We found that out last year when an unvaccinated teen returned from a trip overseas and developed measles.
“Although patient A’s parents had chosen not to vaccinate him, his immunocompromised brother, an organ transplant recipient, had received intravenous immunoglobulin to protect him against measles before traveling overseas. When patient A’s illness was reported, SCCPHD recommended that his brother receive additional intravenous immunoglobulin and be quarantined 7 additional days; the family followed both recommendations. Patient C’s unvaccinated sister, aged 17 years, received parental permission to choose to receive MMR vaccine when her brother was quarantined; she opted to receive the vaccine.”
Notes from the Field: Measles Outbreak in an Era of Stricter Immunization Requirements — California, March 2018
While that isn’t so surprising, it is that instead of cooperating with health department investigators, so that they can find and quarantine contact, several people lied. That led to more people getting sick and the outbreak going on longer than it should have.
It is also amazing that they hadn’t already vaccinated their kids, having a high risk, immunocompromised child in the house who couldn’t receive the MMR vaccine!
Shingles is a reactivation of chicken pox, which can occur even after you have gotten the chicken pox vaccine, since it is a live virus vaccine.
Does the Chicken Pox Vaccine Protect You from Shingles?
We have long expected that the risk of shingles after vaccination with the chicken pox vaccine would be lower than a natural infection.
“In the early post-varicella vaccination period, incidence rates of medically attended herpes zoster did not increase for the overall population and decreased moderately for children 9 years and younger, the age group targeted for varicella vaccination.
Tanuseputro et al on Population-based incidence of herpes zoster after introduction of a publicly funded varicella vaccination program
And now we have even more evidence!
A recent study, The Epidemiology of Herpes Zoster in the United States During the Era of Varicella and Herpes Zoster Vaccines: Changing Patterns Among Children, has found that the incidence of shingles “declined in a step-wise pattern since the varicella vaccination program was introduced.”
“We found that HZ incidence declined dramatically among children since 1998 as the varicella vaccination program was being introduced and was maturing…”
Harpez et al on The Epidemiology of Herpes Zoster in the United States During the Era of Varicella and Herpes Zoster Vaccines: Changing Patterns Among Children
Did you need another reason to get your kids vaccinated and protected with the chicken pox vaccine?
More on Protection Against Shingles with the Chicken Pox Vaccine
Consider what a group of anti-vaccine folks did with the above post about a child with severe complications to a chicken pox infection…
What are some of the big complications of chicken pox infections? Complications that help make chicken pox deadly?
That’s right, secondary skin and soft tissue bacterial infections (cellulitis and necrotizing fasciitis). In fact, bacterial super-infections of the skin are the most common complication of chicken pox infections.
“Necrotizing fasciitis can lead to sepsis, shock, and organ failure. It can also result in life-long complications from loss of limbs or severe scarring due to surgically removing infected tissue. Even with treatment, up to 1 in 3 people with necrotizing fasciitis die from the infection.”
Necrotizing Fasciitis: All You Need to Know
No, chicken pox is not necrotizing fasciitis, but all of the breaks in the skin from chicken pox lesions give bacteria, including group A Streptococcus (group A strep) and Staphylococcus aureus, plenty of opportunities to enter a child’s body and quickly spread.
We often hear that chicken pox isn’t serious in other countries that don’t routinely use the chicken pox vaccine. Don’t believe them.
On average, about two young children die in the Netherlands each year due to chicken pox.
“Based on the results presented in this study we estimate that between 3 to 8% of all Dutch patients with varicella, depending on age, consult a GP due to a complication. Our findings are similar to data from Germany, France and the United States of America, were it is estimated that in approximately 2 to 6% of cases attending a general practice. Furthermore of these varicella patients 1.7% experiences complications severe enough to seek hospital care.”
Pierik et al on Epidemiological characteristics and societal burden of varicella zoster virus in the Netherlands
And folks in the Netherlands have similar rates of complications as we did in the United States in the pre-vaccine era and many are hospitalized.
And chicken pox parties, while not as common as some folks imagine, were definitely a thing, because you didn’t want your child to become an adult and get chicken pox, when it was more dangerous. But since most kids got chicken pox so easily, most got it when they were kids, even without a chicken pox parties, and tragically, many learned that it wasn’t only dangerous to adults.
These days, most cases and outbreaks of chicken pox are in unvaccinated children and adults.
