Avoid Chickenpox. (Oatmeal Bath Is No Picnic.)

Medical texts describe chickenpox, or varicella, as a highly contagious but rather mild childhood disease that only rarely results in serious complications, a fact that has set off decades of controversy over whether the vaccine to prevent chickenpox is warranted.

Had anyone asked me, I would have said absolutely. Although I had none of the characteristics associated with more severe cases, at age 8 I had what my pediatrician called the "worst case of chickenpox" he had ever seen — more than 1,000 intensely itchy blisters all over my body.

Sick for three weeks, I spent hours each day in a cool oatmeal bath to relieve the itching temporarily. Between baths, my grandmother fanned me and painted my blisters with calamine lotion. The scars from the scabs on my torso remained visible for more than a decade, and a few on my face never faded.

A North Carolina mother, Rebecca Cole, shares my enthusiasm for a vaccine. Her 12-year-old son Christopher Aaron Chinnes, who had been using steroids for asthma, died in 1988 after chickenpox rampaged uncontrollably through his young body.

While Christopher fell into a "high risk" category because of his steroid use, the Centers for Disease Control and Prevention has pointed out that 90 percent of children who die from chickenpox do not fall into a high-risk category.

Since 1995 we have had a licensed immunization — an attenuated live virus vaccine that can stimulate immunity to the chickenpox virus, herpes zoster, without causing the disease itself. Schools in nearly 40 states require the vaccination.

With millions of children vaccinated, rates of the disease and its rare complications have fallen sharply. Millions of children are now sailing through childhood without even a hint of the misery that I suffered nearly 55 years ago. Each year, thousands of hospitalizations and nearly 100 lives are saved by the vaccine.

But there is bad news along with that positive development: we are facing some of the quandaries that thoughtful opponents of this vaccine foresaw years ago. Like nearly all other vaccines, this one, which is usually administered as a single shot at 12 months of age, does not always protect those who are vaccinated. About 10 percent of children who receive the varicella vaccine are inadequately unprotected.

Recent studies have also revealed that even among those who may at first be well protected by the vaccine, the level of immunity tends to wear off with time, suggesting that one or more booster shots later in childhood and perhaps in adulthood may be needed to assure continued protection.

For example, a medical team writing in the March issue of the journal Pediatrics described a chickenpox outbreak in Portland, Ore., where 97 percent of children who had not had chickenpox naturally had been vaccinated. Children who received the vaccine more than five years before the outbreak were nearly seven times as likely to contract the disease as those vaccinated in the previous five years.

A month earlier, researchers at Yale reported that the effectiveness of the varicella vaccine fades substantially a year after it is given. It also seems to be less effective when given to children under 15 months.

Nonetheless, the two research teams noted that children who had been vaccinated and came down with chickenpox had milder symptoms that cleared up faster than those in unvaccinated children. This suggests that even when immunity is not good enough to prevent this viral infection, it does offer some protection.

Fading immunity, however, can result in severe problems as the vaccinated population ages. When chickenpox occurs in unvaccinated people older than 13, the symptoms tend to be far more severe, sometimes resulting in hospitalization and life-threatening complications.

Also still hypothetical is another vaccine-associated problem. There are at least two reasons some vaccines are not given before a year of age. The main one is that an infant's ability to mount an immune response to an antiviral vaccine is not well developed. But pediatricians are concerned that waiting until 15 months to administer the varicella vaccine, when it is likely to be more effective, will place many children at risk of chickenpox during the intervening three months and may result in some being missed if their mothers do not bring them back.

Another reason for not immunizing newborn babies is that they are protected by the antibodies they receive from their mothers during pregnancy and breast-feeding, usually making it safe to wait a year before giving vaccines.

But if a mother has been protected against chickenpox by a vaccine that has lost its effectiveness, two untoward consequences are possible: the mother may contract chickenpox in her pregnancy, possibly harming the fetus, or her baby, unprotected by maternal antibodies or vaccine, may become seriously ill if exposed to someone with chickenpox.

Women planning pregnancy may choose to have their immune status checked beforehand and, if found wanting, take two booster shots before becoming pregnant. Or those who know they have been exposed to chickenpox during pregnancy can take immunoglobulin to create temporary immunity before the virus can gain a foothold.

The herpes virus that causes chickenpox is a sneaky one. It peaks in the spring, and it takes 10 to 21 days after exposure to the virus for the disease to develop. The virus is spread through the air by coughs and sneezes and by direct contact with the fluid in the blisters, hundreds of them appearing in successive waves. Once the blisters scab over, the period of contagion has passed. The pox are most severe in those with other skin problems, like eczema or a recent sunburn.

A person with chickenpox is contagious for one to two days before the characteristic blistery rash becomes apparent and when symptoms — fatigue, fever, headache, loss of appetite — are still vague. It is possible to catch chickenpox from people in the theater or supermarket or on the bus or subway before they know they have it.

