Tuesday, June 5, 2012

Meanwhile in London... (with update - day 6)

This boy is on day 3 of fever and chicken pox - new pox are still appearing (usually they do for 5 days after onset) - have a glimpse:

Mum had tried to get her two kids the varicella vaccine,  however,  the NHS does not offer varicella vaccine in their regular schedule. They say
"Chickenpox in children is considered a mild illness, but expect your child to feel pretty miserable and irritable while they have it."
No kidding: have another look at the boy's back - According to the NHS
"The chickenpox vaccine is not part of the UK childhood vaccination programme, because experts think that introducing a chickenpox vaccination for children could increase the risk of shingles in older people."
There are a number of papers, most of them from the same author, "independent computer scientist" Gary S. Goldman, violently arguing that the varicella vaccination programme has led to an increase in the prevalence of shingles, while not really protecting against chicken pox. However, actual data collected in various countries shows a different picture:
In Israel in a partially vaccinated population, shingles were associated with early (especially under the age of 1) infection with wild varicella and varicella vaccine was found to be protective. In Canada, shingles incidence in the vaccinated age group declined slightly, while it remained the same for older age groups. In Taiwan, the incidence of shingles started increasing before the varicella vaccine was introduced. The same was observed in the United States. In Australia, a slight increase on shingles rate occurred over the past 14 years, although this is not as ambiguous as the drop in varicella cases in the same time period, concomitant with the introduction of the varicella vaccine (see box 1 here). And finally, comparing countries with and without general varicella vaccine recommendations showed that shingles incidence seems to be independent of any vaccination programmes.

UK analyses come to the conclusion that a general vaccination programme for varicella may not be cost effective in the first 30 to 50 years after introduction. However, as the picture above impressively demonstrates and systematic studies also show, the impact of varicella on children and cost to carers is not necessarily captured by data available through health service usage.

The positive effect of varicella vaccination on pediatric health is undebated: between the introduction of the varicella vaccine in the US in 1995 and 2006, disease incidence fell by 57% to 90%, hospitalizations by 75% to 88%, deaths by >74%, and direct inpatient and outpatient medical expenditures by 74%. Varicella vaccination reduced the risk of pediatric stroke, a known complication of chicken pox also in the UK, by over 60% (similar observations were made in Italy).

What can I say? Have another look at that photograph - if you are in a country with a varicella vaccination programme, go get the vaccine. If you are in the UK, consider going private for the varicella - it is not fair that you have to pay out of pocket for a vaccination that will ultimately not only benefit your child's health, but also the NHS and your employer, but I would still consider this a good investment. If you are in the UK and you have gotten the varicella vaccine privately, please leave a comment and tell us where and how much it was as a resource for other parents.

ETA (6/6/12): this is day 6 - the young man (6 years old, no history of eczema or any other "condition") is feeling much better, the back is starting to crust over - take a look:


  1. Wait, they are actually using papers from Goldman to come up with their conclusion? His "PhD" is not even from an accredited college. He is a full fledged crank!

    And I think it is cruel and heartless to make children suffer through chicken pox even if it did keep down shingles. If the NHS really wanted to reduce the chance of the older population getting shingles, then they should provide the shingles vaccine.

  2. I had heard that SM wasn't sure that a program of complete vaccination was the best idea. Has there been new information since then?

  3. I just checked, Chris, and the last English paper does not cite Goldman.

  4. MR - good point. SM, what do you think?

  5. No new information as far as I'm aware. I don't agree with this vaccine being compulsory even though I think it's a good vaccine to have available. The reason it was put on the schedule in the U.S. was purely economical, i.e. parental loss of work days. The efficacy of the vaccine leaves older children and adults vulnerable.

  6. I'm this boy's mum. We are very pro-vaccine and have always vaccinated on schedule. This one isn't on our schedule though. We had planned to do it privately but just hadn't actually done it yet.

    I know that chicken pox isn't always this bad. His sister had it 2 weeks ago and was mostly uncomfortable and bored rather than in pain, feverish and clearly ill. Because I'm a stay-at-home parent and this hit during a long holiday weekend, there's been no real economic effect on us beyond the cost of over the counter medications, gels and calamine lotion. There has been a boy in pain with a high fever for days though and that suffering alone is anough to make me regret not searching out the vaccine privately sooner. Even my daughter's much more "normal" case was enough to cause that regret.

