Sherri Tenpenny wants us to stop calling chickenpox and measles diseases.
She thinks that we should call them infections instead…
Should I Stop Calling Chickenpox and Measles Diseases?
If you are like most people, you are probably thinking to yourself and maybe even shouting at your computer screen right now, “who cares what you call them, just get vaccinated and stop the outbreaks!”
Believe it or not, there is actually some precedent for changing the way we talk about diseases. While you may still refer to them as STDs, or sexually transmitted diseases out of habit, the prefererable term is actually STI, or sexually tranmistted infection.
Of course, this has nothing to do with Tenpenny’s reasoning.
“Why the change? The concept of ‘disease,’ as in STD, suggests a clear medical problem, usually some obvious signs or symptoms. But several of the most common STDs have no signs or symptoms in the majority of persons infected. Or they have mild signs and symptoms that can be easily overlooked. So the sexually transmitted virus or bacteria can be described as creating ‘infection,’ which may or may not result in ‘disease.’ This is true of chlamydia, gonorrhea, herpes, and human papillomavirus (HPV), to name a few.
For this reason, for some professionals and organizations the term ‘disease’ is being replaced by ‘infection.'”
ASHA on STDs/STIs
In fact, their definitions sound nothing like Tenpennys…
Unfortunately, many STIs, even if they aren’t causing symptoms and disease, can still be contagious.
Measles and chickenpox don’t do that. Although you can be contagious just before you start to have symptoms, you will very quickly develop symptoms.
It is true that some viruses and bacteria can lead to subclinical infections, in which you develop immunity without ever developing symptoms, but that doesn’t usually happen with measles and chicken pox.
Polio is one of the best examples of when it does happen. Remember, nearly 75% of kids who got polio never had any symptoms. Tragically, those symptoms could be severe in the small percentage who did.
If most adults aren’t immune because they haven’t been vaccinated or don’t get boosters, then since we aren’t seeing that many outbreaks, herd immunity itself must be a myth.
The thing is though, adults were either born in the pre-vaccine era and likely earned their natural immunity or were born in the vaccine era and are vaccinated and immune.
It is also important to understand that herd immunity is disease specific, so when we talk about herd immunity for measles, it doesn’t matter if everyone has herd immunity levels of protection against hepatitis A or Hib.
And adults do get a few boosters and some vaccines that are only recommended for adults, including the shingles vaccine.
In addition, some vaccines, like Hib and Prevnar, have indirect effects, protecting adults even though they aren’t vaccinated, because vaccinated kids are less likely to become infectious.
But back to the original question, how many adults are up to date on their immunizations?
“While modest gains occurred in vaccination coverage for pneumococcal, Tdap, hepatitis A (persons with chronic liver conditions), herpes zoster, and HPV vaccination, coverage did not improve for other vaccinations and many adults remained unvaccinated with recommended vaccines. “
Vaccination Coverage Among Adults in the United States, National Health Interview Survey, 2016
While most adults are immune to what were once common childhood diseases, like measles and mumps, because they were either vaccinated or had the disease naturally, many could do better with newer vaccines that weren’t available when they were kids.
Shingrix became the second shingles vaccine to be licensed in the United States, becoming the preferred shingles vaccine in 2017.
“Shingrix provides strong protection against shingles and PHN. Two doses of Shingrix is more than 90% effective at preventing shingles and PHN. Protection stays above 85% for at least the first four years after you get vaccinated.”
Not being able to actually get the vaccine and get vaccinated and protected isn’t so good. There has been a shortage of the vaccine due to high levels of demand since last year.
“Recombinant zoster vaccine (RZV) is recommended for the prevention of herpes zoster and related complications for immunocompetent adults aged ≥50 years.”
Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines
Fortunately, we will likely see more doses of the vaccine available this year and everyone will eventually be able to get vaccinated. In addition to your doctor or favorite pharmacy, the Shingrix Vaccine Locator might help you find a dose until the shortage is over.
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
It is very easy to get confused when thinking or talking about chicken pox and shingles.
Remembering a few things should help though:
shingles (herpes zoster) is a reactivation of chicken pox (varicella zoster) – since they are caused by the same virus, you had to have been exposed to the chicken pox virus (varicella zoster virus) to later get shingles
exposure to the chicken pox virus can come from a natural chicken pox infection or from getting vaccinated against chicken pox, as it is a live, attenuated vaccine (Varivax)
So no, getting the chicken pox vaccine will not prevent you from later getting shingles. The shingles vaccine is a different vaccine that is given to seniors to help prevent them from getting shingles.
Can You Still Get Shingles After Having the Chicken Pox Vaccine?
Have you ever heard of a child vaccinated against chicken pox getting shingles? It can happen. It’s not a vaccine injury.
Remember that you can get shingles at any age – it is not just a disease of senior citizens. Even preschools or teens can get shingles, with the risk increasing with age.
Although the chicken pox vaccine won’t prevent you from getting shingles, it does work well to prevent you from getting chicken pox.
And it is thought that getting vaccinated and protected against chicken pox will decrease your risk of later getting shingles, even before you ever get the shingles vaccine.
“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
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.
“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.