I don’t diagnose Chickenpox often. I’ve seen patients with Chickenpox only a handful of times since I started medical school in 1998. Auspiciously, there simply haven’t been many children to serve as my teachers. Varicella virus causes Chickenpox and there’s a vaccine for that. So, like Smallpox or Polio, I’ve been forced to learn a lot about Chickenpox in textbooks. My strongest professor in the Chickenpox department is my own memory; I had Varicella between the age of 5 and 6 years. It was the one week of my childhood where I remember being really babied– my mom gave me a small gift or craft every day while I was home from school. I got to watch TV on the couch. I must have looked pretty awful…But it wasn’t so bad and I was lucky. I was a healthy 5 year old girl who had a case of chicken pox that was “run of the mill”: lots of spots, lots of itching, a week of fever and feeling crummy. Then poof, I scabbed over and got better. The only remaining trace (besides the virus that may live in my nerves) is the scar on my L forehead. You seen it?
The big trouble with Chickenpox is you can’t predict which child will have a serious complication (a brain infection, an overgrowth of flesh eating bacteria in the sores, or a life-threatening pneumonia).
While I was finishing up college, the Varicella vaccination was introduced into the United States. At that time, over 150 people died every year from Chickenpox and over 11,000 people were hospitalized annually. This created a huge economic toll (from missed work to health care costs).
So my apparent lack of clinical opportunity with Chickenpox reflects reality. A study published this week found that over the last 12 years there has been a 97% reduction in deaths from Chickenpox in children and adolescents younger than 20 years of age. There’s been an 88% reduction of Chickenpox deaths over all (kids plus adults). These are staggering statistics.
Varicella and Varicella Vaccine in the US:
- Prior to the mid-1990’s, Varicella caused hundreds of deaths every single year. It caused thousands more hospitalizations.
- Since 1995, we’ve been vaccinating children between 12 and 18 months of age against Varicella (Chickenpox). Some children can’t receive the vaccine (those with suppressed immune systems, history of recent bone marrow transplant, or cancer for example) so they are protected by those vaccinated. I have plenty of patients who are protected by YOU/YOUR children being vaccinated. Thank you.
- Between 1997 and 2007, only 77 total people died from Chickenpox.
- Between 1997 and 2007, the rate of those vaccinated against Chickenpox increased from 27% to 90%!
- In 2002, we started to do a booster dose for Varicella at 4-6 years of age to increase protection against Chickenpox. We have been catching up all other children with another dose and now when children enter kindergarten, very child should have 2 doses total. The reason: research has found that 1 dose of the vaccine is 85% effective in preventing all Varicella but with 2 doses, effectiveness rises to 97-100%.
- Most of the 77 deaths occurred in patients “without apparent contraindication to vaccination” and therefore were potentially preventable. (Major missed opportunity)
- The vaccine works. Of the 77 total deaths since 1997, only 2 deaths occurred in children who had received 1 dose of the Varicella shot. Both of those children were on steroid therapy (suppressing their immune system) and 1 of the children had cancer.
This tells us we’re living in a wonderful era where few die from Chickenpox disease and complications. We’ve created a safer environment. If your a child born in 2011 and get the Varicella vaccine and have no other immune-related medical problems, the likelihood of dying from Chickenpox disease is nearing zero. Further, through the combination of your own immunization and from the protection of the “herd” of vaccinated children around you, you’re even better protected. Well done, everyone. We should be very proud of ourselves. This is a big accomplishment; keep up the good work.
PS–a note on the photo. Chickens don’t cause or spread Chickenpox.
I had chicken pox when I was about thirteen. It was awful. (Apparently, the older you are, the worse you tend to get the disease.) I was horribly sick for two weeks, with sores even in my throat. And two weeks after I got better, I was at the doctor’s office for my school check-up and we saw signs everywhere announcing the brand new chicken pox vaccination.
dr. robyn says
Thank you for posting-Varicella is not just a benign infection that families used to have to suffer through-there are complications in addition to the misery. I still see a handful of cases, but they are always less severe than the horrible course I had to go through as a child. I also have patients who opt against the vaccine and some that even support the “chickenpox party” idea-both of which I feel are begging for trouble. Lets continue to provide safe methods of protecting our kids from sometimes deadly diseases!
