To ask for opinions on varicella vaccine vs natural immunity?

[Moopp]

I am not an anti vaxxer - me and my kids have had every vaccine offered so far. My kids will be eligible for a single dose of vaccine in the next year on the NHS. They have not yet had chickenpox, as there's only been one outbreak locally and we missed it.

The varicella vaccine offers protection for 10-20 years, and many people may get lifelong immunity, but it's only been in use since the 90s so it's presumably actually an unknown.
Natural infection generally offers lifelong protection.

My options:

• try to get the kids infected naturally before their vaccine appointment comes through. Very low risk of serious complications as they are both healthy, age 3 and nearly 5. They get lifelong protection.

• get them a single dose of vaccine, which offers 95% protection for 10-20 years (maybe more). They might then contract chickenpox in adulthood and it is much nastier for adults.

I will not leave them both unvaccinated AND uninfected, as I want to contribute to herd immunity. That's not an option.

Obviously eventually we might as a country get to a point where so many people being vaccinated means there is so little chickenpox circulating that their chances of catching it as older adults is really small. But that relies on vaccine uptake (or natural immunity) being above 80% I believe, and I'm not sure I have that much faith in people's decision to choose to vaccinate anymore. It will be generally offered with MMR, and uptake for that is currently 84% and declining.

It's worth mentioning that both my kids are boys, so I don't have to worry about the additional risk of them getting chickenpox in pregnancy should their vaccine based immunity wear off in less than 40 years.

If anyone is really knowledgeable about long-term varicella vaccine immunity I'd really value your input. Also I'm just interested if anyone has a perspective I haven't thought of.

Hmm. I don’t have any medical knowledge but my 15 year old had virulent chicken pox aged 3 and is currently recovering from a nasty dose of shingles. So I’m not convinced on the lifelong immunity point. He’s been so unwell he’s missed all
his GCSE mocks and some other things that are pretty important to him. He’s since given his primary aged sister chicken pox and she’s been very unwell also. If I’d had time to get her vaccinated before she contracted it I would have done. It’s a nasty virus and had made both of my children very unwell not to mention given them scars, and no ‘benefit’ around avoiding future doses of shingles which can be recurring. I think they should hurry up and roll out the vaccine.

Are you an epidemiologist?

I don’t know anything about this vaccine, and I don’t have any kids, but it sounds weird to me to try and get them infected, rather than the vaccine. Like the pox parties of the past. Sounds riskier to try and get the actual disease than just the vaccine?

I’m conflicted - it’s a horrible illness for some and can cause severe complications rarely but enough to be considered problematic. It’s why the rest of the world do vax.

At the same time when I had my first child my nct group had a few GPs who were also debating it, especially for girls. One said that it was better to get natural immunity for girls to be sure they’re covered when pregnant. At this time the vax could be bought privately.

I was also told once by a hcp that being exposed regularly to the circulating virus helped prevent shingles, but I don’t know if that’s correct.

some gp mums were getting it for their kids as you need to take so much time off work to look after them - and it’s just a horrible infection for some.

even though I had it as a child and my own kids had it and I’ve been in contact with 1000s of children via my job I caught it a couple of years ago. Probably due to post cancer treatment. It was fucking awful; I still had new spots popping up after 3 weeks. You’d get a wave of horrible fatigue a few hours before a crop popped up. I had to have 3 weeks off work and I felt like shit for about 5-6 weeks in total. Also took a few days to diagnose. But if everyone was vaccinated there’d be less circulating.

I don’t think everyone would get the vax though given measles vax rates? And they’re used to not getting it.

Other countries must have a good evidence base now to know the reasoning why.

the shingles vaccine is associated with reducing dementia risk. https://www.nature.com/articles/s41591-024-03201-5

i took the same view as you about a decade ago before it was offered on NHS. I considered buying it privately but I didn’t want them getting chickenpox as adults if the vaccine wore off but disease was still circulating in kids nationally because of no NHS vaccine. I wouldn’t have deliberately tried to get them infected though. I don’t regret not buying the vaccine privately as I made the best decision I could with the information I had at the time.

But having actually then experienced both my kids having fairly severe infections, one after the other, if I had another child now I’d get them the vaccine and definitely now it’s on the NHS. Both kids had literally hundreds of spots (including in their mouths and ears) and a pretty miserable week. Neither of them had lasting effects or scarring but watching my child scream in pain every time she urinated due to spots in her nappy area is not something I would want to repeat.

I'm in the US where we've been vaccinating since the 90s.

