Wednesday, 18 June 2014

Some Poxy Questions - And Why Doesn't the UK Vaccinate Against Chicken Pox?


My kids recently had chicken pox, there seems to be a lot of it locally, so one of my mummy friends decided to get her daughter vaccinated. The response she got from some other parents shocked her:

"They looked at me like I had two heads!"

Most had no idea there was a vaccine and couldn't see why you would bother stumping up the cash to get it done anyway.

I meanwhile was getting similarly shocked responses from overseas friends:

"Are your kids not vaccinated? Why are they not vaccinated? That's nuts!"

(Gosh look, a parenting decision where, whatever you do, someone will judge you to be wrong, how very refreshing...ahem)

After much chatting in playgrounds social research, I've realised just how little many of us (me included) know about a disease that almost all of us have had and have nursed our children through. So I fired up the academic search engines (and what's left of my brain after a week on house arrest) to try to answer some FAPQs (that's Frequently Asked Poxy Questions) and to try to get my head around just why some countries vaccinate against chicken pox but we in the UK don't.

First, the practical stuff...

How long are kids infectious for?

They stop being infectious once all the spots have scabbed over. Unfortunately they start being infectious about two days before the spots even appear as the virus is lurking in the respiratory system at this point and can be spread by coughs and sneezes. Annoyingly the disease also has an incubation period of up to 21 days. So if one of your children develops symptoms, you won't know for weeks if their siblings are in the clear or if they are quietly  spreading the pox in that two day window.


Do I need to keep my kid away from Granny? I don't want to give her shingles.

You can't catch shingles from someone with chicken pox. Actually, Granny my be both the winner and the villain in this story...

**waves**read this bit - It'll be important later**

The varicella virus that causes both chicken pox and shingles is sneaky. Once you recover from chickenpox it's not destroyed.  Instead it slinks away and hides harmlessly in nerve cells for years, maybe forever. With your immune system now primed and on the lookout it's trapped there, but if that immunity is weakened,  usually by age, then the virus can re-emerge and it's this old, long forgotten virus that causes shingles.

Granny may even benefit from a visit from her spotty descendant. There is a theory (that's theory in the common usage sense science types) that being exposed to chicken pox might actually help prevent shingles.  It's like giving the immune system a booster shot so it can keep the old virus trapped.

Actually Granny might be to blame for the pox in the first place. You can't get shingles from someone with chicken pox but there is evidence of children catching the pox after getting the varicella virus from an  adult with shingles. Oh and there's more, but we'll come to that later....


Any tips for dealing with it?

Based solely on my very unscientific sample of n=2 here are my 4 top tips for dealing with chicken pox:

1- Poxclin- much easier to apply than the traditional calamine lotion, but much more expensive!

2-Oaty baths - oats in an old pop sock in the bath, meant to be soothing on itchy skin, not sure if there is any evidence of that but they thought having a bath in porridge was fantastically funny.

3-DVDs/Cbeebies/Netflix etc. If you can arrange a weeks worth of wholesome, educational, crafting activities at zero notice then well done you, you are a better woman than I. For the rest of us, best to just ignore that screen-time guilt for a while.

4-Remember it will all be over eventually...



It's basically harmless, right?

For the vast majority of cases yes. However the itching is pretty horrible and add in a small child with questionable personal hygiene and it's not surprising that skin infections are pretty common. Much more rarely infections can get inside the body and effect the brain or other organs. If you took 100,000 under 16's with Chicken pox somewhere between 12.9 and 28 of them would end up with a hospital stay (ref) (and no one wants 0.9 of their toddler in hospital!) Deaths can happen but are incredibly rare, in the UK it's about  0.04–0.05/100,000 per year (ref). It's also worth pointing out here that adults getting the disease for the first time are far more likely to suffer serious complications than children and also that complications don't just happen to those with other medical problems.

