I should have known…

So, yesterday morning I had to spend an hour in employee health, having my lungs checked out and my blood banked just in case I end up needing to work in a BSL-3 lab sometime in the future (due to a grant we’re pursuing). Stupid me didn’t realize I’d have to wait so long and went there empty-handed, and my choices of reading material consisted of either hunting magazines or a really old People magazine (I swear, this week is a conspiracy to get me to obsess about pop culture). In the midst of all the celeb stories, though, was an article on chickenpox parties. Where people take their kids to get them purposely infected with varicella. Probably would have done my mental state better to just read about Tom Cruise…

Like I said, I should have known this was probably still going on. I remember when I had chicken pox in first grade, and my cousin brought her three kids (who were my age–tangled family tree and long story) over to our house with the purpose of infecting them. It worked, and within a few days there were 6 of us spotted kids. But–this was in 1982, long before the introduction of the varicella vaccine here in the United States. Chickenpox “parties” were deemed a better alternative to potentially encountering the disease as an adult–when the frequency of serious complications is higher. Today, however, that just ain’t so.

I know that many people still view chickenpox as “just a harmless childhood illness.” Sure, for many of us, that’s the case. So far, I’ve escaped with little more than a few scars on my forehead (I admit, I was a scratcher) and the ugliest childhood picture *ever*, since I decided to do some surgery on my bangs while I was pocked–resulting in about quarter-inch long, very crooked bangs. Did I mention I also had giant pink glasses and a few missing teeth at the time as well? Anyhoo, other than that, so far, so good. However, there’s a very real possibility that I could develop shingles later in my life. Additionally, the wild virus just ain’t as benign as we’d like to think. It can cause severe pneumonia or encephalitis. Additionally, I mentioned here that deadly infections with the group A streptococcus are becoming more common. Guess what’s a major risk factor for these infections? Yep–chicken pox. Check out, for example, this manuscript on invasive group A strep disease in Alberta, Canada, which notes that “varicella virus infection preceded invasive GAS disease in 25% of children 8 years of age and under.” It has the potential to be much more than just an inconvenient itch.

What about the vaccine? Though it’s only been on the market in the US for about 10 years, it was initially developed in the 1970s and was used in Japan and Korea since the 1980s. It’s a live attenuated vaccine, so it doesn’t completely eliminate the risk for shingles later in life, but several studies suggest shingles is less common and less severe in those who received the vaccine than those who acquired chickenpox naturally.

What about thimerosal? Even if you were a parent who was worried about the potential connection between thimerosal and autism (one I disagree with, I might add), the chickenpox shot (“Varivax”) doesn’t even contain thimerosal. I just don’t get it.

Vaccination, Thimerosal, Infectious disease

Comments

#1 CanuckRob
February 14, 2006

We did the same thing with our kids in the mid 80′s. Sounds like it was not the best idea but frankly the thought of three kids all sick for a week seemed better than one kid at at time sick for a week each. I don’t recall a vaccine being avaialble (in Canada) at the time but I know that greatnieces and greatnephews have since received one. I will pass your post along to other folks I know with young kids that have mentioned the idea of poxparties. Thanks as always for a good read.
#2 ericnh
February 14, 2006

As someone who plans on starting a family pretty soon, I don’t see why the “possible” link between thimerosal and autism and risks therein should take precedence over the very real risks posed by the diseases these vaccines are protecting against. I’m going with the vaccines until someone shows me definitively otherwise.

On a side note, it’s interesting that parents are still hosting “chickenpox” parties (don’t know if that’s how I got it, though I doubt it). I recently saw an old South Park episode where the parents did that very thing. The twist at the end was when the kids heard someone mention that chickenpox is a herpes virus, they took revenge on the “parental conspiracy” by hiring a prostitute to come into their homes and spread her herpes around to infect the parents.
#3 Orac
February 14, 2006

