The Chickenpox/ Shingles Story (Pedcast)
I was having a discussion the other day with the mom of one of my patients. She was asking me why we vaccinate children against chickenpox; a disease that her mother told her was a benign mild childhood illness that doesn’t hurt kids. Keep in mind that almost none of the parents of my current patients have ever seen or had any experience with the disease of chickenpox. The disease is virtually gone in the United States so everything parents know today is based on what they have heard. This particular mom had so many questions and a few misconceptions about chickenpox. Because of this I thought many of my blog listeners probably have many of the same questions, so today were going to talk about the disease known as chickenpox: the myths and facts and the rationale behind vaccinating today’s children. Why do we bother vaccinating for a harmless childhood illness?
The biology of chickenpox
Let’s start with the basics. Chickenpox is caused by a herpes virus that goes by few names: Varicella, herpes zoster, and HHV-3 or human herpes virus type three. It’s very contagious, one of the most contagious diseases ever known to exist. In fact, it can spread airborne up to 7 feet, which means that Just being in the same room with someone who has chickenpox can spread the disease to the others in the room. No touch is needed. The rash itself looks a lot like it’s deadly cousin, smallpox. Fortunately smallpox has been eradicated from earth since the 1970’s since it is a deadly infection in both adults and children. Chickenpox however is usually a relatively mild illness for most kids so my patient’s mom was correct on that point. In fact when I was a child it was common for Mom’s to have a chickenpox parties when there was an active case in the neighborhood so that all the kids would go ahead and get exposed and get the disease out of the way. It was just considered a right of passage to have chickenpox. Spring was the big season for chickenpox for some reason.
So why do we go to all the expense of vaccinating children against what’s usually such a mild disease. Well there are two reasons. The first is that there were deaths from chickenpox years ago the illness was common. Usually a child got chickenpox and then got a nasty strep or staph infection on top of some of there open sores. This could be lethal. Remember the flesh eating strep? Germs like this love all the broken skin chickenpox creates. Death from natural chickenpox happened 150 times per year in the United States before we start vaccinating in children 1995. But 11,000 children a year ended up in the hospital secondary to complications from the chickenpox in the US alone, many with life threatening complications such as encephalitis, an often fatal liver disease called Reyes syndrome, pneumonia, or just good old dehydration. Chickenpox can be a very frightening disease. The second reason we vaccinate children today is a little more complicated to understand. You need to understand that everyone who gets infected with any chickenpox virus harbors this herpes virus for the rest of his or her life, an infectious disease time bomb so to speak. In the short run, the virus becomes dormant, hanging out silently for decades in the nervous system of anyone who has had chickenpox. But weaken that person’s immune system with age, sickness, or stress, and it can spring right back out as a disease known as shingles. You’ve heard about that old age disease shingles. Remember, shingles and chickenpox are caused by the same virus. Chickenpox is the form of the disease that is systemic, in the blood, and everywhere. A child gets chickenpox on their initial exposure to the chickenpox virus. If the virus reactivates in a localized area we call that shingles and that’s a serious health problem for older folks. You probably have heard that children can get chickenpox from touching someone shingles if they’ve never had chickenpox. Well that’s true. You probably have also heard that adults can get shingles from being around a child with active chickenpox. Well, that is not true.
In the United States the FDA approved a vaccine in 1995 that was a weakened form of the natural chickenpox virus. It is called the Oka strain, developed in Japan in the 1970’s, and it’s been extremely successful at eliminating chickenpox in today’s American children. Chickenpox has been virtually eliminated and experts are pretty sure that vaccinated children will be at extremely low risk for getting shingles in their old age. So the vaccine has done two things: it’s has eliminated the deaths and a lot of hospital stays from chickenpox and it also has greatly reduced the chance that a vaccinated child will ever get shingles in their life. And, should the child ever get shingles, experts are pretty sure that the shingles that they will get will be a very mild because these children carry a weakened vaccine form of virus, not the mean wild virus that most older people in the US carry.
Why are rates of shingles rising among older Americans?
How can the rate of shingles in the US be rising? You just told me that we have eliminated the chickenpox disease and vaccinated children are much less likely to get shingles. Well there are two theories about why this is happening. The first is that older adults, who carry natural chickenpox, are not able to keep the virus dormant because they are not getting their immunity boosted by periodic exposure to children with active chickenpox. Their bodies have forgotten about the germ and it can pop back out since it has often been 60 years since they first encountered the germ. Theory two surmises that there is something else going on unrelated to lack of exposure to chickenpox. Many people feel that our immune systems are not as strong as our ancestors and that’s allowing chickenpox to come back as shingles more often than in the past. Of course we are living longer as well and shingles is an old age disease. Remember it’s your immune system that keeps the germ in check.
So, it seems like what we were told back in 1995, chickenpox vaccine would greatly reduce the chance of getting shingles as these children age. Evidence today says that this is true. Remember these kids are only 20 years old now, so we really don’t know what’s going to happen when they’re 80 but researchers are pretty confident that they will have a much-reduced chance of getting shingles and if they do get shingles, it will be very mild. As I said, this is one of the major reasons we vaccinate children today. Additionally, the vaccination of young children has virtually eliminated death and hospitalizations from chickenpox in contemporary America. Add chickenpox vaccine to the long list of amazing success stories for vaccines have scored in the past 100 years. In my opinion, anyone who tells you that chickenpox was just a minor illness of childhood and we needn’t vaccinate children today just doesn’t know what they are talking about.
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Edited by Dr. Monica Miller
Incidence of shingles actually going up in U.S.
Incidence of Shingles increasing in U.S. not related to vaccine
Reduction in Chickenpox deaths