Where chicken pox might be a real worry is if a woman reaches childbearing age without ever having caught it. This is still pretty unusual, roughly 95% of people have had the pox by the time they are an adult but catching it for the first time during early pregnancy can badly effect the developing baby. Catching it right before the birth can be even worse. Newborns who's mothers had the pox in childhood will get some temporary antibodies against the virus from her. But if Mum gets it right before the birth there isn't time to make those antibodies and the newborn is completely unprotected. This is a pretty horrible thought, but left untreated, the death rate could be up to 30% (ref)


Can Chicken Pox be prevented?

Two doses of the vaccine will give total immunity to about 95% of kids. If 90% of kids were vaccinated the disease wouldn't be able to spread so everyone would be protected. But the vaccine is only available on the NHS to specific, high risk individuals. You can get it privately but it is very expensive. In London you are looking at about £65 per dose plus a £45 appointment fee. (Compare this to the $24 that a friend paid at a very fancy clinic in NYC).


But don't you get better immunity from actually having chicken pox rather than having the vaccine?

I couldn't find any evidence at all of this. Long term the Jab actually seems to be a much better bet as it also significantly decreases the chance of getting shingles. (ref)


OK, so how come some countries vaccinate against this but in the UK  we don't?

**Waves**This is where that earlier bit is important**

There are a few potential downsides to vaccinating all children against chicken pox. The official reason here seems to be the worry about shingles. The concern is, that if we get rid of chicken pox then older people will no longer get their "booster" and there will be more cases of shingles, a potentially more serious condition and one that costs the NHS more than chicken pox. You remember I said there was more on the Granny front? Yep, saving Granny from shingles is apparently why we're not sparing kids from chicken pox.

There are other worries too. It's unlikely that absolutely everyone would have the vaccine, maybe less than the magical 90% would. In which case the disease would become rare but wouldn't disappear and that unvaccinated minority may escape the disease in childhood only to get it, far worse, as an adult.

The thing is though, there doesn't seem to be much evidence for either of these ideas.

Universal chicken pox vaccination has been going on in the US since 1995 and levels of the disease have plummeted. Other countries have followed suit so surely those countries should be seeing lots of cases of shingles and adult chicken pox?

A recent review looked at studies into this from the US and a few other parts of the world. It found that since the introduction of the vaccine for toddlers, cases of chicken pox have dropped in every age group. Meaning that even those who aren't vaccinated are benefiting overall. On a personal note I think it's a pretty naff excuse anyway, if the vaccine were free on the NHS then anyone denied it by their parents as a child could choose to have it as a young adult.

The review also looked at shingles cases. It did find an increase over time - but in the period before vaccination was introduced and ongoing in countries where it isn't given. Overall some individual studies found a  rise after vaccination, some didn't and it's impossible to tell if vaccination has made any difference at all to the general upwards trend. Some people have predicted that there will be a decrease in coming years as those who were protected by vaccination enter the at risk age groups (ref).


Then there are the other reasons.

The Media and the Money

Sadly, following the whole MMR press-frenzy-debacle, there is still a lot of lingering public concern about the safety of vaccinations and one of the common ways of giving the varicella vaccine is in combination with the MMR as a single MMRV jab. There is already a (completely incorrect but understandable) fear that the body can't cope with lots of vaccines all in one go so there is a worry that MMR+V= tipping some people over the edge into not vaccinating against anything. We've seen the return of measles to some areas of the UK, more of that is a scary prospect.

Finally of course, in the "cash-strapped NHS" there is the economic argument. Kids getting chicken pox costs the NHS very little. Most won't even go to the GP, very few need money spending on them in hospital. The major costs are to families and businesses when parents need to take time of work. the long incubation means siblings probably won't all get it at the same time so a family with multiple kids could be at home for weeks. No doubt that has an economic effect, but not one felt by the NHS, so I can understand why they are unwilling to be the ones forking out to vaccinate everyone. The review mentioned above also looked at the economics of the vaccine and couldn't come to any conclusion as to weather vaccination saved a country money overall or not. 


So should we be vaccinating here? 

