have you given your child the chicken pox vaccine

[passivehoovering]

Hi all,

DD is 3.5 and is about to start her second year at nursery. She hasn't had chicken pox, and I really don't want her to. I don't want my darling child to get ill, feel bed, get scars, have awful complications, be seperated from her friends...So I was thinking about getting the Chicken pox vacine for her. I have mooted this with friends who also have children but they seem to want their kids to get chicken pox so I am wavering a bit.

If you have vacinated your children could you tell me how you went about it and where you found info? I don't know if I should try her GP in the first instance and ask them for info from Medline and if they know of anywhere that does the vacine. Also how was your child after? Anything else you can tell me would be much appreciated too.

Thanks

BBB

I have no doubt that increasing CP vaccinations will increase the incidence of shingles. The evidence is strong. It therefore makes sense to vaccinate against shingles as well - even in the absence of CP vaccination it makes sense.

My point with BM is that the process by which exposure to the CP virus by the elderly decreases is the exact same process as unvaccinated children are protected when others are vaccinated - ie herd immunity. She has previously denied that herd immunity can exist for vaccinated populations. In other words, if you vaccinate, you do not decrease the risk of exposure to the pathogen for others. In which case, vaccinating would not have any impact on the incidence of shingles. One outcome of herd immunity is positive (ie non immune pregnant women, immunocompromised people etc are LESS likely to be exposed and therefore get CP) and one outcome of herd immunity is negative (ie elderly people who have had CP are LESS likely to exposed and therefore more likely to develop shingles). All I'm pointing out is that you can't say that herd immunity doesn't exist for vaccinated populations if you accept that vaccinating against CP increases the incidence of shingles.

BTW, BM, if your mass education campaign to quarantine children with CP works, wouldn't that therefore have the same impact upon incidence of shingles? You say it would protect pregnant women so wouldn't it therefore decrease exposure to the virus?

As Catherina pointed out, no evidence that the vaccine wears off when people are in their 20s.

So, to be clear. We'd need to vaccinate all children against CP. Who would need a shingles vaccination? What age groups?

ideally 60+. In the UK, it's going to be rolled out to 70+. A shingles vaccine should be (and is being) introduced regardless of whether a CP vaccine is rolled out. 250,000 cases of shingles, which is preventable through vaccination, is scandalous.

But if we vaccinated all children against CP, would we need to vaccinate everyone else against shingles or only pensioners?

In the US where children are routinely vaccinated against CP, it's recommended for all adults above 60.

I see. But could they not do that even if they didn't vaccinate against CP?

Yes, Elaine, I hadn't thought of that flaw with bm's idea. Btw, isn't the increase in shingles a tempory situation? I would expect that once circulating cp virus was brought down enough it would no longer be around to ever cause shingles. The problem with vaccination programs in adults, however, is with uptake. They mention this in BBB's link and I naturally feel this to be true.

Yes, Tabithta. I think they should vaccinate against shingles regardless of a CP vax.

LeBFG - I think adults need to be responsible for themselves. Shingles is nasty enough that I think uptake would be significant.

www.ncbi.nlm.nih.gov/pmc/articles/PMC2563790/
"Combined results from three studies suggest the increased incidence of shingles would last for 30?50 years and would affect mostly those aged 10?44 years at the time of vaccine introduction."

So we'd have to vaccinate against CP for 30 to 50 years?

If we are talking of vaccinating the over 60s against shingles, perhaps it could be offered at the time of their flu jab? From the pensioners I know, the flu jab is popular.

I'm being an idiot. They wouldn't need an annual shingles jab, would they? Perhaps the shingles jab could be offered when they go for their first annual flu jab?

I think the chances of the virus being reactivated to shingles when in a vaccinated person as opposed to wild is significantly less.

So we're the unlucky generation! Oh, and those children whose parents decide not to vaccinate them (when it eventaully becomes available in the UK) - I'm sure they'll thank them for increasing their risk of later getting shingles!

But from what the article was saying that I linked to earlier, the incidence of shingles in younger people, people who have been vaccinated is increasing too. I don't know if anybody got as far as the comments on that piece but there as a post from a mother of a 3 year old who had had the CP vaccination at about 12mths but then got a bout of shingles at 3. That is just horrible.

I haven't read anything that it explains this but surely if you are immune through vaccination with a live but weakened virus you have the same dormant virus in your nerve endings as as person who had immunity by having CP? Would that not mean your risk of shingles wouldn't change? If anybody know of any article that clarifies that I would be grateful. Tabitha's link seems to to suggest that vaccination viruses don't cause shingles in later life but that is not what has been suggested in other things I have read. Maybe we just won't know for 50 years.

And yes, Tabitha, I would think we would have to vaccinate against CP for at least the next 50 years. I can't see this being like smallpox which has now been irradicated. For a start, there are an awful lot of countries which don't offer the vaccine as standard. Smallpox was irradicated by a global vaccination programme. Secondly, there is the issue of the dormant virus and shingles (unless somebody can find that link which shows that the vaccine can't cause shingles in the same way as immunity to CP can). And third is that the world is a different place now. After the MMR mess, people are not so quick to do as they are told or to trust doctors so the uptake won't be nearly high enough to get rid of the disease, I suspect. We have been vaccinating for measles, mumps, TB, tetnus, etc, since I was a child, which is coming up for 50 years, and we still have to do it. The only one which may possibly be irradicated soon is polio and then we will be able to halt the vaccination programme. Also I don't think, given the relatively mild nature of CP and the low mortality, compared with some of the other diseases mentioned, that there will be a real desire to irradicate it. Introducing a vaccine will be a very long term commitment.

