Why Does My Child Need a Chickenpox Vaccine?

Chickenpox Vaccine

If you have a young child, you may have spoken with your pediatrician about a chickenpox vaccine. You may be thinking, “What’s the big deal? I had chickenpox, and although it wasn’t fun, it didn’t kill me. Does my child really need a chickenpox shot?” The short answer is yes, she does.

Chickenpox: The Myth and the Reality

Chickenpox is caused by the varicella zoster virus, which is why chickenpox is also known as varicella.

Many adults of a certain age remember getting chickenpox as a child, and think of it as a benign, though annoying, illness. Chickenpox is marked by fever, malaise, and those characteristic itchy spots all over the body. For many of us, that’s all it was, and we made a complete recovery. But for some, chickenpox can be a serious illness, and even deadly.

There are complications from chickenpox, including pneumonia, sepsis, severe skin infections, and neurological conditions such as encephalitis (infection of the brain) and hemorrhages (bleeding). Before the vaccine, infection was almost universal around the world, leading to about 3 deaths per every 100,000 cases. In the US, before the vaccine, chickenpox accounted for over 100 deaths per year, usually of children, and over 10,000 hospitalizations per year.1,2 Many of those children died from severe complications, such as necrotizing fasciitis, a disease caused by common bacteria that are often referred to as “flesh-eating bacteria.” If offered a vaccine against “flesh-eating bacteria,” most people wouldn’t think twice about getting that one.

For those people who are immunocompromised, such as patients undergoing cancer treatment or those with immunodeficiencies, chickenpox can be especially dangerous.

And for women who contract chickenpox while pregnant, their fetuses can be severely affected. Thought it is extremely rare, congenital varicella syndrome can result in cataracts, intrauterine growth retardation, microcephaly (very small head), microphthalmia (small eyes), micromelia (underdeveloped limbs), and intellectual disability, among other problems.

Vaccine Details

The chickenpox vaccine was first used in other countries in the 1980s, but licensed for use in the US in 1995. Since then, with widespread adoption, the vaccine has reduced the incidence of chickenpox by 90%, and the incidence of severe chickenpox by 97-98%.1 This last point is important, because complications occur in the more severe cases, so by almost eliminating severe cases of chickenpox, the vaccine reduces deaths and poor outcomes.

Since vaccination in the US became routine, deaths have decreased by 90% and hospitalizations have decreased by 84%. The vaccine has been a big success.3

You should be aware that because the vaccine’s goal is to prevent serious cases of chickenpox, your child may get a mild case of chickenpox even though she has been immunized. Such a case might consist of low-grade (or no) fever, a handful of spots (as opposed to a hundred or more in a “natural” case), and most importantly, no complications. When this happens, parents sometimes think the vaccine didn’t work, but the fact that a serious case was prevented means it worked exactly as planned.

In the US, the vaccine is given first at around 12-15 months of age, and again around 5 years old, just before entrance to kindergarten.

What Not To Do

Before the vaccine, it was common for parents to throw a “chickenpox” party: they would have all the kids gather for a sleepover at the home of a child who had an active case of the chickenpox, so that the kids would come down with it at the same time. Since infection was universal (meaning everyone got it, and there was no way to prevent it), getting the chickenpox when it was convenient for you seemed like a good idea.

But now, with a safe vaccination readily available, there is no need to put your child at risk, even if the risk is quite small. There are still communities where vaccination rates are low, and these types of parties are still being held. But such a gathering is strongly discouraged. Instead of having a party, make sure your child is vaccinated.

What About Shingles?

Chickenpox isn’t the only disease caused by the varicella virus. It also causes shingles, otherwise known as zoster. In a “natural” case of chickenpox, the virus doesn’t leave the person’s body completely after the illness is over. The virus settles in the spinal cord of the infected person, and is dormant (inactive) there for years. Later, often after decades, the virus is reactivated, travels along a nerve coming from the spinal cord, and manifests itself as shingles, a painful, red rash that is limited to the skin that is served by that nerve.

Anyone who has had chickenpox can get shingles, even children, though shingles is usually seen in adults, especially older adults. Up to 33% of all adults will get shingles at some point in their lives. There can be complications with shingles, as well, such as neuralgia (debilitating pain), eye involvement, meningoencephalitis, nerve palsies, and even stroke or heart attack.1

The effect of varicella vaccination in children on the incidence of shingles in adults is unclear at this point. The live virus in the vaccine does not reactivate as frequently into shingles as the wild (natural) virus does, so for those who are vaccinated, this may help reduce the incidence of shingles.

But in the past, people who got the chickenpox disease “naturally” had their immunity “boosted” by exposure to chickenpox in the community. With the vaccine-driven disappearance of chickenpox, this booster effect is gone, and some scientists have speculated that shingles cases will increase in people who got the disease naturally.

But in the US, this has not happened. Despite being commonplace for over 20 years, there has been no rapid increase in shingles cases.

Don’t Be A Chicken–Get The Chickenpox Shot

So the bottom line is this: Your child needs a chickenpox shot to prevent the rare but serious complications, and she should get it on time as scheduled. Although you (or your parents) may remember chickenpox as a “harmless” disease, it isn’t always so. With a safe way to prevent complications, it’s a good idea to vaccinate your child against chickenpox.

References:

  1. Warren-Gash C, Forbes H, Breuer J. Varicella and herpes zoster vaccine development: lessons learned. Expert Rev Vaccines. 2017 Dec; 16(12):1191-1201.
  2. CDC. Chickenpox Vaccine Saves Lives and Prevents Serious Illness Infographic. https://www.cdc.gov/chickenpox/vaccine-infographic.html. Last updated 11/18/14. Accessed 10/26/18.
Ruben Rucoba
Dr. Rucoba has over 25 years of experience as a primary care pediatrician after completing medical school at the University of California, San Francisco. His clinical areas of expertise include caring for children with special health care needs and assisting families with international adoption. He has been a freelance medical writer since 2010, writing for health websites, continuing medical education providers, and various print outlets. He currently works at Wheaton Pediatrics in the suburbs of Chicago, where he lives with his wife and four daughters, including a set of twins.

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