The Chickenpox Vaccine … to immunise or not??

I’ve recently had a few people ask me for my thoughts on the varicella (or chickenpox) vaccine…. so here goes….


vaccination

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 edited chickenpoxweek 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.

needleThere 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.

hands-family-1314523-mThere 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!

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6 responses

  1. Really interesting post – I also wrote about this too when my kids had the dreaded pox. http://www.southwarkbelle.blogspot.co.uk/2014/06/some-poxy-questions-why-doesnt-uk.html

    I find the shingles argument pretty unconvincing as there doesn’t seem to be any evidence for it in countries where chicken pox vaccination had been routine for 20 years. I suspect the real issue in the UK is that if the NHS forked out for it they wouldn’t get any cost savings in return, which is itself a valid argument.

    With hindsight I wish I had vaccinated, I was put off by the ridiculous cost of doing it privately but add up all the costs incurred by both kids being ill in turn when both parents work and no local family to help and it’s probably about the same, except I’d have spared the girls a horrible week and a few scars.

    More recently my nephew was hospitalised with a chest infection secondary to chicken pox.

    Nationally it’s a tough but I’d like to at least see the jab offered to teenage girls if they haven’t had the disease, in the same way rubella was pre MMR

    SB

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    1. Thanks for taking the time to read my post and for your message. Loved your article and think you summed up all the points in a much more amusing way than I did!
      I think its a really difficult one and like so many of these things there is no clear right or wrong answer. I’m sure attitudes to the vaccine are very much driven by peoples previous experiences….anyone who’s older child had a rough time with the pox will probably be more inclined to vaccinate their younger kids?
      Think your point about adolescent girls getting vaccinated is very valid, sadly as far as I know there are no government plans to introduce such a programme.
      X

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  2. We’ve just been through this decision process ourselves. Our eldest son had chickenpox when he was 15 months old and although he was a bit miserable for a few days, in less than a week he was completely better. At the time I didn’t know about the chickenpox vaccine so didn’t even consider it as an option.

    About a year ago I read up about the chickenpox vaccine and started to think whether we should have our second son vaccinated. I couldn’t see any reason not to go ahead with it, but at the same time, knowing that it’s usually quite a mild illness hadn’t got round to doing anything about it. It was only after we’d booked flights to America for the Easter holidays that we thought that it would be just our luck if our son caught chicken pox just before we flew or was ill whilst we were away and we decided that we didn’t want to take the risk.

    It turns out we made the right decision! Having been vaccinated at the start of the year, we went to our regular playgroup exactly a week before we went on holiday. The little boy that our son played with for most of the session came down with chickenpox the next day and I’ve since found out that more than 5 other children at the play group also caught it. I have no doubt that if it hadn’t been for the vaccine that we would have been trying to smuggle a spotty, grumpy boy onto the aeroplane!

    Quick question – I wasn’t aware that the vaccine only lasted 15-20 years. Does that mean that there’s a risk that children who have been vaccinated catching chicken pox in adulthood? Is it recommended that they vaccinated every 15 years?

    Loving the blog!

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    1. Thank you Rachel for your comment. Seems like you made a good decision. As with many such decisions there often isn’t a clear right or wrong answer and it depends on circumstances as much as anything.
      Countries which routinely vaccinate children for chickenpox don’t recommend booster jabs in adolescence/adulthood. This seems to be impart due to the fact that the ‘pool’ of infection dwindles the more people are immunised, so even if the vaccine wears off there is less chance of them catching it as there is less pox about to catch. (Does that make sense?).
      x

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  3. I did not actually know about the vaccine, as a mother of five I have health issues and have been told I have a compromised immune system due to syringomyelia fibromyalgia and hypermobility syndrome – at times it feels like I’m constantly fighting off some kind of bug. I got chicken pox at 25 from my then one year old who was fine, I was so ill I had to stay at my mums n then was in hospital I could not eat they were in my throat etc, Intetestinglyblood tests showed I have no immunity to chicken pox, I wondered what your thoughts are on This?

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    1. Thank you so much for your comment Julie. Unfortunately I am unable to comment on individual cases, but hope you enjoy reading some of my other articles (if you ever get any time to yourself with 5 children!).

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