Chickenpox Vaccination May Not Prevent Infection

Fri Jul 30, 1:17 PM ET

NEW YORK (Reuters Health) - During an outbreak of chickenpox in Minnesota in the fall of 2002, more than half the children who became infected had been immunized with the varicella vaccine, according to a new report.

Evidently, booster shots may be required to provide stronger protection against chickenpox. Dr. Brian R. Lee, at the Minnesota Department of Health in Minneapolis, and his colleagues investigated the outbreak that involved 55 children among 319 attending an elementary school in northern Minnesota.  According to the team's report in the Journal of infectious Diseases, 29 of the affected children had been vaccinated, and 6 had apparently had chickenpox previously -- which usually prevents another infection.

The primary case in the outbreak was a vaccinated 6-year-old boy. The investigators found that 25 percent of vaccinated children came down with chickenpox, as did 56 percent of unvaccinated students; among those with a history of varicella, the infection rate was 6 percent. Lee's group estimates that the effectiveness of the vaccine in warding off infection was 56 percent. However, immunized children did have fewer lesions, less fever, and fewer sick days than their non-immunized kids. The risk of catching chickenpox was more than two-fold higher for those vaccinated 4 or more years before the outbreak, compared with those vaccinated more recently -- so protection wanes over time.

These findings underscore the importance of keeping any child with chickenpox out of school, regardless of their vaccination status, Lee's team states. They also highlight the importance of continuing "to maintain and improve the national level of vaccination against varicella zoster and to consider whether a booster dose will offer additional protection," the researchers conclude.


SOURCE: Journal of infectious Diseases, August 1, 2004.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&
dopt=Abstract&list_uids=15138400

MMWR Morb Mortal Wkly Rep. 2004 May 14;53(18):389-92.    
Outbreak of varicella among vaccinated children--Michigan, 2003.

Centers for Disease Control and Prevention (CDC).

On November 18, 2003, the Oakland County Health Division alerted the Michigan Department of Community Health (MDCH) to a varicella (chicken pox) outbreak in a kindergarten-third grade elementary school. On December 11, MDCH and Oakland County public health epidemiologists, with the technical assistance of CDC, conducted a retrospective cohort study to describe the outbreak, determine varicella vaccine effectiveness (VE), and examine risk factors for breakthrough disease (i.e., varicella occurring >42 days after vaccination). This report summarizes the results of that study, which indicated that 1) transmission of varicella was sustained at the school for nearly 1 month despite high vaccination coverage, 2) vaccinated patients had substantially milder disease (<50 lesions), and 3) a period of > or =4 years since vaccination was a risk factor for breakthrough disease. These findings highlight the importance of case-based reporting of varicella and the exclusion of patients from school until all lesions crust or fade away. Information about recognizing vaccinated patients with mild cases should be disseminated to health-care providers, school administrators, and parents.

PMID: 15138400 [PubMed - indexed for MEDLINE]  

 

http://www.mothering.com/articles/growing_child/child_health/chickenpox_part
y.html

Chickenpox Party: Developing Natural Varicella Immunity
By Brian Wimer, Jacquelyn L. Emm and Deren Bader
Issue 122, January/February 2004

"Whoopee!" When word got out that little George's cousin Natalie had chickenpox, the playgroup phone tree lit up with the jubilant consensus: "Chickenpox party!" George was there, as was Natalie, our "Patient Zero." Jonah, Timothy, Sam, and Luka came with parents in tow, hoping to bring home a lifelong party favor of double-stranded DNA herpesvirus.

Yes, it sounds cruel and unusual to subject one's child to a biological sneak attack. But we weren't going blindly into this affair like Tupperware-toting lemmings. We'd done our homework. On the kitchen table was a stack of clinical studies citing the pros, cons, dos, and don'ts of catching wild chickenpox in the company of friends.

Sharing sippy cups, whistles, and lollipops (sugar- and saccharine-free, of course), the wee revelers romped and stomped and ran amok as microscopic varicella viruses triggered the alarms of their mucous membranes, manufacturing ideal antibodies for a lifetime of immunity.

Admittedly, we mommies and daddies were not caught in the mainstream with this somewhat rebellious act. Today's conventional wisdom says to go with the shot, which many parents do "to be on the safe side." But we at the party were doing what we felt was safest, after weeding through the
propaganda and rhetoric about America 's latest "Red Scare": the deadly scourge of chickenpox panic.

You've seen them: The spooky Merck & Co. ads with the crying rubber duck. The statistics of children dying from chickenpox. The assurances of vaccination safety. Slick. Even convincing, to some.

The leading edge of a new slew of mandatory policies is a recent decision from an Illinois immunization advisory committee that has recommended that chickenpox vaccinations be required for admission to Illinois schools-against the advice of the state health board. Allegedly, five of the committee's 18 members-and Illinois's governor, George Ryan, who vetoed a bill that would have banned people with financial ties to pharmaceutical companies from serving on the committee-had financial ties to Merck. 1 Conflict of interest or not, 29 states now require proof that children entering daycare or school either have had chickenpox or have been vaccinated against the disease.

Varivax, the varicella vaccine manufactured by Merck, was approved by the FDA in 1995. The latest Centers for Disease Control (CDC) reports estimate that 75 percent of the nation's children have been vaccinated with it. They credit the vaccine with a significant statistical drop in the number of chickenpox cases reported, and they have stacks of studies to back up their claim. From 1987 to 1997, the reported national incidence of chickenpox decreased 58 percent. 2 In fact, doctors are no longer required to report chickenpox cases to local and state health departments-which just might have some influence on optimistically low chickenpox statistics.

"The decrease from 1987 to 1997 corresponded with decreases in the number of states reporting to NNDSS and the completeness of reporting," admits the CDC. Areas reporting dropped from 46 states and DC in 1972 to 20 states in 1997. What declined was the reporting, not the incidence of chickenpox. Today, the CDC actively watches only three US sites for varicella: West Philadelphia , Pennsylvania ; Travis County, Texas; and Antelope Valley , Los Angeles County , California. 3

Two years after vaccine licensure, in the 14 states that maintained continuous reporting of varicella, the incidence remained completely unchanged, at 107.0 cases per 100,000 population. (The national incidence, however, was reported by the CDC as dropping to 36.9. 4 )

While the CDC estimates the vaccine to be 86 percent effective in children, a 2001 CDC study showed that that effectiveness might actually be as low as 40 percent. 5 But authorities at Maryland's Takoma Park Elementary School might quarrel even with that. There, reportedly, 12 of the 16 cases of a recent chickenpox outbreak involved children who had already been vaccinated. 6