The “link” between thimerosal and autism is, as far as epidemiological studies go, exceedingly weak to nonexistent as is the claim of an “autism epidemic.” For example, the claim that autism was unknown before thimerosal was introduced in the 1930′s is utterly ridiculous, as there are many descriptions of symptom clusters that we would recognize today as autism dating back at least to the 18th century. Also, before the syndrome known as autism was formally described in the early 1940′s by Leo Kanner, it had been described in less detail by Eugen Bleuler in 1911. Until fairly recently, it was not uncommon for autistics to be misdiagnosed as schizophrenic. The apparent rise in cases of autism is almost entirely due to the broadening of diagnostic criteria back in the early 1990′s. Finally, even though thimerosal was removed from all routine childhood vaccines with the exception of the flu vaccine by early 2003, there is no evidence of a decrease in the rate of diagnosis of new autism cases, a diagnosis that is most commonly made between ages 2 and 5. In a couple of more years, if autism rates in this country do not fall quite dramatically, that will be the final piece of epidemiological evidence refuting the claim of groups like Generation Rescue that autism is mercury poisoning.

In fact, autism is not mercury poisoning. The symptoms and clinical course of the two conditions are quite distinct. The sad thing is that desperate parents are being bilked and subjecting their children to potentially dangerous chelation therapy in an effort to “cleanse” the mercury from their children.
#4 Clark Bartram
February 14, 2006

Sunday’s rerun of the Simpson’s featured a chicken pox party. Funny coincidence or did you see the episode? Anyway back to varicella. In children with poor immune function such as with leukemia, mortality rates from varicella have ranged from 7-28%. This is even more striking when compared to the case fatality rate in the general population of 6.7/100,000. The vaccine not only saves a whole bunch of money, more importantly it saves the lives of people of all ages.

Typically morbidity associated with varicella is due to overwhelming viremia, encephalitis, bacterial superinfection(as you eloquently pointed out), pneumonia, and Reye syndrome (a result of concurrent aspirin use and why we say no aspirin for kids). Common complications include secondary staphylococcal or streptococcal infections of the skin and upper respiratory tract, including otitis media. Central nervous system complications include aseptic meningitis and Guillain Barre syndrome. Other complications include thrombocytopenia, arthritis, hepatitis, and glomerulonephritis.

Another important aspect of chicken pox infections that people tend to forget is the effect on neonates. In pregnant women, varicella during the first 20 weeks of gestation can lead to multiple congenital anomalies including limb atrophy, neurologic and ocular abnormalities, as well as growth retardation.
Infants born to women who have varicella 5 days or fewer before delivery or 2 days postpartum may develop disseminated varicella neonatorum. Hemorrhagic lesions of the liver and lungs characterize this potentially fatal disease.

I don’t think that the people who attend pox parties realize this or else they are just plain loco.
#5 Kristjan Wager
February 14, 2006

In fact, autism is not mercury poisoning. The symptoms and clinical course of the two conditions are quite distinct. The sad thing is that desperate parents are being bilked and subjecting their children to potentially dangerous chelation therapy in an effort to “cleanse” the mercury from their children.

Ah, but Orac, as a doctor, and thus a member of the world-wide mercury conspiracy, you would say that.

[note to the readers who don't know me - I don't really believe in a mercury-autism link, and I certainly don't believe in doctors trying to cover up such a link]
#6 Tara
February 14, 2006

Heh. I’d not seen the Simpsons or South Park episodes with pox parties. I didn’t realize this was still so widespread; I’d assumed they went the way of the dinosaur.

I don’t think that the people who attend pox parties realize this or else they are just plain loco.

I really think it’s mostly the former (with a bit of the latter thrown in). As I said, few people think of chicken pox as a deadly disease–and your point regarding varicella in pregnancy is another good one that I’d not mentioned. Still, one would hope that parents would educate themselves, and that their pediatricians were forthcoming about the very real risk of a “wild” chickenpox infection, compared with the minimal risks of the vaccine.
#7 Vasha
February 14, 2006

Hm, ignorant question here. So varicella is a herpes virus? Seems to be quite a large and diverse group of viruses. About how many types of herpes virus are there, and why do they cause such diverse pathologies? Are there any non-pathogenic ones?