My kids haven't gotten chicken pox and thus won't be getting shingles. That's a big win.

I would regard catching Chickenpox (varicella zoster) as something to be avoided if at all possible.

Low risk of serious complications from varicella zoster infection isn’t no risk. The rare but serious / life threatening complications can occur in previously healthy children.

www.thetimes.com/article/9119df77-f3eb-4437-ad84-fffd4fb4ac7a?shareToken=27bd6ca7be041e2a9e2ef34eb81aba9d

There is also the risk of getting shingles as a consequence of childhood chickenpox infection. It’s an unpleasant condition at the best of times but can be more serious in immunosuppressed adults - for example those undergoing cancer treatment. We never know what is around the corner. People who have never had chickenpox can’t get shingles.

The chickenpox vaccination programme is, as you say, still evolving. If adulthood infections in previously vaccinated people turn out to be a problem, there’s always going to be the option of a booster vaccine.

I paid privately for DS3 to have a chickenpox vaccine on his first birthday, and I’m still convinced it was the right decision

Tbh writing it all down, I’d get the vaccine. One if my children behaved very strangely around the time it might affect the brain and it was worrying. Only lasted a day. A friend had to take her child into hospital to be monitored and put on a drip. The risk is encephalitis.

looking after one with CP and one with scarlet fever the same week with DH away nearly killed me.

My son has an auto-immune disease (Colitis), directly as a result of chickenpox when he was 8. He now has PSC liver as an extension of colitis. He will be looking at a liver transplant in the next 10 years. He is still only 19.

Chickenpox is a horrible, horrible disease.

Both my other children had it with no complications: I was naively expecting the same for child 3.

Why the fuck I didn’t get shingles but caught CP again I’ll never know.

If there’s a vaccine for it I’d opt for the vaccine. Infection is generally less problematic in early childhood than later in life, hence the “chicken pox parties” of old prior to the vaccine, but it can still have nasty, albeit uncommon, symptoms and follow on illnesses, and natural immunity doesn’t prevent shingles later on.

NHS weighs up risks v cost benefits so there must be an overall benefit

I'm no epidemiologist but - if you're aiming to get your children infected, then I don't understand how you're contributing to herd immunity? Aren't you just propagating the disease?

I believe this is incorrect. Your chances of getting shingles after the vaccine are lower than if you have contracted the actual virus, but you can still get it.

If I was I would not be asking!

I couldn't afford to stay home with a week each (at least!) for each of mine.

also, our family is excema prone and it's strongly recommended.

plus it can be really nasty. one neighbour's dc had the pocks in the lung and this resulted in a really poorly child.

Just remembered that (I think) in NZ they get the CP before some other the others; I know someone who came back here and had to get catch up mmr etc for their toddler but he’d had the CP

chickenpox as an adult is nasty. Go for the vaccine.
I always thought I had 'natural immunity' as I'd top/tailed in a bed with my cousin who had CP badly,and I didn't get it (age 6). I got it when I was 18. Not recommended.

At a population level there definitely is in the future if vaccine uptake is high enough. Cases will be much lower as far less chickenpox will be circulating.

I’m so sorry, what an awful thing to happen. On this basis alone I’d get it. Really hope your son gets the transplant he needs and is well.

The vaccine wasn't a thing when I was a kid. For years, I thought I'd acquired immunity because I never got it, even though many of my school friends did.

I had chicken pox when I was 36, I think I caught it from my neighbour, who was 49. We were both really ill, and was off work for around 3 weeks. I had repeated attacks of shingles for 10 years or so afterwards.

If I hadn't had it, I'd definitely have the vaccine.

I really appreciate those pointing out the possible severe side effects. I'm well aware that's a risk. But if the vaccine does NOT offer lifelong immunity, as may be the case, I am choosing between the risk of side effects in children, and the risk of side effects in adults (which tend to be more common and more severe)?

I opted not to vaccinate 20 years ago (living in a country where they routinely vaccinated) because I was worried that they wouldn’t be able to access boosters in the U.K. when we moved back. They both caught chicken pox within 6 weeks of landing back here!

I had shingles recently and I have never felt so ill or been in so much pain, it was similar levels to being in labour! For that reason alone I would get the vaccine as natural immunity from getting cp means you are at much higher risk of shingles later in life

Testing had shown that the vaccine does not decline in effectiveness over 25 years. They haven't tested it after that but the assumption is if it hasn't changed in 25 years it probably lasts indefinitely.