Varicella vaccinations

[PeZook]

I am having a quandary.

My son is almost 5 months old now, and soon his window for varicella vaccination will come.

Problem is, while information about varicella complications is widely available, I have been hearing stuff that it's better for the kid to go through the sickness, since vaccination only gives resistance for a limited time.

The problem is, that limited time varies every time I hear it, and the information has the distinct stink of rumor and hearsay.

Another problem is that my pediatrician is useless and won't give a definitive answer (I know, we should change our pediatrician, but that might take a while), my emails to various instutions were not returned so far, and the internet is of course full of anti vaccine sites repeating the argument so it's equally useless.

So I turn to SDN as my last resort in an attempt to confirm or deny that information. Because it's kind of important, and I won't deny myself a resource - especially since we have one or two health care professionals who might've run into the issue before.

So...is it true that varicella vaccinations don't give immunity for life?

[Serafina]

All i can say by now is that the Robert-Koch insitute is recommending that vaccination. Therefore i only have a german source right now.

According to that source, you need a second vaccination at a later age (around 13) in order to get a life-long immunity. That's probably behind the rumors you've heard.

[Tsyroc]

The vaccine is recommended in the US by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, American Academy of Pediatrics, American Academy of Family Physicians.

From what I can tell it's only been used regularly in the US since 1995 but has been around in countries like Japan a lot longer.

Is the vaccine commonly given where you are?

It looks like there is also an MMRV vaccine that combines, measles, mumps, rubella and varicella in one shot.


Anyway, one thing that I heard but can not confirm is that in the long run it's still better to avoid getting the disease at all since it can lead to shingles in old age. Even if that's not true the older a person gets the more dangerous a varicella infection can be. It can be bad in children but usually isn't.

[PeZook]

The vaccine is recommended, but not mandatory. It's not commonly given, most people are of the opinion that it's better to go through it.

As for complications, out of about 150 000 cases yearly in Poland about 1000 require hospitalization. Deaths are very rare, but potential complications include brain inflammation that can leave you crippled for life.

A 1:150 chance of hospitalization is pretty damn high, AND the virus stays in the body and can cause shingles later on when your immune system is weakened - and shingles can leave you blind, paralyzed or deaf.

So everything seems to speak for vaccination, except if the vaccine is only effective for some time, then the chances of complications rise exponentially (adults and very young babies are most at risk of complications), which is a very big minus.

I really hope it's bullshit, though, which it seems to be (why the hell would your immune system only be good for 18 years when reacting the vaccine, and your entire life when you get the actual disease, when the antibodies are exactly the same?)

[someone_else]

I really hope it's bullshit, though, which it seems to be (why the hell would your immune system only be good for 18 years when reacting the vaccine, and your entire life when you get the actual disease, when the antibodies are exactly the same?)

Well, Tetanus vaccine must be repeated once per decade (they are called "boosters" but that is), so it may not be totally bullshit to repeat other vaccines.

[Broomstick]

I am having a quandary.

My son is almost 5 months old now, and soon his window for varicella vaccination will come.

Problem is, while information about varicella complications is widely available, I have been hearing stuff that it's better for the kid to go through the sickness, since vaccination only gives resistance for a limited time.

It's better to go through the sickness when he is young – if he doesn't catch it in childhood then getting it as an adult is MUCH worse. Adults are much more likely to suffer complications of all sorts, even life-threatening ones.

Another problem is that my pediatrician is useless and won't give a definitive answer (I know, we should change our pediatrician, but that might take a while)

At present, there isn't a definitive answer to “vaccinate against varicella or not”. There are legitimate arguments both pro and con. You, the parent, will need to make this decision.

So...is it true that varicella vaccinations don't give immunity for life?

True. I'll try to explain more about this in a bit.

According to that source, you need a second vaccination at a later age (around 13) in order to get a life-long immunity. That's probably behind the rumors you've heard.

It's unlikely that a booster at age 13, or the early teens, will guarantee life-long immunity. More on vaccination and immunity in a bit.

A 1:150 chance of hospitalization is pretty damn high, AND the virus stays in the body and can cause shingles later on when your immune system is weakened - and shingles can leave you blind, paralyzed or deaf.