Moreover, the CDC's Jane Seward, MD; Karin Galil, MD, MPH; and Anne A. Gershon, MD, director of the infectious disease division at Columbia University College of Physicians and Surgeons, found further cause for concern about the vaccine in a recent outbreak of chickenpox at a Concord, New Hampshire daycare center. 7 It began with a child who had been vaccinated, contradicting the theory that "breakthrough" cases-i.e., children who develop true chickenpox despite having been vaccinated-are not contagious. Studies from Cedars-Sinai Medical Center also refute the idea that vaccine-borne varicella is not contagious. 8-10

Nor, perhaps, is the vaccine as safe as advertised. A 2000 article in the Journal of the American Medical Association disclosed a wealth of reports made by doctors and parents to the Vaccine Adverse Event Reporting System (VAERS). "This FDA report confirms our concern that the chickenpox vaccine may be more reactive than anticipated in individuals with both known and unknown biological high risk factors," said Barbara Loe Fisher, president of the National Vaccine Information Center (NVIC). 11

Allowing for underreporting, the authors estimated that 4 percent of vaccine-induced adverse reactions (about 1 in 33,000 doses) were serious, resulting in shock, convulsions, encephalitis, thrombocytopenia, and 14 deaths. The report adds 17 adverse events to the manufacturer's product label, including secondary bacterial infections (cellulitis), secondary transmission (infection of close contacts), and Guillain-Barré syndrome.

"This vaccine should not be mandated," said Fisher. "There are too many questions about the true adverse event and efficacy profile of this relatively new live virus vaccine." 12 Fisher's concerns are not theoretical. Her son was left with multiple learning disabilities and attention deficit disorder after a severe reaction to a DPT shot.

This is not to say that wild chickenpox is entirely benign. The CDC estimates that the 4 million annual cases result in 11,000 hospitalizations and 100 deaths every year. (Although deaths first became reportable to the CDC only in 1999.) The risk of death from chickenpox complications in healthy children is quite minimal. However, the CDC contends that chickenpox is the leading "vaccine-preventable" killer of children, and many clinical studies have been published attesting to the vaccine's safety and efficacy.

But, some vaccine critics say, the wild version has its advantages. Allegedly, it produces much higher antibody levels than the vaccine, making individuals less prone to developing shingles, the adult version of chickenpox.

Getting chickenpox naturally works something like this: The virus enters the body through the mucous membranes and the upper respiratory and gastrointestinal tracts, giving the body time to work up a strong immune response. Once the body's immune system has built an antibody for the virus, the body will always build that same antibody on future contacts with the virus. Theoretically, if the first encounter with chickenpox is through vaccination, the resulting inferior antibody that the body develops is what will be used whenever the body encounters chickenpox in the future.

Critics of vaccines say that catching the wild version can mean the difference between temporary and lifelong immunity. According to Merck's literature, "the duration of protection of Varivax is unknown at present." Although studies in Japan report a 20-year vaccine duration, the CDC theorizes that that immunity will wane if wild viruses are wiped out. 13

The danger here is illustrated well by Kristine M. Severyn, RPh, PhD, a vaccine critic who has exposed drug-policy corruption in Ohio, Texas, Illinois, the American Academy of Pediatrics (AAP), and the Advisory Committee on Immunization Practices. 14 According to her studies, a widespread national chickenpox vaccination program might shift the incidence of chickenpox to adults, where the complication and death rate rise sharply. 15 In America today, adults comprise only 2 percent of
chickenpox cases, but are responsible for 47.5 percent of deaths from chickenpox. 16

Dr. Arthur Lavin, a pediatrician at St. Luke's Medical Center in Cleveland , agrees, writing in The Lancet that routine varicella vaccination in healthy children might pose a "grave danger of advancing the age of onset of chickenpox into adulthood." 17

We were able to witness this firsthand. Luka's uncle Damir, 32, caught chickenpox in the wake of our party. While all the kids had mild responses, Damir got the worst case his doctor had ever seen: hundreds of lesions, even in his mouth and down his throat; headache; and tender kidneys. Uncle
Damir couldn't sleep for two days. "Please, kill me," he joked as he staggered about, coated head to toe in calamine lotion.

Painful or not, catching chickenpox may be necessary for health, claim some clinicians. Internet medical celebrity Dr. Joseph Mercola theorizes that since varicella virus is a member of the Human Herpes virus family (herpesvirus 3 or HHV3), naturally acquired chickenpox may provide protection against other herpesviruses that have been implicated in causing cancer, Bell's Palsy, multiple sclerosis, AIDS, and chronic fatigue syndrome. 18

On the other side of the debate, Dr. Anne Gershon of Columbia University recommends vaccinating children to help patients cope with leukemia. "Because of the complexities involved in immunizing leukemic children, there seems to be a greater interest in vaccinating healthy varicella-susceptible individuals rather than leukemic children. If immunization with varicella vaccine were recommended for all 15-month-old infants, most children who become immunosuppressed because of development of leukemia would already have been vaccinated against varicella-zoster virus." 19

Although technically correct, Gershon's opinion isn't taken seriously by critics of vaccines. Vaccinating millions of healthy babies every year to protect leukemic children against chickenpox seems a stretch, but it's the kind of thinking that forms vaccination policy. The official reason behind vaccinating infants for Hepatitis B was in case these tots grew up to engage in high-risk sex or use IV drugs. Babies aren't statistically at risk for Hepatitis B. They are vaccinated because they are "accessible."

Still, what about the 100 people who die of chickenpox each year? You certainly wouldn't want your child to be one of them. "Sadly, about 7,400 kids end up in the hospital each year because of problems due to chickenpox. . . . And tragically, about forty children lose their lives," warns a Merck Varivax advertisement. But, a skeptic would ask, are those numbers accurate? Not entirely. Even Merck's clinical papers characterize chickenpox as a "benign, self-limiting disease." Technically speaking, people die not from chickenpox, but from complications, such as pneumonia, staph infection, meningitis, and encephalitis.

Moreover, some investigators suggest that modern medicine is to blame. After reviewing the medical records of several children who had allegedly died of chickenpox, Gary Krasner, director of the Coalition for Informed Choice, an anti-vaccine advocacy group, concludes: "Nearly all of these deaths were a result of standard medical care. Physicians would treat the children with antibiotics, analgesics, or steroidal medications as their condition grew progressively worse. . . . The doctors responded to each new symptom with yet another drug, until the children died." 20 Here's one such
report:

"On February 28, 1997 , a previously healthy, unvaccinated 21-month-old boy developed a typical varicella rash. . . . On March 1, he was taken to a local emergency department (ED) with a high fever and was started on oral acetaminophen [Tylenol] and diphenhydramine [an antihistamine]. On March 3, his primary-care physician prescribed oral acyclovir [an antiviral]. On March 4, his mother noted a new petechial-like rash. . . . [H]is primary-care physician noted lethargy, a purpuric rash, and poor perfusion [pulse]. He was transferred to a local ED. Fluid resuscitation and intravenous ceftriaxone [an antibiotic] were initiated, but the child continued to deteriorate rapidly, requiring intubation, mechanical ventilation, and inotropic [heart] support with dopamine [a morphine-like neurotransmitter]. . . . [H]e suffered cardiac arrest and died. The death was attributed to varicella." 21 (our italics)

What's interesting about this case is that it and two others were specific examples published in a 1998 issue of the CDC's Morbidity and Mortality Weekly to promote childhood vaccinations. 22 The cases were from 1997 in Texas and Iowa . It's unclear why these deaths were highlighted out of the alleged 100 chickenpox deaths that year. However, it's crucial to know that the second child, an asthmatic on the steroid Prednisone, was also given an antipyretic (probably aspirin or acetaminophen), and eventually developed and died from Group A strep (GAS).