Apparently, the recurring upper respiratory ailment that one of my cats suffers from is also from a herpes virus. Once every year or so (usually triggered by a stressful event) he starts to sneeze and sniffle; the vet said it’s probably not a fresh infection but just the resident virus population becoming active, the way humans have periodic cold sore outbreaks.
#8 biosparite
February 14, 2006

I dare you to post your chicken-pox photo.
#9 Ocellated
February 15, 2006

Tara, you know you want to post that picture… After all, you can never be objective about your own pictures. For a truly fair opinion, you need to let everyone see it.
#10 Joseph O'Donnell
February 15, 2006

Vasha:

Seems to be quite a large and diverse group of viruses. About how many types of herpes virus are there, and why do they cause such diverse pathologies? Are there any non-pathogenic ones?

Many viruses are capable of causing more than kind of infection depending on where it ends up in the body. Herpes is no exception, being able to cause cold sores in one environment (on the lips), genital warts in another (in ‘special’ places) and more serious disease if it can infect the central nervous system.

More specific to your questions there are three main groups of viruses in the ‘herpes’ group. They are alpha, beta and gamma herpesviruses, of which varicella (that causes chickenpox) and herpes are both in the alphaherpesvirus group. Epstein-Barr virus is an example of a gammaherpesvirus and cytomegalovirus (CMV) is a betaherpesvirus. All of these viruses have some pretty diverse range of infections and the kind of pathology they present.

There are probably quite a few herpes viruses that are pretty benign in the end. For example, I would guess that there are evolutionary related herpes viruses that infect other animals including household pets. Due to their specialisation for their host however, they probably don’t present any real worry for the human immune system.

Tara:

Chicken pox photos? Yes please.
#11 Tara
February 15, 2006

Heh. Pox photo is 600 miles away at my parents’ house. I’ll have to see if I can dig it up while I’m there this weekend…
#12 Dr. Andy
February 17, 2006

I haven’t seen this article (I did see the Simpsons episode), but since children are routinely vaccinated for varicella at 12-18 months, the “pox parties” presumably involve infants, which. But we know that infection before a year of age leads to a less vigorous and long-lasting immune response, increasing the risk of repeat infection and shingles. Yet another reason these parties are a bad idea

Dr. Andy
#13 clarkbar2019
February 17, 2006

Speaking of inane parental choices. I recently discovered that wet nursing is still around. Granted it’s used by silly rich people such as celebrities but still, wet nursing. I just don’t get it. You’ve got to really trust a woman to let her feed your child with her breast milk.
#14 CarstenS
March 1, 2006

From South Park episode 210:

DR. DOCTOR
He’ll be okay. But it’s a good idea
for us to monitor him for a while.

SHARON
Oh God, what have we done?

DR. DOCTOR
There there now, it’s not your fault.

RANDY
Doctor, we-uuuh purposefully-ee sent
our son to stay with a friend who had
chicken pox so that he would get it
early.

DR. DOCTOR
Oh, wow. You did? Wow… You guys suck.
#15 M
March 2, 2006

If you could pass this on to the NHS, who still don’t immunise children against Chickenpox, that might be nice….

(I have heard people blaming Andrew Wakefield for that one – there isn’t the political will to introduce something that could have the same reaction from the Daily Mail as MMR has had. I hate the tabloids)
#16 Ron Sullivan
March 3, 2006

Sometimes a factual story works where the accumulation of facts doesn’t. People respond at a gut level to stories. Here’s mine, factual and first-person:

I knew a kid who was one of those statistics of chickenpox complications.

I worked as a nurse in a pediatric hospital in the late ’70s�early ’80s. I met, let’s call him Tony, in the ICU and later on the floor where I was based. And again in a year or so, ditto. He was a brave, bright, and engaging kid, and we all got to know him by his “Tony Macaroni” nickname. He came from what I’d call a middle- or upper-middle-class family in the suburbs here, had caring and involved parents (also bright and engaging), good nutrition, fresh air and sunshine and the whole happy-childhood suite, no known predispositions to ill health.