Even when it doesn't cause permanent damage shingles is extraordinarily painful, as it is the nerves themselves that are inflamed. It requires narcotics to make the pain bearable at all, and that usually over a period of weeks. There are anti-virals that can be used, but the condition needs to be diagnosed within 72 hours and the anti-virals administered in that window to be at all effective. They won't get you over the outbreak any sooner, just keep it from getting worse. Just nursed my spouse through an outbreak this past year, a mild outbreak, and it was still pretty awful.

I really hope it's bullshit, though, which it seems to be (why the hell would your immune system only be good for 18 years when reacting the vaccine, and your entire life when you get the actual disease, when the antibodies are exactly the same?)

Actually... there is now mounting evidence that even catching the disease naturally does not provide life-long immunity. Apparently, the immune system needs occasional “reminders” to keep producing antibodies. If enough time elapses the body stops making them and immunity drops to zero. Granted, this does take decades, but most of us will live long enough that this might be a concern.

It used to be thought that vaccinations were good for life – in the early days, things like smallpox vaccinations apparently were. Not anymore. You see, in the 1800's a vaccinated person kept encountering the offending virus from time to time, and the immune system kept making antibodies in response to those encounters that were never sufficient to cause illness but were sufficient to maintain immunity. Ditto for all the other stuff we vaccinate against – measles, mumps, etc. were all much more common in the environment, and vaccinations seemed to be good forever.

Well, the second to last person to die of smallpox in the world had had several smallpox vaccinations over his life, but so much had elapsed since his last one that when his daughter (who did not know she was ill) exposed him to it all his immunity had vanished. (She was the last one to die from smallpox, unfortunately).

Right now, it seems that, absent the occasional exposure to the offending disease, NO vaccination is reliably effective past about 10 years. Out to about 20 years it might confer some advantage in fighting off the disease, but it won't keep you from getting ill, just reduce the severity of that illness. The only exception is if you are occasionally exposed to the disease durign that 10 year window.

This explains why we need booster shots, and why we seem to need them more often now than in the past. More boosters is a result of massive reduction in exposure from the environment.

So... here's the thing: he can get the disease now, when he's young, and that will confer the longest possible immunity. It will, however, put him at risk of shingles later in life. While shingles is usually a disease of middle age or older it can and has occurred in younger people (I had a 26 year old coworker once who came down with shingles. He was not happy.)

He can skip the shot, and maybe he doesn't get the disease in his childhood. I've known people in their 30's who got chickenpox. All of them wound up in intensive care for a couple weeks. This is NOT a trivial disease in an adult. That's a problem. If he's not getting vaccinated then if he doesn't get the disease early getting it later could be a horrible thing.

He can get the shot now, and get regular boosters as needed through life. Getting jabbed in the arm with a needle is annoying, but if that's the case he won't be inconvenienced as a child, he won't get a life-threatening infection as an adult, and he won't get shingles later in life. This, really, is the ideal.

The problem is, he might get his shot now and not get the booster later. If he's regularly exposed to varicella in the environment that vaccination might, in fact, last him for life but if he doesn't get exposed (more and more likely as the rate of chickenpox drops) then later in life he risks getting chickenpox as an adult. Depending on when that happens, his prior vaccination may or may not mitigate the resulting infection.

You, as a parent, much now decide among these alternatives. I'm sorry, but this is part of the sucky part of parenting, having to make these decisions when you can't predict the future.

[PeZook]

Well, Tetanus vaccine must be repeated once per decade (they are called "boosters" but that is), so it may not be totally bullshit to repeat other vaccines.

Well, I don't know enough about immunology to comment, hence why I try to locate reliable sources. Broomstick's information is pretty interesting: it may indeed be the case the chickenpox lasts for life because it's such a massively popular virus that your immune system gets a booster naturaly from time to time (of course the problem is that later in life, exposure may lead to shingles...)

The main reason why this information strikes me as one of those incredibly persistent weed-rumors is that the time keeps changing from person to person and it plays directly into the misconception that vaccines are somehow "unnatural" and "tax your immune system" that is incredibly prevalent.

It's better to go through the sickness when he is young – if he doesn't catch it in childhood then getting it as an adult is MUCH worse. Adults are much more likely to suffer complications of all sorts, even life-threatening ones.

