Why vaccinating Children against Chickenpox might give YOU Shingles
After a childhood attack of chicken pox, the virus lies dormant in the nerves until triggered in later life when it flares up as shingles. Children might soon be vaccinated against chicken pox, according to recent reports. But some experts question the need for a vaccine against an infection that’s so mild – especially when it could put thousands of elderly people at greater risk of shingles.
Chicken pox causes up to 50 deaths a year, 40 of them children, and it seems the Government’s Joint Committee on Vaccination and Immunisation is considering adding a vaccine against it to the MMR jab.
But there is widespread concern about this. First because a similar MMR super jab now used in America has been found to double the risk of fits in some children.
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Also the jab has raised the rate of shingles among the old – according to one U.S. study, cases have risen by 90 per cent. Here even the Government health watchdog, the Health Protection Agency, has predicted that a vaccine could cause a 20 per cent rise in shingles cases.
But how could a vaccine for children make old people ill? Chicken pox and shingles are caused by the varicella virus – after a childhood attack of chicken pox, the virus lies dormant in the nerves until triggered in later life when it flares up as shingles.
‘Every time adults come into contact with children who’ve just caught chicken pox, they get the natural equivalent of a booster shot of the virus which strengthens their resistance,’ explains Dr Phillip Welsby, an infectious diseases expert who has just retired from Western General Hospital, Edinburgh.
In the past, when a child got chicken pox their mother would invite neighbours’ children to a ‘chicken pox party’ so they, too, could become infected and get it over with.
‘What the parents usually didn’t realise was they were benefiting as well,’ says Welsby. ‘GPs, for instance, are less likely to develop shingles, because they are regularly exposed to children with chicken pox.’
However, a nationwide campaign to vaccinate children against the disease would mean adults would be exposed to fewer children with chicken pox, so they miss out on this natural booster ‘jab’.
While nearly all cases of chicken pox are pretty mild – a slight fever for a few days and small itchy blisters – shingles is often a nasty condition in the elderly. By the age of 85, 65 per cent of us will have suffered this often extremely painful disease.
It begins as a burning sensation along the nerves down which the virus is moving, followed by the rash and fever, usually lasting three to five days. But in some cases – as many as 20 per cent of those over 50 – severe pain will be there six months later.
40 per cent of sufferers will have long-lasting pain due to permanent nerve damage, according to the Shingles Support Society.
If the virus reaches your eyes, it can cause blindness. If you have to go to hospital for chicken pox, your average stay will be three days, but for shingles it is 11 days and you are six times more likely to die.
Although the inflammation doesn’t kill you, it can lead to fatal conditions such as pneumonia, inflammation of the brain or severe bacterial infections in the eruptions in the skin leading to toxic shock. Some experts put the death rate from shingles at five times that from chicken pox.
Just how many cases of shingles a vaccination programme would cause is disputed. Welsby says there could be a 50 per cent increase in cases for 30 to 50 years.
‘Anyone aged between ten and 44 when it started would be at greater risk,’ he says, ‘because they’d be getting fewer and fewer boosts from coming into contact with infected children.
‘Eventually, however, there would be fewer cases as almost no one will have an active virus in their body to trigger shingles when they are older.’
One American researcher claims there are going to be an additional 14.6 million cases of shingles over the next 50 years because of the vaccine.
For eight years Dr Gary Goldman was a researcher with the Varicella Active Surveillance Project in Los Angeles. Then in 2005 he went public, claiming the official figures for shingles were not accurate.
In a paper published in the International Journal Of Toxicology, Dr Goldman claimed that since shingles results in three times as many hospitalisations and five times as many deaths as chicken pox, this increase meant the vaccination made no sense.
One solution is to vaccinate both children and the elderly at the same time, which is what the Government’s vaccination committee is considering.
Meanwhile, concerns are being raised about the benefits of the chicken pox vaccine for children. The U.S. vaccination programme cut the number of infections by 79 per cent, with a corresponding drop in the number of hospital visits and deaths; down from 100 to 20.
But critics say reporting the disease is no longer mandatory in the U.S. – making it appear less common – and that those who died before vaccination were very often already ill.
It’s a point made by London GP Richard Halvorsen, whose book The Truth About Vaccines is sceptical about their use.
‘A recent UK study used to support the idea that we should start vaccinating found that in just over a year, 112 children had chicken pox badly enough that they had to go to hospital and eight died,’ he says. ‘But one of those eight was still in the womb and five also already had serious medical conditions.
‘In fact, out of a population of 10 million children in the UK, only one previously healthy child died from chicken pox. It’s tragic of course, but is it really worth all the other risks, not to mention the millions it will cost, to reduce those figures?’
‘We don’t know why the UK child died, but American research suggests some of the drugs used to treat serious cases, such as antibiotics and steroids, may make it worse, he adds.
There is another potential problem. It is sure to reignite the debate over the MMR vaccine at a time when the Government is seeking to increase its uptake and warn of a measles epidemic.
‘If it’s added to the MMR, doctors will be asking parents to give a combination of four live vaccines at once,’ says Halvorsen. ‘For many parents, the thought of that will be just too much.’
Some parents might also be concerned by what has happened to the MMR plus chicken pox vaccine Proquad which has been used in the U.S. Last year a U.S. government-funded study found children given it were twice as likely to suffer fever-related convulsions compared to those given the MMR with chicken pox vaccine separately.
The number of extra cases was small, about one more in 2,000, but there is another difference between the two regimes. Proquad contains five times the amount of chicken pox virus as the single dose. Whether that caused the additional convulsions is disputed.
In the end, the decision to go with the vaccine might not be down to medical evidence at all.
Professor Steve Field, chairman of the Royal College of General Practitioners, supports it on economic grounds. ‘It would only save a few lives,’ he admits, ‘but it would reduce the pressure on hospital beds.’
The vaccination committee will be considering all the data and will report later this month.
‘The medical case for doing it is not strong,’ says Welsby.
‘The natural system is certainly very elegant with infected youngsters protecting their elders and we won’t know for sure if it is really worth it for 40 or 50 years. In the end it’s going to be a political decision.’
4 March 2009