I was listening to talk radio while driving home from work the other day. It was no surprise that all the stations were talking about anthrax. This one particular host and his guest got sidetracked and were discussing smallpox and the vaccine. They were reminiscing about the scars that they had on their arms from when they were children.
Then the guest said, “Well you know, when I was little, my mom and all the other moms in the neighborhood would get all the kids together and have “chickenpox parties”. In other words, when a child in the neighborhood would come down with chickenpox, all the mothers would “get the word out” to the other moms. And, if their child had not had it yet, they would arrange to have the kids play together in hopes of their child getting chickenpox out of the way. It was as if chickenpox was a rite of passage…and, as it is so highly contagious, so it is, in a way. I stopped at a stop sign and thought to myself, “Boy, we sure have come a long way.”
To my amazement, a number of parents called the talk show to tell how they, along with their siblings, had indeed been to such parties when they were young. What really shocked me was how many parents called and said, “Oh, yeah, I can’t wait until my baby is just a little older to do the same for her. She’s got to get it over with, and I don’t want her to have to get another vaccine.” In my wildest dreams I couldn’t conceive of putting an infant or child through something like that.
The FDA approved the chickenpox vaccine, Varivax, in 1995, and the American Academy of Pediatrics and the Advisory Committee on Immunization Practices recommended it shortly thereafter. Prior to the vaccine, chickenpox was responsible for around 4 million cases each year in the United States, over 10,000 hospitalizations per year, and around 100 deaths per year. The school absenteeism and missed days at work due to chickenpox was astronomical, and the cost to society was staggering.
What parents need to know is that chickenpox is NOT a benign disease; it has potentially dreadful side effects. An unsuspecting parent may get far more than they bargain for by having their child get chickenpox for the heck of it. The skin lesions of chickenpox can easily become infected with a bacteria, group A streptococcus, which can set up a serious skin infection called a cellulitis. This is usually treated with IV antibiotics in the hospital. Viral meningitis and encephalitis can occur as a serious complication of chickenpox, as can pneumonia. Infections of a joint or bone due to group A streptococcus are also associated with chickenpox. A not so common, but devastating, complication of chickenpox is a “hemorrhagic varicella”, whereby the patient bleeds into the fluid filled blisters and is desperately ill.
The Varivax is a well-studied and time-tested vaccine. It is very safe, and is very effective. The AAP recommends that one dose be given to all infants on or after their first birthday, unless there are extraordinary circumstances that would preclude them from receiving it. Only one shot is necessary through the twelfth year of life. After that, there are two shots needed, and they need to be given one-two months apart. The only contraindications to the Varivax are a) a pregnant woman in her second – third trimester of pregnancy, and b) any immune-system problems, including HIV. Currently 22 states plus the District of Columbia require the Varivax for entrance to first grade.
The Smiths brought their one-year-old daughter to the office for her well check. I was surprised to see her father, I know how hard it is for him to get off from work to keep daytime appointments. He seemed antsy when I talked to mom about the shots that Megan was going to receive. He sighed a deep sigh when his wife stated, “I’d like my husband to get the chickenpox shot, if that’s OK with you. I checked with his parents, and they said that he was the only one of the five kids who never got the chickenpox.”
Mr. Smith sat there like a trapped animal that had no place to run or hide. He started to make a case for himself, but his wife cut him off. “Don’t pull this now! We talked to your mother and your aunt, and they swear that you never had it…that’s why you came.”
I told them that growing up with four siblings who all had the chickenpox would make it very unlikely for him not to have gotten the disease…but it wasn’t impossible. Even though he didn’t have a noticeable case that his parents could recall, it was plausible that he may have had a mild sampling, or a sub-clinical case. Therefore, he would be protected. Mr. Smith liked this idea.
It was important to draw some blood from him and send it to the lab to measure varicella titers. These are the immunoglobulins formed by the body when there is a chickenpox infection. Early in the course of an infection, the lgM immunoglobulin will rapidly rise and stay elevated for a couple of weeks before returning to it’s normal level. As one gets into a chickenpox infection, the lgG starts to rise and remains elevated for the rest of one’s life. This is what protects an individual from getting chickenpox again. (It is extremely rare, but second cases of chickenpox can occur). We can measure the lgM and lgG for varicella to judge if a person is protected. If so, they do not need the shot. Checking with the lab, the cost of running the immunoglobulins is less than $30.00. The two shots that Mr. Smith would need would cost over $100.00. Needless to say, he liked these odds very much, and Mrs. Smith agreed that it made sense to do it this way. It could be a saving of $70.00, but more importantly, it would be senseless to give him a vaccine that he didn’t need.
I sent the blood and got the results in two days. Sure enough, Mr. Smith’s lgG was very elevated, confirming that he was fully protected from varicella. He did NOT need the vaccine. He couldn’t wait to tell his wife.
“You know, Doc, I’m going to tell her as soon as I buy some lottery tickets. This seems to be my lucky day.”