Chickenpox - why isn’t vaccination routine?

[RebeccaJM]

What the title says - I genuinely don’t understand why the NHS doesn’t offer chickenpox vaccinations as part of the routine childhood immunisations. It’s a nasty virus that can make children extremely unhappy for days if not weeks, can leave significant lifelong scars, almost always means that parents (mostly mothers) have to take time off work (which as an economic cost must surely outweigh the costs of mass vaccination), and can sometimes lead to very serious complications for the child.

Where I’m from (Australia) it’s part of the compulsory pre-school vaccination programme. I got my DD vaccinated privately and every time there’s an outbreak at her nursery I’m so thankful I did.

I’m so baffled by the UK public health position on this.

Because it's expensive.

The theory is that exposure to poxy children protects the adult population against shingles.
I also got my children vaccinated.

Funnily enough I was just thinking about this today and wondering if I made the right choice in vaccinating my little one. Most people will assume that it's just something children should go through but his nursery group is having so many children off with it. I don't think it's a routine vaccination because of this whole attitude of it being just something kids go through!

Mmm! down to money probably - my SIL who is born and bred USA was horrified our kids are not routinely vaccinated. DS had it aged 4 and it wasn't so bad for him but I never has it as a kid so was very ill with it in my mid 30's when I caught it from him.

Twenty years ago, they realised that the chicken pox vaccine caused several deaths of older adults from shingles for every child saved by it. So they did not mandate it, and developed a shingles vaccine. The countries than mandate chicken pox, also encourage shingles vaccines for middle aged and older adults.

Now we have had successes with the shingles vaccine, I think that the U.K. will eventually add the chicken pox vaccine to the NHS immunisation schedule.

I agree cost of doing both chicken pox and shingles vaccines across the board is probably the source of the delay. The NHS is massively underfunded and has been for over a decade.

So does this mean if I paid for DS to have chickenpox vaccines when he was about 5, he needs to schedule some kind of shingles vaccine later when he is an adult?

@barlie no, it means that you should pay for yourself to have a shingles vaccine at the same time.

Shingles is the same virus as chicken pox but adults don't usually catch it because their own immune system which learned to beat the chicken pox virus during childhood stays active and able to protect the body for many years. However that immunity can degrade if not regularly challenged. A low level but regular exposure to chicken pox that circulates among children helps keep adults immune from shingles. When most children are vaccinated that protective effect disappears and the adult population becomes much more vulnerable to shingles. Any widespread roll out of a children's vaccine for chicken pox must be accompanied by a massive roll out of shingles vaccines for adults but that won't happen.

AIUI has been under review and expected to change (delayed by COVID). Questionable assumptions in the original cost benefit modelling and the experience of other countries suggests the benefits outweigh the hypothetical downsides.

@JaukiVexnoydi Thank you for that excellent explanation, it made me wish people I work with could be so clear.

OP, I had my DC vaccinated privately because as a single parent it was cheaper than taking unpaid leave from work when they inevitably got it.

I think the “shingles” reason looks very dubious. Most countries rolled out the CP vaccine quite a long time ago, before the shingles vaccine became widespread, yet shingles rates in those years look similar to the UK.

The real reason for the non-issuing of CP vaccine here was because the original plan was to include it within the MMR (so, creating MMRV), but then Wakefield happened just when this was about to be rolled out, MMR uptake rates went through the floor, and the powers that be decided that they simply couldn’t risk adding another element to the MMR in case it made the mass panic even worse. Now the momentum has gone and the NHS is struggling and has no money, so the situation has been allowed to persist.

Everyone should get their child vaccinated. I’ve seen full blown CP cases result in some really grim pockmarks on faces.

For my eldest, I didn't even know there was a chickenpox vaccine. I've had my youngest vaccinated. I think there's an element of using kids as human vaccines in this country and playing down impacts of illnesses on them.

In Australia it's included on the government funded list.

But I think meningococcal B is included in the UK whereas you pay privately in Australia.

It would mean that if you get your DC vaccinated against chicken pox, you should probably schedule a shingles vaccine for yourself at age 50, and shingles vaccines for any grandparents now.

BUT this is old science from early 2000s and scientists today are not sure that the chicken pox vaccine was actually the cause of the increase in shingles and shingles deaths in adults?

Here is what they knew when the U.K. decided not to mandate the chickenpox vaccine: In 2005, Gary Goldman, PhD, was among the first researchers to publish an analysis of the mass use of chickenpox vaccine by children in the U.S. since 1995. His conclusion was that, by limiting the circulation of wild type Varicella Zoster virus in the population through mass vaccination, there is limited asymptomatic boosting of natural chickenpox immunity among adults, who had recovered from chickenpox as children. This would, in turn, cause an epidemic of shingles. In 2008 the Health Protection Agency (HPA), of the United Kingdom published new modelling that confirmed that mass use of chickenpox vaccine would lead to an increase in shingles despite the shingles vaccine. The HPA estimated that, while mass vaccination would reduce the incidence of chickenpox in children, there was an over 20 percent projected increase in the incidence of shingles in adults. The HPA confirmed that this projected increase in shingles is because adults are no longer coming in contact with natural chickenpox cases due to vaccine acquired immunity among children. In addition, studies from countries that routinely vaccinate children against chickenpox, such as the U.S., demonstrated that there is an increase in shingles in unvaccinated persons, who have not had chickenpox or the chickenpox vaccine.

you should probably schedule a shingles vaccine for yourself at age 50, and shingles vaccines for any grandparents now.

People get the shingles vaccine when they turn seventy now - in England at least, don't know about the rest of the UK.

Absolutely, but if you get your child vaccinated, you should bring your own shingles vaccine forward to age about 50. The thinking being that because you are not regularly challenging your immunity, (because your DC won't get chicken pox) you are more likely to catch shingles earlier

The eligibility for NHS shingles vaccine is widening and there are plans to offer it to even more age groups in years to come.

https://www.england.nhs.uk/2023/07/nhs-shingles-vaccine-will-be-offered-to-almost-one-million-more-people/

Having had a horrific bout of chickenpox aged 32 via my son, I'm hoping I've got extra strength immunity meanwhile!