Yeah, I'm aware of that. The disproportion is extreme.

At present, there isn't a definitive answer to “vaccinate against varicella or not”. There are legitimate arguments both pro and con. You, the parent, will need to make this decision.

The Health Ministry recommends the vaccine, though.

Your information about immunization periods is rather interesting, I have to admit. It does seem that in both cases, the wee one will require developed medical infrastructure, either to treat shingles if he ever gets them, or to receive booster shots.

[Serafina]

So...is it true that varicella vaccinations don't give immunity for life?

What's so problematic about having to get booster shots for a vaccine anyway?

The only problem i see is if your child does not learn that skill - but it is a required skill anyway, for tetanus-vaccines at least. It's also very easy to do, and teaching your child to take proper care of it's health (go to a doctor when sick and other basic rules) is IMO a necessity anyway.

Your only other option is "let's hope my child get's sick at a save age". That might or might not give you immunity for a longer time, but it does not remove the issue on any other vaccines (again, tetanus) nor does it entirely resolve the non-permanent immunity issue.
Don't get demoralized by anti-vaccination crowds using facts for once - just because vaccines don't hold for life doesn't mean they don't work, or that they are dangerous.

[PeZook]

The problem is that if he misses the booster for whatever reason, he's got a vastly, vastly higher probability of ending up dead or crippled.

[PainRack]

http://www.immunizationinfo.org/vaccine ... chickenpox

Varicella vaccine is 85% to 90% effective for prevention of varicella and 100% effective for prevention of moderate or severe disease.

Children receiving varicella vaccine in pre-licensure trials in the United States have been shown to be protected for 11 years. Studies in Japan have demonstrated protection for at least 20 years. However, breakthrough infection (i.e., cases of chickenpox after vaccination) can occur in some who have been immunized. Although breakthrough varicella usually results in mild rather than severe illness, some school outbreaks have resulted in some children with more lesions and them also being contagious. For this reason, a second dose of a varicella-containing vaccine is recommended.

I think that's the information you wanted, without a pubmed search.
The CDC website says the protection lasts for more than 10 years. Of course, you could look at this instead
http://www.annals.edu.sg/pdf200403/V33N2p243.pdf
Where no loss in protection was seen after twenty years. But the caveat is that Healthcare workers are exposed to the virus more often.

The recommended actions by CDC and other US AAP is that children only need to get two doses of the varicella vaccine anyway for continued protection. So, its not going to be like the tetanus or hepatitis vaccine where the recommendation is routine boosters every now or then.

Actually... there is now mounting evidence that even catching the disease naturally does not provide life-long immunity. Apparently, the immune system needs occasional “reminders” to keep producing antibodies. If enough time elapses the body stops making them and immunity drops to zero. Granted, this does take decades, but most of us will live long enough that this might be a concern.

The science of immunity works on this. Your body is exposed to antigen, clonal selection of the cell that actually produces the antibody happens, this cell is activated to produce antibody and growth signals activated to mass produce said cell. Afterwards, memory cells are left behind.

These cells are then primed to rapidly grow again so that the next time that your immune system presents this antigen to the B cells, the immune response is much larger and faster. The issue is, there's actually a form of selection force working here. The more often an antigen is presented, the more memory cells there is left so as to speak. Probably bastardised and simplified beyond recognition, but that's how I understand it:D

[PainRack]

The problem is that if he misses the booster for whatever reason, he's got a vastly, vastly higher probability of ending up dead or crippled.

No, he doesn't. There's always a catch up booster later in life if you do need it unless he just manage to get exposed and manage to fall ill.... and why should it be vastly higher? The chances of him being hospitalised would still be the same, more importantly, there isn't any evidence that they will get the more virulent disease after vaccination.

[PainRack]

And for the part regarding vaccination immunity,
http://jama.ama-assn.org/content/291/7/851.abstract
Reports of outbreaks of varicella in highly immunized groups have increased concern about the effectiveness of varicella vaccine.