The third child was treated with five antibiotics: one "unspecified," then methicillin and ceftriaxone, until he developed penicillin-resistant Staphylococcus. He was then put on nafcillin and gentamicin. Antibiotics can complicate varicella. First off, varicella is a virus, against which antibiotics are useless. Antibiotics may be necessary in advanced cases against secondary bacterial infections, but, Gary Krasner says, they impair the immune system-and the healing process, since they kill the good bacteria along with the bad. "After cells have been damaged, it is important for bacteria, acting as scavengers, to attack and devour the weakened, injured and dead cells. Otherwise, these dead cells would become accumulated toxic waste themselves." 23

Antibiotics were recently found to increase the risk of hemolytic-uremic syndrome when used for treatment of children with E. coli. 24 Whether or not they also complicate varicella remains unknown. Another issue to consider is that overuse of antibiotics has led to antibiotic-resistant bacteria. Of note are the relative prevalence of antibiotic-resistant streptococcus pneumoniae in daycare centers, and the relative prevalence of streptococcus pneumoniae in varicella complications and deaths. 25

Krasner's theories are partially substantiated by a 1999 paper by Benjamin Estrada, MD, of the University of South Alabama . Estrada reports that nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, acetaminophen, naproxin, and ibuprofen (Motrin, Advil, Nuprin) promote such GAS infections as necrotizing fasciitis (NF) and streptococcal toxic-shock syndrome-some of the major complications of varicella. The correspondence is significant: doctors routinely prescribe NSAIDs to lessen the aches and itching of chickenpox. 26

Estrada cites several studies. One found that development of invasive GAS infection was 8.3 times more likely in patients who used ibuprofen during the first five days after the onset of chickenpox. Another, focusing on NF, found that ibuprofen use led to twice as many hospitalizations as in control groups. 27-29

But with dangerous regularity, physicians prescribe NSAIDs such as ibuprofen to children with chickenpox. Take online Parents Place/Parent Soup "expert" Robert Steele, MD, for example. His column was awarded Best of the Pediatric Internet by the AAP, and Sesame Street magazine calls it one of the Best Health Sites for Parents. Yet Steele happily promotes ibuprofen for "fever control" during chickenpox because it's free of "sticky theoretical considerations." 30 Theoretical? Estrada would differ.

One other varicella-linked pharmacological danger is Reye's Syndrome, a life-threatening condition that causes liver failure and swelling of the brain. Epidemiological research links Reye's Syndrome and the use of aspirin for treating the symptoms (usually fever) of chickenpox. 31 Moreover, according to the National Reye's Syndrome Foundation, "An epidemic of flu or chickenpox is commonly followed by an increase in the number of cases of Reye's Syndrome." 32 Symptoms include irregular breathing and lethargy, two symptoms that often appear in case studies of varicella deaths. Reye's Syndrome is often misdiagnosed as encephalitis or meningitis, two complications that often appear in case studies of varicella deaths. Is it possible that aspirin is making a benign virus a killer?

Then there's the "death by misadventure" case of Lexie McConnell, a nine-year-old girl from England . She, too, died of chickenpox, but the coroner's inquest directly linked her death to the steroid Prednisone. She had been prescribed the potent anti-inflammatory drug for a pre-existing eye  infection. Her parents have since collected a 20,000-signature petition calling for an inquiry into corticosteroid prescription in Britain, a motion that has reached as high as the European Parliament. 33

The VAERS post-licensure study also faulted medical practitioners for contributing to varicella complications by simply administering the vaccine. "Pregnant women occasionally received varicella vaccine through confusion with varicella zoster immunoglobulin," 34 According to JAMA.

Besides these medical mishaps, there is another pattern in chickenpox-related fatalities: pre-existing medical conditions. Vaccine proponents often refer to a Reuters report that cites six Florida deaths in 1998 linked to chickenpox. "Since all six were good candidates for the vaccine, these deaths could have been prevented." A closer examination of the cases reveals that only two of the deaths were of children. One, an asthmatic, had been on steroids and died on a respirator. The other had leukemia and had been on immunosuppressive therapy since receiving a bone-marrow transplant. Of the adults, one was also an asthmatic on steroids (Prednisone again); another had diabetes, asthma, and cirrhosis of the liver. 35 Also interesting to note is that two of the adults who died were born and raised in Cuba. Because varicella is susceptible to heat, it is less easily communicated in tropical areas. People from the tropics are less likely to acquire immunity in childhood, and thus have higher rates of susceptibility as adults.

But we at the party knew all that. Our children were all healthy. None had asthma or leukemia (that we knew of), and no one was on steroids. Nor were we planning to give anyone Tylenol, aspirin, or NSAIDS of any kind. It was our belief that, given the correct circumstances, what we were doing was acceptably safe, rationally prudent, and would give our children a lifetime of immunity to a disease that could be dangerous in adulthood.

Yes, we all lost a night or two of sleep with a fussy child-the vaccine reportedly results in a milder version of chickenpox. But we felt those missed hours were worth the preservation of our children's health and well-being. Besides, they don't give out party hats at the doctor's office.