    1. I swear I do know how to spell "enough".

  7. My child aged 7 moths developed severe sepsis from an infected chicken pox spot and nearly died. 15 days in hospital, 7 in Paed intensive care. I wish I had known about a vaccine and certainly would have paid. If nothing else having 4 kids catching it one after the other was bad enough.

    1. Yikes Anon! What a nightmare :(

    2. This is the boy's mum.

      I am so sorry. People dismiss chicken pox as being inconsequential, but clearly it isn't always.

    3. Oh no! That is terrible!

      All three of mine caught chicken pox, but at least two of them caught it at the same time from the middle child. One was only six months old, but while the pox got very close to her eyes, she did not get a secondary infection.

      Still, I could have done without the months of little sleep (the baby stopped sleeping through the night) and the kindergartener was sick enough to wet his bed again.

      This was a year before the USA put the varicella vaccine on the schedule. The baby graduates from high school in a week.

    4. Ugh, I meant to write "month of little sleep." Really it was only about four weeks of misery.

      (why does one of the "words" we have to write out look like numbers of street addresses?)

    5. my son had a pox on his eyeball - I have been looking for the pictures, but have moved computers since I took those..

  8. I'm so sorry Anons. I hope your infant is well. Thank you for sharing your stories and insight; it is all too easy for people to forget that even "mild" diseases can have serious consequences.

  9. So catching it as an adult when a vaccine has worn off is better? V

    1. Anon - you assume that disease-acquired infection is always permanent and that the 2x varicella vaccine wears off. I'd rather have a booster shot ever so often than what the boy above is going through (or worse).

  10. No anon, boosting older children/young adults if they have never had chicken pox or been adequately vaccinated is what you do. And Catherina is correct, a single exposure to chicken pox doesn't necessarily confer lifetime immunity, subsequent boosting is necessary.

  11. I'm in Australia and paid for my daughter to have the varicella and pneumococcal vaccines because they were available but not on the free schedule when she was little. I think she was about 3-4 years old when I had them done. She's just had her booster for varicella and I know I have done the right thing. I did my research by talking to my doctor and also talking to a close friend who works for the Australian National Centre for Immunisation Reporting and Surveillance. In addition, I had the experience of seeing my younger brother have it three times in five years - natural immunity didn't take for him. Interestingly, when I was pregnant they tested me for antibodies and I have some sort of super immunity despite never having had a full blown case myself.

  12. Funny thing: Gary S Goldman actually was part of a CDC publication in JAMA touting effectiveness of Varicella vaccine, and arguing for increased vaccination in the population. See:


    Varicella disease after introduction of varicella vaccine in the United States, 1995-2000.

    Seward JF, Watson BM, Peterson CL, Mascola L, Pelosi JW, Zhang JX, Maupin TJ, Goldman GS, Tabony LJ, Brodovicz KG, Jumaan AO, Wharton M.

    JAMA. 2002 Feb 6;287(5):606-11.

    11829699 [PubMed - indexed for MEDLINE]

    Then he went off his rocker, and started publishing his own articles starting 2003, all focused on why we shouldn't advocate varicella vaccine, etc.

    Chris, just curious. Where did Goldman get his PhD? I couldn't find it anywhere...

  13. See in LinkdeIn:
    and elsewhere:

    He went to Pacific Western University before it was accredited with a different name in 2007:
    and it is still on several state lists, for example:

    Now, your fist link is just a name search for him on PubMed, and includes a paper that Orac tore apart:

    And second paper you listed, http://jama.jamanetwork.com/article.aspx?volume=287&page=606, shows him way down the list of authors. He may have been part of the computer analysis portion of the paper (which is actually mentioned in the second link above).

  14. SM
    What type of "schedule" would you suggest for Varicella? Or, to put it another way, when would you suggest Varicella be given?

  15. MR, it depends upon personal circumstances but it is most likely more effective if given after 18 months old as they respond better to live viral vaccines and then again after four years old if you want to avoid chicken pox in childhood and be "school legal". If you want to roll the dice and if your child has not gotten wild-type chicken pox then vaccinate ~10 years old and I would even go so far as to say a booster in the late teens. Chicken pox severity and complications increase with age.

