Pox in Your House?
Protect your childs health with the chicken pox vaccine
By Dennis Clements, MD, PhD
exposing a child to a virulent virus seems like the last thing a
parent would want to do, doesn't it? Throughout my pediatric practice,
however, mothers have frequently asked me if they could take their
children to a neighbor's house to expose them to a youngster with
chicken pox. Why? Because chicken pox (which is caused by the varicella
virus) has been considered such an unavoidable rite of passage for
children that their folks often just wanted to "get it over
with." Little did these well-meaning moms realize that chicken
pox, while frequently benign, can also cause death and significant
varicella vaccine turned 10 this past spring. It was licensed in
March 1995 after 20 years of study (including several trials conducted
at Duke). Before then, at least 90 percent of the U.S. population
had evidence of having had varicella infection by 20 years of age.
Today, thanks to the development of the vaccine, chicken pox is
no longer an inevitable part of childhood. To keep your child as
healthy as possible, it's worth learning the facts about chicken
pox and how your child can benefit from the varicella vaccine.
While most cases of chicken pox are self-limited with few complications,
some individuals are susceptible to more severe effects. In fact,
infants under one year of age and adults have a complication rate
from chicken pox of five to 10 times greater than that of children
between the ages of 1 to 18. Before the development of the varicella
vaccine, most children had chicken pox when they were between 1
and 4 years of age. Those who hadn't caught it during that time
usually did so in grammar school.
both families and caregivers often didn't realize during those years
was that chicken pox infection carried the potential for significant
side effects such as secondary bacterial infection, pneumonia, encephalitis,
kidney disease, and fasciitis (spreading skin infection often requiring
skin grafts to repair). The approximately 4 million varicella cases
that occurred in the U.S. each year resulted in about 10,000 hospitalizations
and 100 deaths (evenly distributed between children and adults).
varicella infection can also affect us later in life. During an
initial episode of chicken pox, some of the virus travels up nerve
cells and becomes dormant in the spinal cord. As we grow older and
become less able to fight infections, the virus can reactivate and
travel down the nerve cells and sprout clusters of blisters on our
skin, often around the trunk of the body. These lesions are known
as shingles. The condition--which affects between 1 and 5 percent
of adults (the frequency increases with age) who had chicken pox
as children--can be extremely painful and last for weeks; residual
pain and tenderness can linger for months.
all of these reasons, the development of the varicella vaccine was
a significant advance. The suggested timeframe for administering
the varicella vaccine is between the ages of 12-15 months--at the
same time that the MMR (measles-mumps-rubella) vaccine is given.
The varicella vaccine has very few local or system side effects
and prevents about 85 percent of varicella-caused disease. About
15 percent of varicella-vaccinated children fail to have an optimal
response to vaccination and, if exposed to varicella later in life,
can develop a very mild form of varicella. Usually this disease
looks like bug bites; often, the child has no fever and doesn't
seem sick at all.
very small percentage of vaccinated children will get a normal-looking
case of chicken pox when exposed because they did not respond to
the vaccine--just as some children do not respond to their first
dose of the MMR vaccine. Within the next five years, I believe that
it will become routine to recommend a second dose of varicella vaccine
to ensure that those few children who do not respond to the initial
vaccination are covered.
between 80 to 90 percent of children are receiving the varicella
vaccine at the recommended ages. As good as this statistic sounds,
we need to do better. If we do not immunize virtually all children,
there will be a group of children who do not receive the vaccine
and who also do not get the disease before they grow to adulthood.
If we can catch these non-immunized, non-diseased children before
13 years of age, only one shot is required for immunization. For
youngsters over the age 12, we have to give two shots--and it's
difficult to get children in this age group to see a doctor on a
potential benefit of the vaccine is that, up to the present, there
are 80 percent fewer cases of shingles in vaccinated children than
in non-vaccinated children. If these ratios hold, the varicella
vaccine may also eventually decrease the number of cases of shingles
in older people, which would be a very welcome occurrence. While
a vaccine has been formulated to suppress shingles in older adults
who had natural chicken pox, a vaccine that prevents the disease
in the first place would be even better.
pox has been a disease of childhood--and shingles a scourge of older
adulthood--for centuries. The introduction of the varicella vaccine
offers real potential to improve the health of children and adults
alike. To make good on that promise, we need to make sure that all
children receive the vaccine.
Clements, MD, PhD, is the chief medical officer of Duke Children's
Hospital. For more information, visit: www.dukehealth.org
The information presented on this site is intended
solely as a general educational aid, and is neither medical nor
healthcare advice for any individual problem, nor a substitute for
medical or other professional advice and services from a qualified
healthcare provider familiar with your unique circumstances. Always
seek the advice of your physician or other qualified healthcare
professional regarding any medical condition and before starting
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