NOTES
1. Jim Ritter, "Ties to Drug Company Raise Vaccine Questions," Chicago Sun Times, 27 January 2002 .
2. "Evaluation of Varicella Reporting to the National Notifiable Disease Surveillance System: United States, 1972-1997," MMWR 48, no. 3 ( 29 January1999 ): 55-58.
3. Ibid.
4. Ibid.
5. "Low Varicella Vaccine Effectiveness Identified at Day Care Center ," Reuters Health, 19 December 2001 .
6. Avram Goldstein, "Chickenpox Cases Raise Questions," Washington Post, 2 February 2001 : B08.
7. "Chickenpox Vaccine Doesn't Ensure Protection," Reuters Health, 11December 2002 .
8. Victoria Stagg Elliott, "Chickenpox Vaccine's Staying Power Questioned," www.amednews.com , 20 January 2003 .
9. P. A. Brunell, T. Argaw, "Chickenpox Attributable to a Vaccine Virus Contracted from a Vaccinee with Zoster," Pediatrics 106, no. 2 (August 2000): e28.
10. R. P. Wise et al., "Postlicensure Safety Surveillance for Varicella Vaccine," Journal of the American Medical Association 284 (2000): 1271-1279.
11. Barbara Loe Fisher, NVIC Press Release, 13 September 2000 .
12. Ibid.
13. Committee on Infectious Diseases, " American Academy of Pediatrics: Varicella Vaccine Update," Pediatrics 105 (January 2000): 1, 136-141.
14. K. M. Severyn, RPh, PhD, "Profits, Not Science, Drive Vaccine Mandates," Medical Sentinel 5, no. 5 (2000): 173-174.
15. S. L. Thomas et al., "Contacts with Varicella or with Children and Protection Against Herpes Zoster in Adults: A Case-Control Study," The Lancet 360, no. 9334 (2002): 678-682.
16. K. M. Severyn, RPh, PhD, "Chickenpox Vaccine: Does Everyone Need It?." Ohio Parents for Vaccine Safety Newsletter (Autumn 1994).
17. Arthur Lavin , MD , letter to the editor, The Lancet 343, no. 8909 (1994): 1363.
18. www.mercola.com/2001/feb/14/chicken_pox_vaccine.htm .
19. Anne A. Gershon, MD, "Varicella Vaccine: Still at the Crossroads,"Pediatrics 90 (1992): 144-148.
20. Gary Krasner, "Chickenpox: Why Do Children Die?," Well Beings Newsletter (January 1999).
21. "Varicella-Related Deaths Among Children: United States , 1997," MMWR47, no. 18 ( 15 May 1998 ): 365-368.
22. Ibid.
23. See Note 20.
24. L. B. Zimmerhackl, "E. coli, Antibiotics, and the Hemolytic-Uremic Syndrome," New England Journal of Medicine 342, no. 26 ( 29 June 2000 ): 1990-1991.
25. L. A. Mandell et al., "The Battle Against Emerging Antibiotic Resistance: Should Fluoroquinolones Be Used to Treat Children?," Clinical Infectious Diseases 35 (2002): 721-726.
26. Benjamin Estrada , MD , "Varicella and GAS: Do NSAIDs Fuel the Fire?"Infect Med 16, no. 5 (1999): 307.
27. D. M. Zerr et al., "A Case-Control Study of Necrotizing FasciitisDuring Primary Varicella," Pediatrics 103 (1999): 783-790.
28. T. Brogan et al., "Group A Streptococcal Necrotizing FasciitisComplicating Primary Varicella: A Series of Fourteen Patients," Pediatric Infectious Disease Journal 14 (1995): 588-594.
29. C. L. Peterson et al., "Risk Factor for Invasive Group A Streptococcal Infections in Children with Varicella: A Case-Control Study," Pediatric Infectious Disease Journal 15 (1996): 151-156.
30.www.parentsoup.com/experts/ped/qas/0,,200532_417014,00.html?arrivalSA=1&arri
val_freqCap=1&pba=adid=6283455 .
31. "Reye's Syndrome-Ohio, Michigan ," MMWR 46, no.
32 ( 15 August 1997 ): 750-755. 32. www.reyessyndrome.org/what.htm .
33. "Traumatised Parents Agree Payout," BBC News, 23 June 1999 , 01:21 GMT02:21 UK .
34. See Note 10.
35. "Varicella-Related Deaths-Florida, 1998," MMWR 48, no. 18 ( 14 May 1999 ): 379-381.

For more information about chickenpox, see the following past issues of Mothering: "The Chickenpox Vaccine," no. 79 and "Putting Up with Chickenpox," no.70.

Brian Wimer is a freelance writer living in Charlottesville, Virginia, where Deren Bader, CPM, MPH, assists births (most recently, of Brian's daughter Maya-an at-home VBAC, no less); and where Jacquelyn L. Emm, MPH, former director of the Breast Cancer Early Detection Program for Santa
Clara County in San Jose, California, raises two healthy boys, George (3)and Sam (1), who have both had chickenpox.

 

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Infectious Disease & Immunity

PEDIATRICS Vol. 114 No. 2 August 2004, pp. e273-e274

Varicella Zoster Virus Meningitis in a Previously Immunized Child Joel Schwab, MD and Matthew Ryan, MD

From the Department of Pediatrics, University of Chicago, Chicago, Illinois

We are reporting a previously well 5-year-old child with varicella-zoster meningitis who had a history of a previous immunization against varicella. This child also developed a transient sensorineural hearing loss. The child was treated with acyclovir and made a full recovery.
--------------------------------------------------------------------------------

Key Words: varicella • varicella vaccine • varicella meningitis • sensorineural hearing loss

Abbreviations: VZV, varicella-zoster virus • CSF, cerebrospinal fluid • PCR, polymerase chain reaction

The vaccine to protect against varicella was approved by the Food and Drug Administration in 1995. Follow-up studies have verified the effectiveness of the vaccine, and children who were previously vaccinated and were infected with the wild virus had mild to moderate symptoms.1 In a recent report of an outbreak of varicella in a child care center in New Hampshire among immunized children, there were no severe complications or hospitalizations of affected patients.2

We report the case of a previously immunized child who developed skin lesions consistent with varicella and aseptic meningitis. The child did well clinically but developed a transient sensorineural hearing deficit.

CASE REPORT

A previously healthy 5-year-old girl presented to the emergency department with a 5-day history of fever, headache, and rash. The rash began on the face and spread to the trunk. It was described as pruritic and painful, and the lesions were raised. The headache was diffuse, and it would wake her from sleep. She had not experienced vomiting or ataxia. She was started on penicillin a few days before presentation for presumed group A streptococcal pharyngitis, but the culture was subsequently negative and the penicillin was discontinued. There were no known sick contacts or exposures to varicella, and her immunizations were up to date. When she was 3 years of age, she had received the varicella-zoster virus (VZV) vaccine, 18 months before this illness.

On admission, her temperature was 40.3°C, pulse was 148/min, blood pressure was 109/80, and she was awake and responsive. There were vesicles on the soft palate, her neck was supple, and a positive Brudzinski and negative Kernig’s sign were elicited. The skin had diffuse papules, vesicles, and scabbed lesions.

Her serum electrolytes, hemoglobin, and platelet count were normal. Her white blood cell count was 4500 cells/mm with 50% neutrophils, 26% lymphocytes, 12% monocytes, and 7% reactive lymphocytes. Cerebrospinal fluid (CSF) revealed 715 white blood cells with 97% lymphocytes. There were 168 red blood cells/mm, the protein was 133 mg/dL, and the glucose was 46 mg/dL with concurrent serum glucose of 86 mg/dL. The Gram-stain was negative for bacteria. The child was started on acyclovir for presumed VZV meningitis and vancomycin and ceftriaxone for possible partially treated bacterial meningitis. The skin lesions were positive for VZV by direct immunofluorescence antibody, and the CSF was positive for VZV by polymerase chain reaction (PCR). The CSF PCR for herpes simplex virus types 1 and 2 was negative. Serum immunoglobulin and lymphocyte subsets were normal. She completed a 10-day course of acyclovir in the hospital.

