MenHibrix was removed from the schedule, which was expected, as this combinationmeningococcal vaccine for high risk kids was discontinued in 2016 because of low demand. Fortunately, this doesn’t mean that any kids will be left unprotected. They can just get one of the other meningococcal vaccines if they need it, with a separate Hib vaccine, just like other infants.
Menomune was removed from the schedule, which was expected, as this older meningococcal vaccine was discontinued in 2017, as it was replaced with the newer meningococcal conjugate vaccines (Menactra and Menveo).
Shingrix, the new recombinant shingles vaccine is added to the schedule for adults aged 50 or older. They should get 2 doses 2 to 6 months apart, even if they have had shingles in the past or have had the older Zostavax already. And Shingrix becomes the preferred shingles vaccine for those who are at least 60 years old.
The other changes are to the formatting of the schedule and schedule footnotes.
“The schedule footnotes are presented in a new simplified format. The goal was to remove unnecessary text while preserving all pertinent information and maintaining clarity. This was accomplished by a transition from complete sentences to bullets, removal of unnecessary or redundant language, and formatting changes.”
CDC on Changes to This Year’s Schedule
So, unless your child is in a mumps outbreak, the new immunization schedule shouldn’t mean any extra vaccines.
What to Know About the 2018 Immunization Schedule
The 2018 immunization schedule from the CDC, AAP, ACOG, and AAFP incorporates the latest recommendations from the ACIP, including that folks in a mumps outbreak might need a third dose of MMR.
“A person with active shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before the blisters appear. Once the rash has developed crusts, the person is no longer infectious.”
CDC on Shingles Transmission
Herpes zoster (HZ) was described as early as 1867, as can be seen in the lithograph from the Atlas der Hautkranheiten, although the connection with chickenpox didn’t come until later.
Not surprisingly, the biggest factor that will determine what needs to be done is whether or not your child is immune to chicken pox (primary varicella). Has your child ever had a natural chicken pox infection or completed a two dose chicken pox vaccine series?
Chicken pox vaccine?
Yes, because while shingles is contagious, you won’t get shingles if you are exposed to someone with shingles, but you can get chicken pox.
Remember, shingles is a reactivation of the varicella zoster virus (VZV), which also causes chicken pox. After a natural chicken pox infection, or less commonly after having the chicken pox vaccine, the chicken pox virus can stay dormant in the dorsal root ganglia of a spinal nerve. And you get shingles if the virus ever reactivates.
The type of exposure also matters.
Shingles is usually thought to be less contagious than chicken pox and requires direct contact with the rash, while it is in the blister phase, to spread disease. You shouldn’t catch the virus by simply being in the same room as someone with shingles. So if their shingles rash was completely covered by clothing, that decreases the chance of any real exposure.
“Not only was the risk of secondary infection with HZ comparable to that of primary varicella, the risk was similar regardless of the anatomic location of HZ. This finding contradicts the assumption that coverage of active skin lesions with dressings or clothing reduces VZV aerosolization and, if substantiated through further investigation, may warrant a change in current recommendations for VZV prevention.”
Bloch et al on Varicella Zoster Virus Transmission in the Vaccine Era: Unmasking the Role of Herpes Zoster
Covering the shingles rash doesn’t eliminate the risk of exposure though.
Another problem is that it isn’t always easy to recognize that someone has shingles, especially when younger children or teens have it.
“Anyone who has recovered from chickenpox may develop shingles; even children can get shingles. However, the risk of shingles increases as you get older.”
CDC on Shingles Clinical Overview
After all, no one expects an infant or toddler to have shingles, but it is important to remember that you can get shingles at any age, it is just more common the older you get.
Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant. Photo by Kaoutar Zinelabidine et al.
And since it is often less severe in children and younger adults, who get a lot of rashes anyway, shingles isn’t usually the first thing a parent or many pediatricians will think of as a diagnosis.
That increases the risk of exposure before a diagnosis of shingles is finally made.
What to Do If Your Unvaccinated Child Is Exposed to Shingles
If your unvaccinated child, or incompletely vaccinated child, who has never had chicken pox is exposed to shingles, you should talk to your pediatrician about getting him vaccinated with the chicken pox vaccine. The vaccine should be given as soon as possible and preferably within 3 days of the exposure, but it can work even if it is given as long as 5 days afterwards.
“Vaccination within 3 days of exposure to rash was >90% effective in preventing varicella whereas vaccination within 5 days of exposure to rash was approximately 70% effective in preventing varicella and 100% effective in modifying severe disease.”
ACIP on Prevention of Varicella
This post-exposure vaccination can greatly reduce your child’s chances of developing chicken pox and even if your child does develop chicken pox, it will reduce the severity of the disease.
Otherwise, you should watch your child carefully over the next 10 to 21 days for the development of the classic symptoms of chicken pox, including a rash and fever, keeping him quarantined until after this incubation period so that you don’t expose others.
Certain high risk children who aren’t immune and who can’t get a chicken pox vaccine should get VariZIG (varicella zoster immune globulin) after being exposed to shingles (or chicken pox). This includes:
immunocompromised patients
hospitalized premature infants born at or after 28 weeks gestation, if their mother wasn’t immune to chicken pox
hospitalized premature infants born before 28 weeks gestation, even if their mother was immune to chicken pox
pregnant women who are not immune to chicken pox
VariZIG is given as soon as possible and within 10 days of exposure.
What to Do If Your Vaccinated Child Is Exposed to Shingles
If your child has already had chicken pox or two doses of the chicken pox vaccine, then you can likely safely assume that he is protected if he is ever exposed to shingles.
Still, since no vaccine is 100% effective, you should watch him over the next 10 to 21 days in case he does develop any signs or symptoms of chicken pox.
And keep the shingles rash covered to prevent further exposure.
What to Know About Getting Exposed to Shingles
Shingles is contagious and can cause someone to develop chicken pox if they haven’t already had it or aren’t vaccinated and protected.
