that 90% of people born and bred in the UK will have had chickenpox at some stage, the majority before the age of 6. So you might think that if 90% of us get the illness, and in the vast majority of cases it’s mild and self-limiting, what is the point of vaccinating? Is vaccination really necessary to simply avoid a few days of itching and grottiness?
There is also some concern that if lots of children were vaccinated against chickenpox, instead of most kids catching it in their early years the average age of infection would just shift upwards into the teenage years once the effects of the vaccine had worn off. At the moment this remains a theory but more evidence may evolve with time.
There is also the issue of shingles. Shingles occurs in people who have previously had chickenpox. The virus can become ‘reactivated’ causing a nasty and painful skin rash. It typically affects older people who have weaker immune systems. There is now a vaccine against shingles which is currently offered to people in their 70’s. However coming into contact with someone with chickenpox does a similar job to the vaccine, boosting your immunity to the virus, thus reducing your chance of developing shingles (hope you are following this!) So…. if fewer children have chickenpox, the theory goes that more adults may develop shingles. It would appear that the jury is still out on this one and there is no real convincing evidence either way at the moment.
So, those are the facts – and there are many strands to the argument in terms of us as individuals and our wider society. What do you think? – has this changed your views or confirmed your thinking? Have you had your child vaccinated privately, if so I’d love to know your reasons?
I’m sure you are all wondering what would I do? Well – sprog1 has already been poxed so he’s out of the equation. Sprog2 and sprog3 are yet to catch it (despite my best efforts it must be said) and I’ve no imminent plans to vaccinate either of them. Remembering that 90% of children will get in at some stage I plan to let mother nature infect them in her own time. That said I would consider it if they reached their teens and hadn’t yet caught it. Partly because adult chickenpox is a much nastier beast than the childhood version and it could start to interfere with their life a bit more e.g. exams and so forth, and given the potential issues of chickenpox in pregnancy I’d rather my daughter was fully immune before heading down that route (gulp…wow….what a thought!).
Hope that helps some of you who may be weighing up the decision…do let me know what you think!