The child made an uneventful recovery and was discharged from the hospital without medications. A follow-up hearing evaluation 6 weeks later demonstrated mild to moderate sensorineural hearing loss from 500 to 1000 Hz on the right side and normal hearing on the left. Tympanometric testing was normal. Two years later, her hearing was normal and she was doing well.

The American Academy of Pediatrics recommended the routine use of varicella vaccine in May 1995 after licensure of the vaccine in March 1995. Serious complications of varicella are rare, but before licensure of the vaccine, 90 fatal cases per year had been reported to the Centers for Disease Control and Prevention in previously healthy individuals younger than 20 years.3 Although most instances of morbidity associated with varicella are unreported, secondary bacterial skin infections are common. Pneumonia, central nervous system disease, renal disease, and arthritis may also be seen. The incidence of varicella and the rate of hospitalizations as a result of severe varicella infections have declined since the vaccine was introduced.1,4

Aseptic meningitis has been reported in the literature with active varicella. Johnson and Milbourn5 reported 4 cases of aseptic meningitis in the prevaccination era diagnosed clinically. All of the cases had pleocytosis of the CSF, and 2 had elevated protein. Two of the cases had active varicella lesions at the time of diagnosis, 1 had scabbed lesions, and the fourth had a varicella exposure and an associated convulsion. All of the patients recovered without sequelae. Koskiniemi et al6 reported 3231 patients with central nervous system symptoms and suspected viral cause. With PCR testing, a viral cause was demonstrated in 46% of the cases and VZV was confirmed in 29% of those.

Naruse et al7 reported a case of VZV meningitis in a previously immunized 45-month-old child. The child had been immunized 21 months before developing meningitis, and there was evidence of seroconversion by immune adherence agglutination 4 weeks after immunization. Two weeks before this illness, the child had been exposed to an individual with varicella. The child was febrile, vomited, and complained of a headache. He did not demonstrate any meningeal signs. He had the typical rash of varicella with 97 lesions, and the CSF cell count was 413 white blood cells/mm with 98% lymphocytes. The protein was 48 mg/dL, and the glucose was 50 mg/dL. Bacterial cultures were negative, and he received 3 days of acyclovir. The child made an uneventful recovery without complications. The CSF was positive for VZV by PCR. This was the first reported case of aseptic meningitis caused by VZV in a previous immunized patient with evidence of seroconversion. The illness was presumed to be secondary to a wild strain of VZV because of the recent exposure, and the lesions on the skin were not limited to a specific dermatome that would be expected if this were a reactivation of VZV, typical of herpes zoster.

Our patient also had a history of being immunized, although there was no laboratory evidence of seroconversion. She demonstrated a severe headache and had a positive Brudzinski sign. Her CSF demonstrated an elevated protein, an increased number of white blood cells with a predominance of lymphocytes, and a normal glucose. Although she had an uncomplicated course in the hospital, there was a transient sensorineural hearing deficit at follow-up, which eventually resolved. Hearing loss after VZV meningitis has not been previously reported.

Galil et al2 demonstrated that the incidence of breakthrough varicella was twice the risk in children who are vaccinated >3 years before exposure. In contrast, our patient received her varicella vaccination 18 months before her infection. Verstraeten et al8 reported an increased risk of vaccine failure when varicella vaccine was given <28 days after the administration of the measles-mumps-rubella vaccine and in children younger than 15 months. The Redbook9 states that in vaccinated individuals, the disease may be so mild that it is unrecognizable as varicella.

Although the literature has documented cases of varicella after immunization, most reports do not include cases with complications. Our patient and the patient from Japan show that there may be serious complications in previously immunized children.

In summary, although the incidence of varicella and complications has decreased since the licensure of the vaccine, there may be breakthrough cases of varicella with aseptic meningitis and transient sensorineural hearing loss.


FOOTNOTES

Received for publication Jan 29, 2004; accepted Mar 22, 2004.

Address correspondence to Joel Schwab, MD, 5839 S Maryland Ave, MC 3055, Chicago, IL 60637-1470. E-mail: jschwab@peds.bsd.uchicago.edu


REFERENCES

Vasquez V, LaRussa P, Gershon A, Steinberg S, Freudigman K, Shapiro E. The effectiveness of the varicella vaccine in clinical practice. N Engl J Med.2001; 344 :955 –959[Abstract/Free Full Text]
Galil K, Lee B, Strine T, et al. Outbreak of varicella at a day-care center despite vaccination. N Engl J Med.2002; 347 :1909 –1915[Abstract/Free Full Text]
American Academy of Pediatrics, Committee on Infectious Disease. Recommendations for the use of attenuated varicella vaccine. Pediatrics.1995; 95 :791 –796[ISI][Medline]
Galil K, Brown C, Lin F, Seward J. Hospitalizations for varicella in the United States, 1988 to 1999. Pediatr Infect Dis J.2002; 21 :931 –934[CrossRef][ISI][Medline]
Johnson R, Milbourn P. Central nervous system manifestations of chickenpox. Can Med Assoc J.1970; 102 :831 –834[Medline]
Koskiniemi M, Rantalaiho T, Piparinen H, et al. Infections of the central nervous system of suspected viral origin: a collaborative study from Finland. J Neurovirol.2001; 7 :400 –408[CrossRef][ISI][Medline]
Naruse H, Miwata H, Ozaki T, Asano Y, Namazue J, Yamanishi K. Varicella infection complicated with meningitis after immunization. Acta Paediatr Japon.1993; 35 :345 –347[Medline]
Verstraeten T, Jumaan A, Mullooly J, et al. A retrospective cohort study of the association of varicella vaccine failure with asthma, steroid use, age at vaccination, and measles-mumps-rubella vaccination. Pediatrics.2003; 112(2) . Available at: www.pediatrics.org/cgi/content/full/112/2/e98
American Academy of Pediatrics. Redbook: 2003 Report of the Committee on Infectious Disease. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:681
 

Tuesday July 24 5:39 PM ET
Chickenpox Virus Tied to Lower Brain Tumor Risk
By Amy Norton
NEW YORK (Reuters Health) - Chickenpox may seem only a scourge of childhood, but new research suggests that infection with the chickenpox virus somehow protects against the development of brain tumors later in life. A few years ago, researchers came across an unexpected finding in a study of patients with brain tumors called gliomas: patients were less likely than healthy people to report having ever had chickenpox or shingles, another condition caused by the chickenpox virus, varicella-zoster. Now, in a new study delving deeper into the link, the investigators have found that glioma patients are also less likely than people without the cancer to have antibodies to varicella-zoster circulating in their blood. Once a person has had chickenpox, varicella-zoster remains in the central nervous system and years later can be reactivated to cause shingles, a painful condition that affects the nerves and skin.