When I met him in the ICU, he was recovering from amputation of both his legs well above the knees, after complications — if I recall correctly, of the sort called “varicella gangrenosa” — of chickenpox. He was, I heard repeatedly, lucky not to have lost his hands too.

He was two years old, which made the story worse than it first sounds. Not just because he’d been so cruelly mutilated at such a young age, but because he was still growing and the amputations were at such a mid-bone level. Scar tissue doesn’t grow along with skin and muscle and bone, and his stumps would need repeated revision to release the scar tissue and let his leg bones lengthen. The signal that such a revision was needed again was that his legs hurt like hell.

Now this was a kid who cheerfully put up with all the weird dressings and arrangements and IM injections and IV placings and the rest of the medical torture and annoyance routine. In short, not a dramatic child or a whiner. To see him, at three years old, at four, lying in bed waving his stumps in the air and grinding his teeth and then weeping “Ow-ie, OWie!” — we knew it hurt seriously when that bone shaft was pushing against the remaining bits of flesh and nerve at the ends of his legs. We knew, and I suspect that he did too after a repetition or two, that he was going to have to go through this every year, maybe more, from toddlerhood until he stopped growing in his late teens. By then, I hope he’d acquired a vocabulary more adequate to express his pain.

Complications from chickenpox are “rare” of course. But they aren’t all that predictable either, and no parent who deliberately lets a child catch the real full-on virus has any reason to trust that that child has more luck (“grace,” “blessings,” “miracles”) than Tony. I’ve told Tony’s story by way of witnessing to groups that have lots of parents, and asked them to picture their children at his age lying in bed waving their stumps and weeping, at least once every year of their childhood.
#17 Tara
March 3, 2006

Wow–that is truly horrible. I wonder if it was invasive strep that caused the tissue damage–as I mentioned, there are numerous case reports of necrotizing fasciitis following chicken pox (which can lead to amputation, as you describe). That poor kid.
#18 Ron Sullivan
March 3, 2006

Tara — maybe, but (twenty years later) ISTR something about blood-vessel shutdown rather than opportunistic secondary infection.
#19 Jeremy Cherfas
March 17, 2006

OK, I accept that chicken pox is no joke, and having had shingles once, I wouldn’t wish that on anybody. But how about Rubella parties?

I’m working from memory here, but as I recall you need either very high vaccination rates or very low ones to protect fetuses. In the absence of high high vaccination rates, parties are the way to go.

Aren’t they?
#20 Tara C. Smith
March 17, 2006

Why not just get re-vaccinated? I got a booster when I was 16 (nothing to do with pregnancy–long story).
#21 Lucy
April 12, 2006

How can studies show that the incidence of shingles is lower with the vaccine, when shingles is known as a disease that primarily effects older people. If the vaccine was introduced in the 1970s in Japan. The children who had the vaccine would be in their 30s or 40s know, and therefore not prime shingles targets.

I’m not against vaccines. My children have been vaccinated against everything except chickenpox.

I retain 2 doubts over the chickenpox vaccine, the first because of the shingles issue. I had chickenpox as a 6 month old, and I’ve had recurrences of shingles 3 times since then, the first at 4 years old. I know how bad shingles is. I do not wish to knowingly inject my children with a live vaccine which carries the risk of shingles in later life.

Secondly, I did discuss this issue with our PCP. I was told my children would have to have booster shots in their early teens and every so often after that to retain immunity. We are immigrants to the US, we do not know if we intend to stay here. If we move back to our country of origin, where the vaccine is not presently available, will my children be at risk. If they’re going to get chickenpox (hopefully not) surely it is better to have it as a child, rather than a teenager or adult?

If someone can successfully calm my doubts with factual evidence I would have my children vaccinated. In the meantime, I’m going selfishly really on herd immunity. Other people rely on my children’s immunity with regard to other vaccinations.
#22 Tara
April 12, 2006

I retain 2 doubts over the chickenpox vaccine, the first because of the shingles issue. I had chickenpox as a 6 month old, and I’ve had recurrences of shingles 3 times since then, the first at 4 years old. I know how bad shingles is. I do not wish to knowingly inject my children with a live vaccine which carries the risk of shingles in later life.