7 new cases in the outbreak associated with the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 41 in that outbreak, including 4 cases in the community as the outbreak continues to spread (Nov 2018)
6 new cases at the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 34 in that outbreak (Nov 2018)
at least 5 cases at Daybreak Primary School in Battle Ground in Clark County, Washington, leading to quarantine of at least 38 unvaccinated students who will be kept out of class for at least 21 days (Oct 2018)
at least 5 cases at two schools in Ottawa County, Michigan, including Waukazoo Elementary and Kids First – Early Childhood Center in Jenison, leading to the quarantine of at least 34 children (Oct 2018)
a cluster of chicken pox cases in Grant County, Washington at Park Orchard Elementary, North Elementary and Longview Elementary schools (Sept 2018)
at least 5 cases at the The Little Red School House Too daycare in Westbrook, Maine (May 2016)
These cases are just the tip of the iceberg though, as there are still about 7,000 to 10,000 chickenpox cases reported in the United States each year. And that’s with some states, like Oregon and Washington, not reporting cases of this Nationally Notifiable Condition to the CDC.
Still, since chicken pox caused a few hundred deaths and at least 10,000 hospitalizations each year less than twenty-five years ago, that’s a lot of progress.
Getting Chicken Pox
How do you get chicken pox?
Since it is very contagious, if your child is exposed to someone with chicken pox or shingles, then they might develop chicken pox in about 10 to 21 days (incubation period).
are unvaccinated, either intentionally, because they have a true medical exemption, or because they are too young for the vaccine, which is first given when kids are 12-months-old
are partially vaccinated, with only one dose of the chicken pox vaccine
have a problem with their immune system, including kids getting chemotherapy
In addition to being at risk for chicken pox, non-immune pregnant women, newborns born to women who develop chicken pox at around the time of delivery, premature babies, and those are immunocompromised can be at risk for severe disease.
Avoiding Chicken Pox
Want to avoid chicken pox and the chance of ending up in a chicken pox quarantine and having to stay out of school for 3 weeks or more?
That’s not an option for some kids with true medical exemptions though, including most kids who are immunocompromised. When they get caught up in one of these outbreaks and get exposed to chicken pox, it becomes a matter of life and death to work to try and prevent their getting chicken pox.
Even in the pre-vaccine era, when measles would kill 500 people a year in the United States, there is a very good chance that you wouldn’t have known anyone that died of measles. Of course, that doesn’t mean that nobody died of measles or chicken pox or any other now vaccine-preventable disease.
You likely know someone that plays football, right? Maybe on a youth football team or in middle school or high school? Do you know anyone that plays on a team in the NFL? While millions of kids might play football, only a few thousand play in the NFL.
Chicken pox was never a benign disease. It was considered a rite of passage because we all had to endure it, but it wasn’t something anyone looked forward to. You don’t die from a benign disease.
Part of that is actually true – “they keep you a customer for life” because you didn’t die from a vaccine-preventable disease!
Many countries don’t have the chicken pox vaccine on their routine immunization schedule because they don’t think it is cost-effective and they were concerned about what controlling chicken pox could do to rates of shingles.
“About 3 in every 1000 pregnant women in the UK catch chickenpox. Between 1985 and 1998, nine pregnant women died in the UK from chickenpox complications. Their unborn babies are also at risk from a rare condition called foetal varicella syndrome (FVS). This can result in serious long-term damage to the baby or even death, particularly if the mother catches chickenpox in the first 20 weeks of pregnancy.”
Vaccine Knowledge Project on Chickenpox (Varicella)
These countries have the same rates of shingles as countries that do use the chicken pox vaccine, but still have high rates of chicken pox and complications of chicken pox!
The UK does not vaccinate for chicken pox, but young, otherwise healthy kids die with chicken pox in the UK.
While you will be at higher risk for complications from chicken pox and most other diseases if you have a compromised immune system or are malnourished, if you are otherwise healthy, there is nothing you can do to boost your immune system to try and beat chicken pox – besides getting vaccinated.
Chicken pox parties kind of made sense in the pre-vaccine era. Since it was inevitable that your child would get chicken pox, you wanted them to get it at a young age, so they weren’t at increased risk for complications as an adult.