Ed Marcuse, MD, MPH says
In 38 years of hospital based pediatric practice I have seen countless cases of chickenpox, but fortunately very few life threatening complications. However, in the pre vaccine era I regularly cared for previously healthy children hospitalized for the treatment of bacterial infection of their chickenpox lesions. Many of these children will carry the scars of these infections throughout their lives — all too often on their faces. The benefits of varicella vaccine extend well beyond preventing deaths.
Emily Gibson says
As a college health doc for twenty years, I now am seeing more varicella infections in my population due to waning immunity among the late adolescent/young adult patients who had an initial varicella immunization but had not gotten a booster. I routinely recommend getting a varicella titer checked now in our college students, especially if they are going to travel for foreign study in countries where varicella is more common.
Adult varicella infection is a very frightening thing. A pediatrician with infectious disease specialty training who worked in our college health center twenty years ago had managed to go all the way through medical school, residency and fellowship assuming she was varicella immune with no childhood chicken pox history. When her own children got varicella, she found out she was not immune after all and became very ill with varicella encephalitis, requiring weeks for full recovery.
It is great news that we are seeing fewer deaths thanks to this vaccine. But as is true for many vaccine preventable infections, we also need to stay on top of the phenomenon of waning immunity in adolescents and adults.
As a kindergartener in 1979, chickenpox spread through our class like wildfire. I’m so glad my kids won’t have to suffer with the week of itching being covered in calamine lotion and feeling oogey.
I also LOVE your “[disease name] is caused by [name of bug]…and there’s a vaccine for that.” Does the CDC know about this great marketing tag line?
Wendy Sue Swanson, MD says
Thanks, Kathy. I was a kindergartner in 1979. And that’s when I had Chickenpox, too! Did you happen to live in Minnesota? 🙂
I’m at an AAP leadership meeting today and about to do an hour presentation on the use of social media for advocacy and education. But maybe I’ll pitch my tag “there’s a vaccine for that” idea to the group….YOU NEVER KNOW. The reason I put it in italics was because I didn’t want people to miss the tag.
There really is synchronicity in your comment– “oogey” is one of my favorite words…
Ha ha, how funny, but no, I grew up in WA. Hope your presentation went well and I think “they” would be crazy to not adopt your there’s a vax for that tag-line idea. Fantastic! And yes, oogey is a fabulous word, isn’t it?
Ok, I admit I’m a little afraid to say this….but neither of my young daughters are vaccinated for varicella (ages 3 and 1). My understanding is that the vaccine does not provide lifelong immunity and I know that the disease has far more complications and is much more painful/difficult to deal with as we get older. Am I confused and/or am I lacking information? You mention that the booster makes the vaccine 97-100% effective but you don’t mention how long the immunity lasts aside from suggesting a titer to test immunity later. If immunity is low, would you do another booster and continue checkin periodically? I would appreciate knowing more about this issue if you have time to comment.
I enjoy reading your blog and your perspective. Thank you for taking the time to share.
Wendy Sue Swanson, MD says
Alright Alison. Your comment inspired a lot of reading on my behalf. I’m just off the phone with a pediatrician and vaccinologist. I understand more now about Varicella vaccine than every before. For that, I have you to thank. So, thank you.
Here’s what I can say:
We know a lot more about Varicella immunity now than we did in 1995 when we started vaccinating. The reason that we have 2 doses of the vaccine is extremely complicated and needs to be explained on the cellular level.
2 doses of Varicella vaccine provide comprable immunity to having natural Varicella infection. That’s the reason, and the bottom line for 2 doses. This means, after two doses, not only are children’s blood “titers” of equal value, their cellular immunity (the way other immune cells respond) are similar. With what we know now, this would suggest that our children will need no more than 2 doses for lifelong protection. And that being immunized 2 times for Varicella is a lot like having natural Chickenpox disease.
We also know, like any vaccine series, 2 doses of Varicella vaccine improve the chances that your child really is protected from Varicella. What this means is that as we know with any vaccine, not all children mount a perfect response. That’s why it’s so essential the whole community if immunized. The herd of immunized children protects all of our children. By having 2 doses we think we’re close to having nearly 100% kids protected from Varicella into adulthood.