Most children recover in 5 to 10 days, usually missing a week of school. But one child in 10 becomes sick enough to warrant a medical visit. Possible complications include infected skin lesions (these are the ones that leave permanent scars), other bacterial infections, dehydration from vomiting or diarrhea, a worsening of asthma or even pneumonia or encephalitis.

Before the introduction of the varicella vaccine, about 4 million cases of chickenpox occurred annually, resulting in 11,000 hospitalizations and 100 deaths, half of them among adults. Those at greatest risk of complications include children whose immunity is suppressed, for example, by steroids, chemotherapy or H.I.V. infection. Antiviral medications like acyclovir may be used in such children.

For most, treatment involves calamine lotion, oatmeal baths, perhaps an oral antihistamine and acetaminophen, but no aspirin. Fingernails should be trimmed very short to reduce the risk of secondary infections and scarring from scratching.

But even after the symptoms go away, the virus remains in the body. It hides out in nerve roots, kept in check for years and often indefinitely by the immune system. But in about 10 percent of adults, the virus re-emerges during periods of stress to cause a potentially very painful, debilitating disease called shingles.

The vast majority of recent deaths of children with chickenpox (90 %) involved the use of ibuprofen, which in turn brought about fatal attacks of necrotising fascitis (NF) otherwise known as "flesh eating bacteria". Under NO circumstance is a child to be given ibuprofen when chickenpox is suspected.

http://www.suntimes.co.za/1999/05/02/news/news07.htm

"CHILDREN with chickenpox who are fed over-the-counter painkillers run the risk of being infected by a deadly flesh-eating bacterium.

Doctors say the only way to treat the aggressive bacterium - which dissolves human flesh - is by amputating infected limbs and treating patients with antibiotics.

The dangerous link between household medication, chickenpox and the bacterium was exposed in a medical alert to doctors this week.

"Virtually every child in the country will be exposed to chickenpox at some or other time," said Dr Stephen Toovey of Medinfo, an organisation run by South African doctors which monitors international medical trends and research.

"This flesh-eating bug causes rapid tissue destruction, and entire limbs can be lost within a matter of hours," he said.

"Amputation and a high dose of antibiotics offer the only hope of survival."

His warning was triggered by the results of a recent study of children who were hospitalised within three weeks of an attack of chickenpox in the US.

Dr Danielle Zerr, of the Children's Hospital in Seattle, headed a team of scientists who compared 19 children stricken with the bacterium with 29 control children. Those infected were 10 times more likely to have been given ibuprofen as a painkiller."

http://www.med.umich.edu/1libr/pa/pa_chickenp_hhg.htm

"...Acetaminophen may be given in the dose appropriate for your child's age for a few days if your child develops a fever over 102°F (39°C). Do not give ibuprofen products because of a possible link with severe Strep infections. Do not give aspirin to children and adolescents with chickenpox because of the link with Reye's syndrome."

http://pediatrics.aappublications.org/cgi/content/abstract/103/4/783

Results. After controlling for gender, age, and group A streptococcus isolation, cases were more likely than controls to have used ibuprofen before hospitalization (OR, 11.5; 95% confidence interval, 1.4 to 96.9). In most children, ibuprofen was initiated after the onset of symptoms of secondary infection. Children with NF complicated by renal insufficiency and/or streptococcal toxic shock syndrome were more likely than children with uncomplicated NF to have used ibuprofen (OR, 16.0; 95% confidence interval, 1.0 to 825.0). Children with complicated NF also had a higher mean maximum temperature (40.9°C vs 39.3°C), and a longer mean duration of secondary symptoms (1.7 days vs 0.6 days) before admission than children with uncomplicated NF.

Conclusion. Ibuprofen use was associated with NF in the setting of primary varicella. Additional studies are needed to establish whether ibuprofen use has a causal role in the development of NF and its complications during varicella. Key words: fasciitis, necrotizing, ibuprofen, varicella-zoster virus, Streptococcus pyogenes, cResults. After controlling for gender, age, and group A streptococcus isolation, cases were more likely than controls to have used ibuprofen before hospitalization (OR, 11.5; 95% confidence interval, 1.4 to 96.9). In most children, ibuprofen was initiated after the onset of symptoms of secondary infection. Children with NF complicated by renal insufficiency and/or streptococcal toxic shock syndrome were more likely than children with uncomplicated NF to have used ibuprofen (OR, 16.0; 95% confidence interval, 1.0 to 825.0). Children with complicated NF also had a higher mean maximum temperature (40.9°C vs 39.3°C), and a longer mean duration of secondary symptoms (1.7 days vs 0.6 days) before admission than children with uncomplicated NF.

Conclusion. Ibuprofen use was associated with NF in the setting of primary varicella. Additional studies are needed to establish whether ibuprofen use has a causal role in the development of NF and its complications during varicella. Key words: fasciitis, necrotizing, ibuprofen, varicella-zoster virus, Streptococcus pyogenes, case-control study. ase-control study.

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.