  16. Poor baby, I hope he feels better. We get varicella at age 1 I believe it may be 18 months though I can't remember when my kids got it.

  17. Hi. That's my son up there.

    He's doing much better now. He's scabby and was unhappy about being seen in public but got over that to go back to school. This wasn't a terrible event in his life in that he wasn't hospitalised or severely ill, but it was as sick as he's ever been. He's absolutely certain that a shot or two would have been much, much better than chicken pox. I can pretty much guarantee any grandchildren I have some day will be vaccinated against chicken pox if the disease is still around as this has had a big impact on both of my children.

  18. Thanks for the update. I'm glad he is feeling better and am sorry the NHS wasn't more cooperative. The vaccine should be available for free.

  19. When I worked as a public health nurse and when the vaccine became available, all staff was tested for positive IGG titers against varicella. We all tested positive, having had the wild strain infection in childhood.

    I think the vaccine is too new to have reliable information for large populations, to determine long-lasting immunity following immunization against the virus. There is this link to the CDC, with some limited data:


    It did take a number of years to determine that the one shot dose of measles vaccine did not provide enough herd immunity to prevent outbreaks of the disease during the late 1980s-early 1990s; hence the recommendation from the CDC for a second measles vaccine. I believe the U.K. did not implement the second measles jab recommendation for ~ 5 years after the CDC recommendation called for second dose.

    My daughter was born in 1970 and when she entered Junior High School, she needed "proof" (a doctor's notation), that she had chicken pox. Now I suppose, that the proof consists of a record of having had the vaccine...along with proof of two shots of MMR vaccine, polio vaccine, etc.

    It will be interesting to see, following extended studies, if the chicken pox vaccine confers lifelong immunity, just as the MMR vaccines do, for the majority of the population.

    I might add, that here in the United States, most doctors will prescribe the anti-viral Acylovir, if a knowledgeable parent notifies the doctor about the start of the distinct lesions, associated with varicella infection. For my son, who became infected in his late teens, it was a lifesaver, by somewhat limiting the number of poxes, the speedy crusting over the poxes and lessened itching.

  20. Stefan - ask your paediatrician about the varicella vaccine.

    Gibt es auch in D, Ö und CH - Vorbeugen ist schließlich besser als heilen.

  21. Immunity from the vaccine is unlikely to be "life-long", but then again immunity from natural chickenpox is not likely to be lifelong either.

    The reason I say this is that throughout life, people would almost always get tiny immune boosters (the quivalent of a vaccine booster) every time they were exposed to someone with chickenpox (most commonly when their own kids got the pox). This keeps immune responses high and varicella IgG levels high.

    However, as some people age their immune systems start to lose capacity to maintain specific varicella immunity, and the main outward sign of this waning immunity is that latent varicella virus may reactivate, causing an attack of shingles.

    So frequent re-exposure to chickenpox in adult life would help maintain immunity and reduce the risks of developing shingles. Getting the zoster vax at around 50-60 years is the biological equivalent of getting re-exposed to an infectious case of chickenpox - it boosts immunity.

  22. You may be correct about the absence of exogenous boosting of immunity from exposure to wild-type virus, but look what happened (or didn't happen) to older people who had measles, before the availability of measles vaccine.

    Older people all have problems with a degree of immune system impairment...the "perils" of growing older. Most of them, have not been exposed to wild-type measles virus during the past forty years, due to the wide-spread use of measles vaccines given to young children. Many of these "young children" are grown up now...they are in their forties, fifties and sixties, yet we do not see older people, whether their immunity came from an actual case of measles, or from having had the 2-dose measles series, being reported as having a case of measles. According to the CDC reports on measles outbreaks, the only "older" people who are reported as cases are those who have no documented history of measles or no documented history of completing the measles series. Rarely, someone who has undergone stem cell transplantation and has not been re-immunized, will be reported as "a case".

    True, the measles virus is not like the varicella zoster virus (the gift that keeps on 'giving'), but the vaccine is made from a live attenuated virus, a class of vaccines...that usually confers long-term, often lifelong, immunity.

    We, of course, could have this conversation ten years from now :-) to see if my (personal) theory proves to correct.