Objective To assess whether the effectiveness of varicella vaccine is affected either by time since vaccination or by age at the time of vaccination.

there was a substantial difference in the vaccine's effectiveness in the first year after vaccination (97%) and in years 2 to 8 after vaccination (84%, P = .003). The vaccine's effectiveness in year 1 was substantially lower if the vaccine was administered at younger than 15 months (73%) than if it was administered at 15 months or older (99%, P = .01), although the difference in effectiveness overall for children immunized at younger than 15 months was not statistically significantly different than for those immunized at 15 months or older (81% vs 88%, P = .17). Most cases of chickenpox in vaccinees were mild.

[PainRack]

Your only other option is "let's hope my child get's sick at a save age". That might or might not give you immunity for a longer time, but it does not remove the issue on any other vaccines (again, tetanus) nor does it entirely resolve the non-permanent immunity issue.
Don't get demoralized by anti-vaccination crowds using facts for once - just because vaccines don't hold for life doesn't mean they don't work, or that they are dangerous.

Here's the funny thing. Getting sick in and as of itself DOESN"T give you lifelong immunity anyway. I have an ancedotal evidence of a teacher of mine who had chickenpox twice. Not shingles, chickenpox.

[PainRack]

LOL. Wow. Apparently, it takes me 30 min to read through results regarding blood culture and FBC, explain about it to a patient, discuss about stuff and such.........

God, I hate the night shift. My brain is fried and I STILL have tons of things left to do before I hand over to my fellow nurses in 2 hours.......

[PeZook]

No, he doesn't. There's always a catch up booster later in life if you do need it unless he just manage to get exposed and manage to fall ill.... and why should it be vastly higher? The chances of him being hospitalised would still be the same, more importantly, there isn't any evidence that they will get the more virulent disease after vaccination.

I...haven't seen the numbers, just warnings in information pamphlets and such warning that adults have a higher chance of severe complications with chickenpox.

[Broomstick]

They do. Chickenpox is a serious disease in an adult. There are, however, anti-virals that are routinely used in adult cases (the same ones used for shingles) and if administered early in the infection they do vastly reduce the odds of serious complications.

The "breakthough" cases mentioned - where the vaccine immunity has worn off sufficiently to allow infection - do tend to be more mild than otherwise.

Complications of chickenpox vaccine are rare, and usually mild.

Frankly, I'm not seeing much of a downside to vaccination here. If medical standards remain high through his adult years boosters will be readily available. If they deteriorate, he'll get "booster" exposure from the environment, and if he does get a full blown case it will most likely be less severe. Barring a complete collapse of civilization and unavailability of booster shots it seems to me vaccination is the way to go. But that's my opinion.

Then again, I was raised in an era where we were still dealing with horrors like smallpox - I have the vaccination scar for that one still on my upper left arm even after 45+ years. I'm quite pro-vaccination, barring the casse where there are medical contraindications for them.

[PainRack]

I...haven't seen the numbers, just warnings in information pamphlets and such warning that adults have a higher chance of severe complications with chickenpox.

That's true. Its also true that the recommendation is that you should actually go for a second booster(IIRC one year later, but I'm not sure whether this is a standard or just the recommendation over at my side here).

You could just go for a booster at any time in your life. I mean, we're not here talking about some optimal vaccination schedule or stuff, at least, I don't think there's any such recommendation for chickenpox yet.
I mean, missing the booster at age six and getting the booster instead at the age of say... 18 isn't going to be a biggie, right?

Furthermore, the overall effective vaccination rate is still 87% even without the booster, and we're talking about effectiveness as in not getting chickenpox at all, as opposed to having a very mild variant of it, the protection rate stated is more than ten years, so, even if he did miss the booster, it seems that he would still be at less risk than if he didn't go through the vaccination itself.

The alternative, chickenpox party means that he run the risk of getting chickenpox complications, rare, but the risk is an unneccessary one. He would have a much lower risk of reacquiring chickenpox in adulthood, but have a new risk of getting shingles whenever his immunity is low.

Seriously. From my viewpoint, the only problem with getting the vaccine, apart from allergy or other medical contraindications is that you're going to be the one to pin down a screaming kid going for an injection.
That and any money you pay for it. Its probably still cheaper than staying at home for 7 days or more to take care of a screaming kid.

[PainRack]

I think I spotted the real cause for concern you had Pezook. Sorry, I'm... literally drunk with fatigue and in my earlier posts, I was actually whiling away time while waiting for my blood tranfusions and other stuff to complete.