The fact is, we have no idea if we will need a 3rd dose in adulthood. Although experts believe it is unlikely, time will tell. Children have been receiving immunizations since 1995 and thus their adulthood only soon to begin.
I procrastinated on varicella. I preferred my kids just get the disease because I didn’t remember it being a big deal as a kid. I didn’t mind the scars. If the flu didn’t mutate as much as it does so that you could only get it once, I’d have let my older one get the flu. My younger one is the one I worry about more. He got the flu despite the flu shot. Got RSV. Luckily he’s getting heartier but he’s the kid that I was more concerned might be a statistic. In any case, I got all the other kindergarten shots out of the way and my pediatrician laid it out like this: no, it wouldn’t be much of a big deal if she got the virus now. But as she gets older, the virus will be more dangerous, so there is a time limit to the “wait and see” approach. Also, once she enters school, a bout of chicken pox is very inconvenient in terms of loss of school. Quarantine is typically about 3 weeks in these parts.
I’m in the same camp as Viki and Allison, my 3 year old isn’t vaccinated against Varicella. At the time she was due we were dealing with so many developmental delays and she was almost put on a feeding tube numerous times that we decided that her having a reaction to it was far greater than her possibly being exposed to it. I am now pregnant and since it is a live (?) vaccine my OB has requested that we wait to give it to her until I am no longer pregnant. Is it safe to give her the vaccine with a newborn in the house? I have read that 1 in 4 kids have a chicken pox like reaction to it so could it spread to the newborn? I had a mild case when in the first grade and my husband got it twice, the last time when he was around 20.
Wendy Sue Swanson, MD says
It is safe to give Varicella vaccine with a newborn in the house. From Red Book recommendations, it is also safe to give it with a pregnant mom in the house.
Thank you Dr. Swanson!
Michael Belkin says
The Institute of Medicine (IOM) just released a study on vaccine safety that disagrees with the thesis of your article. From Friday Aug 26, 2011 Seattle Times:
‘The vaccine that racked up the highest number of problems was the varicella vaccine, given to prevent chickenpox. In some patients — most of whom had compromised immune systems — the vaccine caused brain swelling, pneumonia, hepatitis, meningitis, shingles and chickenpox itself.’
What steps do you use in your practice to avoid vaccine adverse reactions such as this? Thank you.
Wendy Sue Swanson, MD says
Thanks for your comment, Michael. I am aware of the report which can be found here: https://www.iom.edu/Reports/2011/Adverse-Effects-of-Vaccines-Evidence-and-Causality.aspx
I don’t think the report goes against the thesis of my post (reviewing a study in Pediatrics re the history of the change in varicella deaths) as you suggest.
Here’s a piece from the NYT yesterday that summarizes the IOM findings:
When counseling families about immunizations, I talk about risk and benefit. Every intervention, like every act of non-intervention, comes with risk. Interventions like vaccines also come with great benefit (avoiding preventable illness). When it comes to vaccines, I talk about the great benefits afforded to us all living in a time of immunizations, too.
We never expect or want our children to have compromised immune systems in the future (immune deficiency, cancer, high doses of immune suppressing drugs like steroids, for example) but we (my patients, their families, and me) make vaccine decisions in the context of a child’s health and wellness, their family history, vaccine and public health recommendations, and large studies. The IOM reviewed data from over 1000 studies. The paragraph you posted here is misleading out of the context of the entire report. I don’t want to go back to the rates of death from Varicella we had in the pre-vaccine era.
The IOM report also notes that all of those adverse events occurred MORE frequently with NATURAL infection. Just to clarify, one is MORE likely to have encephalitis (brain swelling as you say – although it’s slightly different), meningitis, pneumonia, hepatitis, shingles and (of course) chicken pox with NATURAL infection. Also, one’s immune system can be so compromised as to have AIDS and still NOT be likely to have an adverse event to the Varicella vaccine, but that same person (criteria are determined by CD4 counts) would very possibly die from natural infection, as would a child with a compromised immune system due to cancer – thankfully we do have antiviral medications that improves one’s chances if one were to acquire chicken pox, and we also do not give Varicella vaccine to children with cancer or severe combined immunodeficiency which is all the more reason that the rest of the population should get vaccinated.