The 134 glioma patients in this study were 60% less likely than similarly aged, healthy participants to have antibodies to varicella-zoster virus--an indicator of past infection. By comparison, their rates of antibodies to three other viruses in the same family as varicella-zoster (herpesviruses) were similar to those among healthy participants, according to the report in the July 15th issue of the American Journal of Epidemiology.
 
``We really don't know what it means,'' the study's lead author, Dr. Margaret Wrensch of the University of California, San Francisco, told Reuters Health. In the original study, she explained, ``we just kind of stumbled on the association'' between chickenpox history and glioma risk. Now that this study gives more weight to the relationship, Wrensch noted, more research will be needed to figure out why chickenpox infection--or lack thereof--might play a role in glioma formation.

She speculated that varicella-zoster cells and developing glioma cells may have some of the same antigens on their surfaces. Antigens are substances on cell surfaces that draw an immune system attack. So a person who has had chickenpox may have an immune system that is primed to fight gliomas ``before they become dangerous,'' Wrensch suggested.

Other immune system factors may be at play as well. Wrensch noted that because varicella-zoster is ``so ubiquitous''--most adults today have had chickenpox--it is very unlikely that different exposures to the virus explain the different rates of infection between glioma patients and people without the brain tumors.

Gliomas are the most common of the tumors that can arise in the brain. Although occupational exposure to certain industrial chemicals has been tied to an increased brain cancer risk, little else is known about why brain tumors develop. Wrensch said there is growing interest in the role various viruses might play.
SOURCE: American Journal of Epidemiology 2001;154:161-165.
Chickenpox Vaccine Increases Risk for Shingles

Vaccinating children against chickenpox (varicella) could increase the risk that adults would develop shingles, a painful blistering rash that is potentially dangerous in the elderly. Researchers from Britain's Public Health Laboratory Service (PHLS), said that thousands of elderly people could also die from the complications of shingles. They called for a re-evaluation of the policy of mass chickenpox vaccination that has been introduced already in the United States and is imminent in many other countries. In 1995, the chickenpox vaccine was approved for use in children over 1 year of age in the US and is now required for school entry.

After a bout of naturally-occurring chickenpox, the varicella zoster virus remains dormant in the body and may reactivate decades later to cause shingles, a painful rash that typically strikes chickenpox veterans after the age of 60. The researchers showed that adults living with children have more exposure to the virus that causes chickenpox and enjoy high levels of protection against shingles.

Being close to children means that adults are exposed to the virus, which acts like a booster vaccine against shingles, they believe. But if all children were vaccinated, adults who have had chickenpox would no longer be protected against developing shingles. The researchers worked out a mathematical model that predicts that eliminating chickenpox in a country the size of the United States would prevent 186 million cases of the disease and 5,000 deaths over 50 years. However they said it could also result in 21 million more cases of shingles and 5,000 deaths.
 
The PHLS said in a statement it was working out what the impact might be of introducing a chickenpox vaccine in Britain. "As more evidence becomes available, it will be shared with the Joint Committee on Vaccination and Immunization, which advises the Department of Health on the immunization schedule.


JAMA May 1, 2002;287(17):2211:

Low Varicella Vaccine Effectiveness
Identified at Day Care Center
CHICAGO (Reuters Health) Dec 19 - New study findings indicate that, at least among one group of children, the varicella vaccine is much less effective than previously reported.

Dr. Jane Seward, from the US Centers for Disease Control and Prevention in Atlanta, and colleagues reported Tuesday on their investigation of a recent outbreak of chickenpox at a New Hampshire day care center. They presented their findings here at the 41st Annual Interscience Conference on Antimicrobial Agents and Chemotherapy. The outbreak in 23 children began with a child who had been vaccinated, contradicting the belief that such "breakthrough" cases are not contagious, Dr. Seward noted. The child, a 4-year-old, was confirmed not to have developed varicella infection from the vaccine, but probably developed it after exposure to a sibling with shingles. Previous findings indicate that the vaccine's effectiveness ranges from 71% to 91%.In the current study, however, the effectiveness that was only about 40%. "Ours is the first study that has shown anything significantly below that level," co-author Dr.B. R. Lee of the CDC told Reuters Health. Dr. Seward and Dr. Lee say they cannot yet explain why the vaccine was ineffective in this group of children. "We'd like to really understand what factors came together to produce it," Dr .


Timing Affects Effectiveness of Chicken Pox Shot
CDC: Don't give it right after measles, mumps, rubella vaccine

By Adam Marcus
HealthScoutNews Reporter
FRIDAY, Nov. 30 (HealthScoutNews) --

Children who get immunized against chicken pox risk developing the disease anyway if the shot comes too soon after bulk vaccination for other infections, according to a new report from the Centers for Disease Control and Prevention.

When children receive the varicella vaccine less than 30 days after getting a shot for measles, mumps and rubella -- the so-called MMR injection -- their likelihood of contracting chicken pox is significantly increased, researchers say. However, officials note, their overall odds of developing the disease are still extremely low -- but far higher than if they don't get vaccinated at all. An unvaccinated person's risk of catching chicken pox by the time he is 30 years old is essentially 100 percent, experts say. The study "supports the recommendations that we have put in place," says Aisha Jumaan, an epidemiologist with the CDC's National Immunization Program and a co-author of the report. "This was not a surprise, but it was good to have the recommendations verified."

Chicken pox is caused by the varicella-zoster virus, which in adults also leads to shingles. The varicella vaccine guidelines are based on the experience with a far deadlier microbe: In the 1960s, doctors recognized that smallpox shots were less effective when delivered within a month of an measles injection, and vice versa.

This happens because the body's immune system is suppressed while it works to generate defenses against the proteins in the inoculation. Although administering both vaccines at the same time weakens neither, waiting for periods of less than a month doesn't give the immune system enough time to rebound, Jumaan says.

In the latest study, Jumaan and her colleagues compared chicken pox infection "breakthrough" rates in more than 114,000 children in California and Oregon between 1995, when the varicella vaccine was introduced, and 1999. Almost 70 percent of the children received the shot when they got their MMR vaccine, 29 percent got it at least 30 days later than the MMR, as health officials suggest, and the rest received the shot less than 30 days after the first inoculation.

Those who didn't wait the requisite month were 2.5 times more likely to be infected with chicken pox in the next several years than those in the other two groups, the researchers say. The risk of chicken pox was also somewhat higher in children who didn't wait 30 days for the shot after getting immunized against hepatitis B or who received the oral polio vaccine.

All pediatricians should be aware of the immunization guidelines, but Jumaan says some parents switch health care providers while their children are receiving their early childhood shots, which could possibly create confusion about what vaccines were administered and when. Fortunately, she says, the number of children who get the varicella vaccine too quickly is small, less than 1 percent in the new study.

