ASK THE DOCTOR: Chicken pox, adults and vaccination
By DR. JIM MITTERANDO
The Patriot LedgerQ. I know getting chicken pox as an adult can be dangerous. I did not recall having chicken pox as a child, so my doctor checked a blood test. It came back negative. If I decide to become pregnant sometime in the future, should I get a vaccine? My doctor recommends it, but I want a second opinion.
What are the pros and cons? One more thing: my doctor said she'd write a prescription for me and I should go to the pharmacy, pick up the vaccine, bring it to her, and she'd give me the shot. Is that the usual procedure?
A. Immunity to chicken pox as an adult is an important issue since chicken pox is much more severe in grown ups than in kids. Chicken pox is a viral illness that causes clear blisters on the skin that then drain and scab and are quit itchy. Symptoms also include fever and malaise.
The illness lasts about a week. The chicken pox vaccine introduced in the early 1990's will hopefully eliminate chicken pox in the U.S. Most people think of chicken pox as a benign childhood illness; but occasionally there are complications such as skin infections and pneumonia.
The biggest problem in a household with chicken pox is that one child will get chicken pox the first week and the next week another sibling will get the illness so that now the parent has had sick, unhappy kids at home for 2 weeks.
Fortunately, with mandatory chicken pox vaccine for children over the past 2-3 years we see a lot less chicken pox. The vaccine is 80-90% effective. In the children that do get chicken pox after vaccination it is a milder, briefer illness.
Shingles (which is caused by the same chicken pox virus that remains in the nerves after chicken pox resolves and emerges years later to cause a painful, isolated rash) is less likely to occur in children that have been vaccinated compared to kids who had chicken pox.
Chicken pox in adults has a higher risk of complications including pneumonia and rarely death. Women in their reproductive years are at particular risk because catching chicken pox during pregnancy is not only dangerous for mom but can cause birth defects in the developing fetus. Teachers, day care workers and health care workers are at much higher risk of being exposed to chicken pox.
95% of adults have had chicken pox in the past and have immunity which means they cannot catch chicken pox again if they are exposed. You cannot get shingles when exposed to chicken pox. Shingles occurs years later after someone has had chicken pox and the dormant virus reemerges.
If you and your parents cannot recall if you had chicken pox as a child, the next step is to do a blood test called a titer to check for antibody levels against the virus. If you had the infection in the past, your body produces antibodies that are designed to attack and kill the virus. In your case, this revealed a "negative titer".
I agree with your doctor that you need to be vaccinated. The vaccine involves 2 shots in adults which includes a booster shot at 2 months. In children, their immune system is more resilient, and they only require one shot. The vaccine is safe. Side effects include a local reaction or tenderness at the site of the injection and occasionally a mild rash and fever which often indicates a good immune response to the vaccine.
It is important for women to clear up this issue before they become pregnant and get vaccinated before pregnancy. It is also important to check that a woman has antibodies to german measles(rubella) which can also cause birth defects if a pregnant woman becomes infected. It is not recommended to have chicken pox vaccine or rubella(MMR) vaccine when pregnant. Vaccines such as the flu vaccine and hepatitis vaccine are safe during pregnancy. In fact, the flu vaccine is now recommended for pregnant women.
Your doctor should be able to order the chicken pox vaccine (called Varivax) without cost from the state of Massachusetts. There are certain vaccines in adults that are not provided by the state that include Hepatitis and Meningococcal vaccines. If you have HMO insurance, these can be ordered by the doctor's office and are covered by your insurance. Other insurance plans may or may not cover these vaccines and you must pick these up at the pharmacy and bring to the doctor's office for administration.
Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com. The information in this column is not intended to diagnose individual conditions. Readers should see their own doctors about specific problems.
Editor's note: This is the first column by Dr. Mitterando, who is taking over "Ask the Doctor."
Copyright 2000 The Patriot Ledger
Transmitted December 12, 2000