If money were no object I'd say yes, absolutely. I've said this before but I thought it was a good point so I'll make it again:

Stuff the moon landings, global vaccination programmes are man's greatest achievement.

 The medical arguments against it are unconvincing and confusing. If its really all down to economics let's just be honest about that and say the money is needed for nurses and cancer drugs. I would like us to vaccinate in the UK but I'd like the NHS to have more money for lots of things and realistically I know the pot isn't big enough for all of them.

It should at least be more widely publicised and more readily available so parents have the choice. Perhaps as an at cost option at GP surgeries, in the way some travel vaccinations are. I begrudge paying a massively inflated cost to a private clinic, especially as many of those clinics also profit from implying there is still uncertainty about the MMR (there isn't) and then flogging the single vaccine alternatives to those they have just terrified.  


If you could go back in time, knowing what you do now - would you vaccinate MissE and MissM?

Yes. The only reason I didn't before was the cost. The cheapest option I could find for both of them was over £300. Ouch! But add up the missed days of  work and already paid for nursery and afterschool club, plus the last minute train ticket for Granny to come up from Devon to help out (Grannies aren't all bad after all), the wasted festival ticket and the pots of poxclin and calpol- we'll I've not done the maths but £300 can't be far off. 

So there it is, stuff I know now that I didn't before. Strange to think how little most of us know about something so common. Does anyone else have some interesting Poxy facts that I've missed or more tips on dealing with it? If so please add them in the comments.

 Neither of my girls was particularly unwell, just very spotty but each had a heartbreaking day of feeling utterly miserable. Like any Mum, I wish I could have taken that away but at least we are done with it now and I've had a really fascinating time finding out more about that sneaky little virus.


Sometimes you just need TV and a really big Teddy
SB

PS.  As a reminder- I'm not a medical doctor, all the above is my interpretation of the best evidence I could find but if you need advice talk to your GP. Never depend on random blogs for medical facts, even my random blog.

8 comments:

  1. Carolyn Ashley19 June 2014 at 13:33

    Fabulous as always...I would only add, on a personal note to SouthwarkBelle, not to have your soon to be poxy older cousin to visit whilst you yourself are still a tiny baby. Sorry and all that. x

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  2. southwarkbelle24 June 2014 at 20:51

    hehe, well at least I couldn't remember it!

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  3. This is all very interesting. Personally I think we vaccinate too much and then worry about things that may or may not have resulted from it. As you say you can't do right for doing wrong though.

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  4. Great story!


    We're here in the US where chicken pox vaccine was added to our routine schedule - my parents all had Measles and I turned out fine being vaccinated against that, so I see this as just another continued step in vaccination progress. My oldest (born 2004) had the varicella vaccine separate from his MMR, but the younger ones (2008, 2010) had the MMRV combination - actually, just last week was our last dose, with the red shoulder to show for it! One of my questions to the doctor back in 2004 was indeed about Shingles. Apparently there is a vaccine for that too now, and since I've been hiding the pox since 1977 I will certainly sign up for the Shingles vaccine as soon as I'm old enough!

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  5. southwarkbelle9 July 2014 at 20:37

    Hi Carina thanks and thanks for commenting. They are now introducing the Shingles vaccine here as part of routine schedule for older people, which just makes the shingles excuse for not giving varicella vaccine all the more dubious really!

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  6. Just found this post. My cousin was one of those neonatal chicken pox cases, shortly before the vaccine was phased in here in the USA. Her older brother got it a few weeks before she was born, then her mother a couple days after.



    The baby survived, though it was not at ALL clear at first that she would, and she was in Children's Hospital for three weeks.

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  7. Hi Thanks for commenting and I'm so glad your poor cousin was ok. It makes me wonder if another option could be to immunise teenage girls who haven't had it in childhood. Prior to the introduction of the MMR here we got a Rubella jab at about age 12 to prevent the damage that can do if caught during pregnancy.

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  8. Chickenpox (Varicella) vaccinations are available for children at the clinics listed here: http://www.varicella.uk

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