Health officials believe that children who get their chicken pox shot less than a month before their measles-mumps-rubella shot may also be at increased risk of the latter diseases. Jumaan, however, says there's no evidence yet to support that hypothesis. "We think the mechanism would be the same, although we haven't seen that happen in actual life," she says.

The chicken pox vaccine, which is recommended for children over 1 year old who haven't already contracted the infection, has met with mixed reviews. Roughly 69 percent of all American kids received the injection in 1999, which is a lower percentage than for all other major childhood inoculations, according to the CDC.

A Washington state study last year of almost 600 parents found that most believed the shot was worthwhile even if its only benefit was shielding children from a rare but serious complication from the disease. But most parents didn't approve of the vaccine simply to save them lost work time.

Before the varicella vaccine was introduced, 4 million Americans -- mostly children -- contracted chicken pox annually, the CDC says. The disease caused between 4,000 and 9,000 hospitalizations and led to approximately 100 deaths each year. Most of the fatalities occurred in adults, for whom the disease is far more serious.

What To Do

To find out more about chicken pox, try the Centers for Disease Control and Prevention.

For more on the varicella vaccine, check out the University of Colorado or the Immunization Action Coalition.

Copyright © 2001 ScoutNews, LLC. All rights reserved.
Last updated 11/30/2001


Chickenpox may Help Lower Brain Tumor Risk

The July 15, 2001 issue of the American Journal of Epidemiology reports that researchers at the University of California, San Francisco have found patients who have brain tumors are much less likely to have had natural cases of the chickenpox.

When a person naturally gets a case of chickenpox, their body forms antibodies to the chickenpox virus that then give that person true lifetime immunity to the disease. In this study, 134 patients with gliomas were studied and found to be 60% less likely to have chickenpox antibodies in their blood, indicating they never had the disease.

The lead researcher, Dr. Margaret Wrench, concludes that a person who has had naturally-occurring chickenpox may have an immune system that is better able to fight the formation of gliomas (the most common type of brain tumor) "before they become dangerous."

By way of commentary, a lot of research reported here and other places is finding that allowing children to experience the "normal" childhood diseases, rather than vaccinating them, will help them build stronger immune systems for the future. Research has also pointed out over and over again how Chiropractic Wellness care will also help build immune system strength as well.

After learning of the legislative attempt to make the varicella vaccine mandatory in New York, I looked for a handle for an article. Since I didn’t recall that chicken pox had ever been grouped in the category of medicine’s infamous “Killer Diseases”, I thought I should find out how the Medical Boys justified making it compulsory for school children. It became apparent that the only medical justification for this vaccine had been the claimed mortalities. I went to the CDC’s website and found something revealing in the May 15, 1998/Vol. 47/No. 18 issue of Morbidity and Mortality Weekly Report (MMWR, their official publication). It was entitled, “Varicella-Related Deaths Among Children: Texas and Iowa notified CDC of three fatal cases of varicella (chickenpox) that occurred in children during 1997.” A short introduction stated that in the U.S. there are approximately 100 deaths (about half of these in children) and 10,000 hospitalizations each year for complications from chicken pox from infection with the varicella virus.

After going over the report, I remembered why I stopped reading medical journals. In each of the three cases the young boys started out with fevers and/or other minor inflammatory conditions. Following each regimen of antibiotics, analgesics, or steroidal medications their condition grew progressively worse. The doctors responded to each new symptom with yet another drug, until they died. Having an understanding of Natural Hygiene (briefly described by Harvey Diamond in his best seller, Fit For Life), I understood specifically why some of the drugs caused the adverse effects. But even equipped with a rudimentary understanding of the principles of N.H., one would realize that chicken pox is not a fatal disease, but rather a very common, benign inflammatory condition. And fatalities—as rare as they are—must actually result from inappropriate care, or the kinds of aggressive medical interventions described in the MMWR report.

With paraphrasing here and there, the remainder of this page is taken from the section on chicken pox from the book, Food Is Your Best Medicine by Henry Bieler, M.D. He was a renowned clinician practicing in Pasadena, CA for over 50 years until his death in 1975. Dr. Bieler’s skills were sought after by Hollywood celebrities and honored by his peers (a medical wing was named after him). Chicken pox arises from the elimination of toxic fat or fatty acids through the hair fat glands. The chemical burn from the purging of waste products though the skin causes the characteristic blister of this disease. This occurs when the liver is congested and cannot perform its eliminative function and metabolic waste matter (toxins) is then thrown into the bloodstream. These toxins in the blood must be discharged, so nature uses vicarious avenues of elimination, or “substitutes”. When these bile poisons (from the liver) in the blood come out through the skin, we get skin conditions manifested by rashes, boils, acne, etc. Or they come out through the mucous membranes (inside skin) manifesting as various catarrhs, like chicken pox. Thus, the skin is “substituting” for the liver, or a vicarious elimination is occurring through the skin.

FOOD AND DRUGS ARE CONTRAINDICATED
During the more acute and involved forms of toxemia, such as measles, chicken pox, fever, or flu, the liver is much too busy neutralizing toxic wastes to be bothered with digestion of food. Therefore, to facilitate the elimination of this waste, fasting on distilled water is essential in such cases. This accounts for the lack of digestive juices produced, and the loss of appetite that accompanies these illnesses.

After cells have been damaged by the toxic wastes, it is important for bacteria—acting as scavengers—to attack and devour the weakened, injured and dead cells. Otherwise, these dead cells would become accumulated toxic waste themselves. Therefore, antibiotics and other bactericides must not be administered. The so called “bad” bacterial strains die out on their own anyway, once their food (toxic waste) is used up. But until that point, they play an important role in the process that converts waste for eventual elimination.

The class of drugs that doctors use to treat catarrhs like chicken pox are called antipyretics. Among antipyretics, aspirin tops the list of favorites. Aspirin is a phenol (carbolic acid) derivative, with all the chemical qualities of phenol, but without the deadly effect of carbolic acid. Aspirin, like phenol, deadens the nerve endings, thereby masking pain. But aspirin also diminishes a fever by partially blocking the thyroid and the adrenal glands (a bad thing). The phenol derivatives interfere with the proper function of the liver and damage liver cells. The use of aspirin, then, is an attempt to drive out one devil (disease toxins) by admitting another devil!