Let's start with the facts.
Yes, cases of chickenpox infection amongst those immunised suggest that immunity isn't lifelong. No biggie there, its a well known thing. Your immune system doesn't keep all those memory cells alive from birth to death.

Protection span from the US CDC suggest that its ten years long. Or longer, depending on whether your son gets re-exposed to chickenpox while he's still protected.

The adage that actually getting sick with the disease will provide you with lifelong immunity is a "common sense" idea that hasn't been tested recently. The very same mechanism that works against lifelong immunity from a vaccine works the same way here. The difference is that from my very, very, very basic understanding, when you're sick, your body is literally chock full of virus antigen to keep presenting to your B cells, your B cells are working longer and harder to produce antibodies to restore you back to health. So, you essentially has a larger "bank" of cells to rely upon.


So, your concern is that immunity may not be lifelong. The american docs say no problem, just give him a second dose. There isn't a fixed timing as to when, but that really shouldn't be a problem. We have nurses here going for the chicken pox vaccine in their twenties and thirties so its literally not a big deal to go for a booster some time later in the future. Even if he doesn't go for a booster, the real kicker is whether he's going to be exposed to someone who's sick with chickenpox. That's getting to be an increasingly rarer event unless you're a healthcare worker,a educational professional or a parent. In fact, increasing uptake= increased herd immunity= profit?!

[PeZook]

Well, what do you know? I just got a reply from the Voyvodship Sanitary Inspector regarding this very matter. They sent me some material which pretty much repeats Painrack's points: the vaccine is 95% effective when it comes to reducing severity of the disease, and 70% when it comes to preventing it altogether.

They also stated it's good for about 8 years with slightly reduced effectiveness, but that there are very few cases of adults who were vaccinated in youth actually catching chickenpox (and those who did catch it had a mild version), and that booster shots are safe and can be administered later in life.

Seeing as about 95% of Poles had the disease and vaccinations still aren't widespread, it's likely he'll get "booster" exposure from the environment while growing up, and of course he should be able to just get a shot when, for example, his child starts going to school.

So yeah, now I have CDC studies, the Robert-Koch institute paper and a Polish instution confirming that. It does look like the vaccine is indeed the right choice: it does not put him in any significant danger later in life, prevents a lot of pain when growing up, and is very likely to prevent him getting outbreaks of shingles.

Thanks for your help! I really appreciate it, since it's the sort of decision that I'd rather make while well informed.

[Serafina]

Thanks for your help! I really appreciate it, since it's the sort of decision that I'd rather make while well informed.

Thank YOU for informing yourself about the safety and health of your child. I admit that i would have just gone ahead with the vaccine without doing so, while the right decision, it would have been done blindly.
Oh, and thank you for making the right decision, and for that contribution to public health.

[PainRack]

A better, technical explaination of what goes on during immunisation.
http://uhaweb.hartford.edu/BUGL/immune.htm#humor

there are many, many receptor shapes available, WBCs seek to optimize the degree of confluence between the two receptors. The number of these "best fit" receptors may be quite small, even as few as a single cell. This attests to the specificity of the interaction. Nevertheless, cells can bind to receptors whose fit is less than optimal when required. This is referred to as cross-reactivity. Cross-reactivity has its limits. There are many receptors to which virions cannot possibly bind. Very few viruses can bind to skin cells.

The design of immunizing vaccines hinges on the specificity and cross-reactivity of these bonds. The more specific the bond, the more effective and long-lived the vaccine. The smallpox vaccine, which is made from the vaccinia virus that causes cowpox, is a very good match for the smallpox receptors. Hence, that vaccine is 100% effective and provides immunity for about 20 years. Vaccines for cholera have a relatively poor fit so they do not protect against all forms of the disease and protect for less than a year.

The goal of all vaccines is promote a primary immune reaction so that when the organism is again exposed to the antigen, a much stronger secondary immune response will be elicited. Any subsequent immune response to an antigen is called a secondary response and it has

a shorter lag time,
more rapid buildup,
a higher overall level of response,
a more specific or better "fit" to the invading antigen,
utilizes IgG instead of the large multipurpose antibody IgM.