It'll take a long time before CP vax is introduced in low income countries. Let's get rid of measles first. Worrying about CP is really a first world problem, we are in a very privileged position.

I read that shingles was increasing before CP vax was introduced. Not sure why.

And I think we're learning about impact of CP vax on shingles as cohorts progress. And it looks like incidence is much less for vaxed individuals.

Measles and also TB are the ones I would be going for too.

I thought TB had greatly reduced to the point that there was a hope of irradicating it but then it mutated or something and now it is on the increase? Anyway, we won't be rid of the dreaded BCG any time soon (still remember that from school with that 7 needle jab. )

From what I have read, the USA, Germany, Australia and Japan are the main countries who have CP vaccinations as part of their standard programme. I tried to find out who esle includes it and there wasn't much information. I don't think it is just low income countries that aren't focussing on CP.

Canada, France, Italy, Greece, Spain, Israel, South Korea, Qatar, Oman, Latvia, Slovenia, Luxembourg - they also vaccinate against cp. Probably others do as well. The UK is definitely in the minority among developed countries.

I think TB is hard because of HIV, it's one of the diseases AIDS sufferers eventually die of :( you've also got multi drug resistant tb now which really is terrifying!

Not so sure about France actually Elaine. It's not on the vaccine schedule they hand out at birth. Perhaps it's available though. I'll ask my paediatrician at our next visit.

You're right to point out cp is a first world problem. It'll be interesting to see what happens in the States. Some projections give shingles peaking after 30/40 years then dropping. I expect it'll depend on how effective the vaccine is at preventing the virus from circulating (seems be very effective, even with vaccinating only part of the population) and at what level the wild virus needs to be brung down to in order that shingles cases drop below pre-vaccine figures. I don't suppose the figures in the models are including 100% vaccine coverage, but I haven't checked.

No France isn't on any list of countries that vaccinate against CP that I have seen. And the last list I saw said only Sicily had the vaccination, not the whole of Italy and weirdly just Madrid in Spain. Looks to me like the UK is not in the minority for not giving CP routinely. What about the Scandanavian countries, Belgium, Netherlands, Portugal? Russia even.

Not that it is particularly an argument for vaccinating or not, we have to decide as a country whether or not to do it, but I don't like the potential for scaremongering that comes with the argument that 'everybody else does it' especially when that isn't true.

It is absolutely an argument - if other developed countries are introducing the vaccine successfully then their experience should inform the debate in the uk. The more countries who do so, the stronger an argument.

France was based on my friend telling me she'd had her kids vaccinated within the public system, not sure if it's necessarily recommended for all. But stil, with the us, Japan, and Germany alone - that's a huge number of children being vaccinated as these are very big countries.

Of course it is part of the debate but it shouldn't be the main argument. I wouldn't want any decision to be made on the basis that everybody else is doing it.

You are also ignoring the fact that with large populations being vaccinated against CP, there will also be a large population in which to have a shingles outbreak of epidemic proportions.

I still do not get why CP is considered more important than shingles. It baffles me why it is a good choice to vaccinate against a mild disease and allow more people to suffer from (and require costly and potentiall long term treatment for) a much more severe disease.

BBB
"Also I don't think, given the relatively mild nature of CP and the low mortality, compared with some of the other diseases mentioned, that there will be a real desire to irradicate it. Introducing a vaccine will be a very long term commitment"
You said that in relation to CP and I've often wondered the same about Mumps. I don't know why a vaccine against mumps was introduced, unless we were aiming at eradication of yet another disease that is usually mild in children.

I think you've got the wrong end of the stick Tabitha. Vaccines are introduced because they are beneficial to the person who is vaccinated. Other benefits such as herd immunity, and maybe even eradication of the disease, are of course also very welcome.

I think the problem with mumps, Tabitha, is that is can lead to infertility in men and that it is quite a common complication which you can get even whilst the illness itself is not especially bad. I might have a look later to see if I can find out if more serious complications are more likely with mumps than CP

Or maybe it is simply that they developed a vaccine that became a standard part of the injection schedule in a time when people were more likely to just do as they were told. I don't think we are quite so accepting these days as threads like this show, plus the internet means that anybody can do their own research and you will always find reasons to be worried if you look hard enough!

Actually BBB, I think we've forgotten as well how deadly and unpleasant these diseases can be. Once the internet is sadly full of stories of children dying and being left permanently disabled - or just the unpleasantness of a week in hospital with pneumonia - from vaccine preventable diseases, vaccine rates will increase again.

People 'doing their own research' is a dangerous thing imo unless you're able to recognize what you don't know!

"you will always find reasons to be worried if you look hard enough!"

So true. And so hard to verify the truth of those 'reasons' too. In a past life doing research, I was aware that a lot of papers available to scientists were not available to the general public (subscriptions required) and even then, you may well use sources such as a PhD thesis or even a lab technician's results for information...all not accessible to the general public. Throw in the blogosphere rumour mill where site after site re-reports the same stuff as if they were the first to say it, so much of it unsubstantiated...dispiriting really.

As I've read more and more of the threads on this board, the more convinced I am that if someone like Paul Offit (people who are in a position of knowing the field, having a broad and deep understanding of the research) comes out with something it really is worth a thousand links to abstracts and websites. I'm not saying have blind faith it these sorts of people, but their opinions really are worth more than taping into google for a few hours.