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Chickenpox: Does My Child Really Need The Shot?

In the day of vaccines, it’s easy to get lulled into the notion of “what’s the big deal?” if my child gets the disease? The chicken pox vaccine (the medical term is “varicella”) has made seeing chicken pox a rarity for most docs. Anymore, most of the calls/visits I get for “chicken pox” are really something else that the parent thought was chickenpox.

What is chickenpox?

Chickenpox is a disease caused by the varicella zoster virus. It is highly contagious. It commonly presents with fever and a very itchy rash. The rash typically starts on the trunk and then spreads. The rash looks like blisters with a red surrounding area. When the blister breaks, it leaves an open sore that then dries and crusts over.

What’s the contagious period?

The timing to chickenpox is the trick. The rash doesn’t usually show up for 10-21 days after being exposed and infected with the virus. Kids are contagious for the couple of days prior to breaking out in the rash which makes it easy to see how it spreads so easy (the infected kid is spreading it to everyone without even knowing he/she has chickenpox). The infected child continues to be contagious for about another week after the rash shows up. Children who have chickenpox cannot attend school (until the rash is gone or at least all the sores are completely crusted). It is worth noting that chickenpox is spread both by respiratory droplets and direct contact.

What’s the risk of getting chickenpox?

Most of the time, kids who get chickenpox completely recover. However, sometimes kids will develop bacterial infections. These infections can be on the skin (from scratching) or infect other parts of the body. The most serious complication happens when the brain gets infected. That is called varicella encephalopathy and can be lead to death or permanent brain damage.

What are the risks of the vaccine?

Statistically speaking, the risks from getting the disease are higher than the risks from getting the vaccine. The most common risks/problems are fever, soreness or swelling at the injection site, and slight rash (the child may actually get 1-2 pox). Very rare, but reported reactions are seizure or pneumonia.

Should I give my child the vaccine?

The short answer is yes, probably. The longer answer is that the vaccine is a live virus vaccine. Sometimes kids, or the people they are around, can’t get live virus vaccines (e.g., because they have an immune problem, making exposes to viruses risky). You should also not give the vaccine when your child is really sick (again, because it’s a live virus vaccine). The other concern is possible reactions. If your child has had an allergic reaction to the antibiotic neomycin or to gelatin, your child should also NOT get the vaccine. Otherwise, I highly recommend it.

I recognize that I come from a jaded perspective. I see the kids when they are suffering from the disease and think it’s tragic that any child suffer from a completely preventable disease. I also come from the perspective of having taken care of a child in the ICU who had a chickenpox brain infection (varicella encephalopathy). The child lived, but was essentially a vegetable thereafter.

When should my child get the vaccine?

The vaccine is a two-shot series, typically given at 12-15 months of age and again at 4-6 years of age. If the vaccine is given as a “catch up” (after the recommended ages), the two shots have to be at least 28 days apart.

How do you treat chickenpox?

There isn’t a cure to chickenpox. It is all about prevention. When your child is too young to vaccinate, make sure the people around your child have been vaccinated (to reduce the risk of spread to your vulnerable child).

In severe cases (or situations where there is increased risk of complications–say for example, a child with an underlying immune problem), sometimes a medication called Acyclovir will be used to help decrease the rate of replication of the virus. Again, it isn’t a cure, but can help. The medication has side effects, so isn’t routinely used.

The other treatments are all “supportive.” If your child develops a fever, try Tylenol or Motrin. Try and calm itchy skin with an oatmeal  bath or some calamine lotion (just don’t use it on the face). It is important to try and keep your child from itching (easier said than done).

How does Shingles fit into this?

Shingles, called herpes zoster is a condition caused by the same varicella zoster virus. People get shingles after having had chickenpox (the virus essentially lays dormant in the body waiting to be activated). Kids who have been vaccinated against chickenpox are much less likely to develop shingles. And if they do, it is typically a very mild case.

As a person who has had both chickenpox and shingles, I wish that a vaccine had been available at the time (I was too young to remember chickenpox, but my mom reports it was miserable and shingles was AWFUL). Needless to say, I didn’t want my kids to suffer and opted to vaccinate them all against it.