I’m sure you know the risks that come with getting chickenpox as an adult. Adults who contract the virus are on the order of 900% more likely to be hospitalized than children, more likely to die from the virus, and it can also cause miscarriage in pregnant women. As far as shingles, indeed, the cohort isn’t yet old enough to have hit the age of maximum shingles incidence (over age 60), but as your experience shows, shingles can also hit younger people. It’s this that’s been investigated thus far, showing that those who received the vaccination have a lower rate of shingles to date than their unvaccinated peers.

Regarding waning immunity, that is a consideration. As more people get the vaccine and less “natural” varicella circulates, there is likely to be a reduced natural booster effect, potentially leading to decreasing immunity with age. However, the research is ongoing, so for your PCP to confidently say they’ll need boosters is, IMO, a bit beyond what the literature says at the moment. It’s a concern, but hasn’t really been established that immunity will wane to a level where boosters will be needed. Either way, this obviously isn’t a such big deal here in the US where one can receive a booster rather easily, but I can understand your concern if you may move somewhere they’re not available. What I would think is if you got them vaccinated now and boosted prior to moving back to your home country (where I assume varicella is more common), they’d have enough immunity initially to avoid infection (or at least serious complications of infection, which is the real goal of the vaccine) and then be boosted from natural exposure and not have to rely upon booster vaccines after that. That’s also something you could discuss with your pediatrician, who may even be able to order antibody tests for your kids before moving elsewhere in order to see how protected they are.

Clearly, it’s your choice and your children, and there are some risks either way. For me, my kids have both been vaccinated.
#23 Mia
April 26, 2006

According to the CDC, Chicken Pox is on the rise this year.
http://wonder.cdc.gov/mmwr/mmwr_reps.asp?mmwr_table=2H&mmwr_year=2006&mmwr_week=15

Of the 17 states that are having outbreaks, only 3 do not mandate the Varicella vaccine.

The 14 states that do mandate it have theoretically reached “herd immunity”, so, why are these outbreaks occuring? If “herd immunity” is correct, then there should be zero outbreaks.

As for the previous poster regarding immunity, just get your blood titers done to see if you are immune. If not, then get the booster.

I was born before the Varicella vaccine and got chicken Pox as an adult. It sucked, but I survived.
I had my blood titers done 6 months later and now have life-long immunity.
The vaccine does not provide life-long immunity, therefore you would need the booster, which would put you at risk for herpes zoster or other complications.
#24 Helen
July 20, 2006

I can’t get in in my head how can parents porpously infect their children with the deseas if they are not sure in positive result.
#25 Mike Crichton
September 20, 2007

Dr. Andy wrote:

I haven’t seen this article (I did see the Simpsons episode), but since children are routinely vaccinated for varicella at 12-18 months, the “pox parties” presumably involve infants

Actually, they usually involve kids whose parents, for whatever reason, chose not to get them vaccinated. Probably for some stupid “It’s not natural! It’s worse than the disease! OMG, Big Pharma is EEEVIL!” reason or other.
#26 yabancı film izle
May 5, 2009

thank you man.Regarding waning immunity, that is a consideration.
#27 mary
March 4, 2010

I’m on my way to a pox party tomorrow. We’ve thought long and hard about immunizations and have chosen to go ahead with a nearly regular schedule of them all, except for the pox.

After researching them all and being grossed out about the cow blood and different animal products used for vaccines, it wasn’t until the human dna from some random guy who had chicken pox when the vaccine was being made, that I drew the line. Medically there’s probably nothing wrong with it…in fact I’m sure there’s nothing wrong with it. It just weirded me out to think that everyone with the vaccine is running around with some other person’s dna permanently floating around in their body.

I know people don’t catch autism, this is not a concern of mine at all, it’s purely a choice I’ve made because A. there is less risk of my child dying from the pox than driving to the grocery store, and B. the immunity is longer lasting than with the vaccine.

Also, I’m a stay at home mom who’s returning to work in September, better he get the pox now while I’m able to care for him without putting kids in daycare at risk or costing my employer sick day money.