a previously healthy, unvaccinated 23-month-old boy developed chicken pox and died three weeks later after developing sepsis, possible viral meningoencephalitis, bacterial endocarditis, and heart failure. (1996)
a previously healthy, unvaccinated 21-month old developed chicken pox and died four days later because of hemorrhagic complications (1997)
an unvaccinated 5-year-old boy with asthma was treated with one dose of prednisone at home for an asthma attack while recovering from chicken pox and died the next day (1997)
a healthy, unvaccinated 6-year-old boy developed chicken pox, was hospitalized three days later, and died the next day (1998)
an 8-year-old being treated for leukemia developed chicken pox and died two weeks later (1998)
an unvaccinated 9-year-old girl was exposed to an unvaccinated children with chicken pox in after-school child care and school, developed chicken pox and died three days later with secondary cellulitis and sepsis. (2002)
a previously healthy, unvaccinated 11-year-old girl developed septic shock and died soon after being admitted to a Pediatric Intensive Care Unit. (2002)
an unvaccinated 12-year-old boy was exposed to an unvaccinated classmate with chickenpox, developed chicken pox two weeks later, was admitted to the hospital after three days because of trouble breathing, and died on his second hospital day after suffering a cardiopulmonary arrest. (2003)
an unvaccinated 10-year-old girl developed chicken pox, with worsening 10 days later, including ataxia and mental status changes. After being hospitalized for three days, she began to have seizures and was declared brain dead the next day. (2004)
an unvaccinated 14-month-old girl developed chicken pox and worsened over the next three to five days. She eventually developed septic shock, was treated in an ER, and died within one hour of being transferred to a children’s hospital for further care. (2004)
a previously healthy, unvaccinated 15-year-old developed chicken pox, was admitted to the hospital three days later in septic shock, and died three weeks later. (2009)
a partially vaccinated 4-year-old girl who was being treated for acute lymphoblastic leukemia (ALL) was exposed to a cousin with chicken pox and later developed multi-organ failure and died (2012)
Chicken pox has always been a deadly disease.
“In the prevaccine era, approximately 11,000 persons with varicella required hospitalization each year. Hospitalization rates were approximately 2 to 3 per 1,000 cases among healthy children and 8 per 1,000 cases among adults. Death occurred in approximately 1 in 60,000 cases. From 1990 through 1996, an average of 103 deaths from varicella were reported each year. Most deaths occur in immunocompetent children and adults”
Epidemiology and Prevention of Vaccine-Preventable Diseases
Although chicken pox is definitely riskier if you are older and have pre-existing medical problems, as you can see from these kids who died, many were otherwise healthy and many were very young.
“Chickenpox (varicella) is generally a much milder illness in children than in adults, with considerably lower rates of severe disease and death. Varicella is also virtually universal in many populations, meaning that very few individuals escape infection over a lifetime. Thus, a sound logic underlies the idea of chickenpox parties, at which susceptible children can acquire the contagious causative pathogen, varicella zoster virus (VZV), from their peers. However, chickenpox is not without risks, even for children of this age; severe, complicated, and occasionally fatal varicella occur in previously healthy children, as well as the immunocompromised (who are at very considerable risk).”
Hambleton et al on Chickenpox Party or Varicella Vaccine?
Most folks understand that. They get their kids vaccinated and have helped get chicken pox under very good control, with outbreaks of chicken pox declining over 95%.
“Each year, more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented by varicella vaccination in the United States”
CDC on Monitoring the Impact of Varicella Vaccination
Apparently, not everyone has gotten the message though.
Remember when CPS had to investigate the mom who was having chicken pox parties in Plano, Texas a few years ago?
“On the page, parents post where they live and ask if anyone with a child who has the chicken pox would be willing to send saliva, infected lollipops or clothing through the mail.”
CBS 5 Investigates mail order diseases
Or when anti-vaccine folks were selling and mailing lollipops contaminated with chicken pox to folks so that they could skip the trouble of finding a chicken pox party?
And then there’s that time that a family served chicken pox contaminated punch at their chicken pox party. Oh wait, that was The Simpsons…
So what are they up to now?
More of the same…
Apparently, there are still plenty of folks looking for chicken pox parties to infect their kids.
It is easy to see a lot of cognitive biases at play in the decision to host or bring a child to a chicken pox party, including ambiguity aversion (prefer what they think are the known risks of getting the disease), bandwagoning (they think everyone else is doing it, because in their echo chambers of anti-vaccine propaganda, everyone might), and optimism bias, etc.
There is also a very poor perception of risks, as the risks from a natural chicken pox infection are far, far greater than any risk from the vaccine.
In bigger news, Facebook has groups who’s mission is “finding pox,” so that parents can get their kids sick!
How many other PoX type groups are there on Facebook?
Do they understand the consequences of having these pox parties?
Of course, an investigation from CPS, the health department, or a medical board isn’t the most serious consequence that should discourage folks from hosting or attending a chicken pox party.
Chicken pox can be a serious, even life-threatening infection. Sure, many kids just get a mild case, but others get more serious cases and have bad complications, including skin infections, encephalitis, sepsis, or stroke.
And some people do still die from chicken pox, which is supposed to be a mild, childhood illness.
“This report describes a varicella death in an unvaccinated, previously healthy adolescent aged 15 years.”
Varicella Death of an Unvaccinated, Previously Healthy Adolescent — Ohio, 2009
Fortunately, these deaths have been nearly eliminated thanks to the chicken pox vaccine.
And that’s why parents who are on a mission for “finding pox” should rethink things and switch to a mission to get their kids vaccinated and protected.