THE IMPORTANCE OF FEVER
Fever in a child is a frightening symptom to the mother. Just what is the function of fever? Is it a harmful process, something to suppress and worry about? Or is it the body’s attempt to burn up a poison, thereby helping to dispose of it more quickly? In the diseases of childhood, fever begins in the liver. In a very strong, robust child, with properly functioning endocrine glands, the toxin is often completely consumed in the liver. The child does not feel sick or have pain; he just has a fever and if the liver area is carefully palpated, it can be noted that there is an elevation of temperature over that organ. In fact, if the temperature under the tongue is 105 degrees, the internal temperature of the liver may be as high as 110 degrees. But if the liver is unable to oxidize completely the poisons of disease so that some leak through into the blood stream, then, under the action of the endocrine glands, the poisons seek vicarious outlets via the mucous membranes. This may be through the upper respiratory tract, in the form of flu, sinusitis, pharyngitis, tonsillitis and possibly even pneumonia, which is a complicated kind of bronchitis. All through this process, the whole power of the liver is diverted into neutralizing the toxic wastes of disease, as evidenced by the fever.

The liver is much too busy to be bothered with the task of the digestion of food. Great strain can be taken off that organ if no food is given. Not only does fasting lower the temperature, relieve the distress and facilitate elimination, but it also lessens the strain on the liver and prevents serious complications, such as middle-ear disease, mastoiditis and meningitis. Left alone, a fever will not exceed 106 degrees. And only about 4 percent of children experience fever-related convulsions, with no serious aftereffects.

A fast (on distilled water, or at least diluted fruit or vegetable juices) should be continued for twenty-four hours after the temperature has returned to normal. A good rule to remember is that the bowel can be cleared of toxins (by physic or enemas) in twenty-four hours; the blood in three days; the liver in five days, providing no food is eaten. Shingles (“adult chicken pox”), an eliminative crisis through the mucous membranes that occurs in adults, may require about a week-long fast to completely clear up.

It appears then, that fever, dreaded because misunderstood, is really nature’s attempt to help. It is discomforting, but never does harm; never is attended with serious aftereffects and never should be suppressed with anti-inflammatory drugs or fed with food. I have seen many a case of flu pushed into a pneumonia because some anxious grandmother insisted upon something “to give the child strength”, such as chicken broth or a thin starchy gruel, both liquids, of course, but protein and starch—just what the liver cannot handle at this point.

THE TRUE CAUSE OF “INFECTIOUS” DISEASE
From Dr. Bieler’s words we gain a little understanding of Natural Hygiene. So called “infectious” diseases like chicken pox, measles, or whooping cough are actually inflammatory diseases. The symptoms during such illnesses should be viewed as eliminative crises. They may be very painful, but they’re a necessary self-limiting process in which an accumulation of retained metabolic waste (dead cells that become toxic), and the residues of undigested, unassimilated foods are being purged from the body through vicarious (abnormal, inappropriate) channels such as the skin or lungs. So the familiar runny nose, cough, stiffness, fever, and numerous rashes, swellings, lesions, and eruptions through the skin are all manifestations of the same cause—which are not pathogenic microbes.

Microbes like bacteria, for example, act as scavengers to consume the toxic wastes and the dead cells following inflammation. Their formation and growth do not precede the diseased state in the host, but rather emerge in its wake; and not exogenically—from say, an “infected” person—but rather endogenically, from the genetic material contained in a cell’s nucleus after the cell’s death and decomposition. Fortunately, a wide range of bacterial strains, or their genetic “blueprints” (e.g., the various cellular and sub cellular—or “filterable”—stages that bacteria cycle through), inhabit our bodies all the time in titers low enough that their waste products do not affect us. Recently reported villains like salmonella, e. coli, or streptococcus are enteric and ever-present inside us. The viruses associated with measles, polio, influenza, and all the rest are also present—both in health and disease—and may have only an associative relationship with the diseases, but no proven causative roles. (Incredibly, modern medicine still hasn’t determined the mechanism by which a virus causes poliomyelitis.) But when we become toxemic and our blood loses its alkalinity, the pathogenic strains begin to flourish in the bodily waste that accumulates—even well before any outward symptoms (inflammation and elimination) begin to appear. Their morphology (strain and function) is determined by the type of waste that is present for them to feed upon.

Symptoms are often triggered by a physiochemical or psychological “trauma”, such as exposure to cold or toxic chemicals, stress, lack of sleep, ingestion of spoiled meat, a sting or bite from an insect, or an injected vaccine. Why these diseases occur predominantly in children is best described by Dr. Bieler: “The childhood years should be the healthiest of all. It is during those early years that the endocrine glands and the liver are in their best functional capacity, giving the healthy child his natural state of exuberance, inexhaustible energy, and faultless elimination”. When elimination ends and symptoms subside, doctors will proclaim that the drug had “taken effect”. But they are confusing symptoms with cause; believing that the disappearance of the former equates to the disappearance of the latter. But obviously a cause and an effect cannot be one in the same. When you stop the body from discharging toxic waste, you are not stopping the disease; you are merely stopping the effects.

But more importantly, when Allopathic physicians employ pain killers, fever suppressants, steroids and other drugs—which are sub-lethal doses of poisons—they have the effect of weakening the patient to the extent of checking elimination. This is a dangerous effect, because the waste products of these germs that have fed on the dead cells, together with the irritation from the toxins themselves may be absorbed into the blood, and irritating the already overworked liver—which is the detoxification center of the body. Antibiotics—which literally means “against life”—act chiefly by violently stimulating the adrenal glands. But if they are weak or depleted, the disease runs a chronic, often recurring course. In the aftermath of these germicides, there are also left fewer germs to convert waste, and no means to carry off and eliminate the dead cells. Not surprisingly, there are more deaths today from septicemia (blood poisoning caused by toxic waste from putrefactive bacteria) than there were before the use of antibiotics. (One of the boys from the MMWR report died from it.) Reactions from antibiotics include anaphylactic shock, aplastic anemia, and induced virulent infections. Death from penicillin still occurs.
CHICKEN POX DOESN’T KILL; DOCTORS KILL .

It’s now plain to see why the children described in the afore-referenced MMWR had died. They were given numerous antibiotics, steroids, antipyretic and antipruritic medications and other fever suppressers, some administered directly into their bloodstreams. Probably they were given food to eat as well, even during the height of their inflammatory responses. The CDC admits that children don’t die from chicken pox per se, but rather “complications” from chicken pox. But what they don’t say is that these complications are all derived from acute blood toxemia established by the very treatments used by allopathic physicians. What does the CDC list as the most common complication? Pneumonia and secondary bacterial infections (caused by the antibiotics). Other complications, according to the CDC, include encephalitis (inflamed brain tissue mostly from the antipyretics), hemorrhagic complications (such as intestinal bleeding, are the most common symptoms of aspirin—an anticoagulant, or “blood thinner”), hepatitis (congested and inflamed liver caused by the antipyretics), arthritis (decalcification of bone for the calcium needed to neutralize acidic blood, mostly caused by the aspirin), and Reye’s syndrome (most commonly associated with giving aspirin to children that have chicken pox or influenza). Prescribing acetaminophen (Tylenol, etc.) in large doses is also toxic to the liver and kidneys, because they also check the vital actions of the body to discharge waste from the blood.

Therefore, to say that “death is a complication of chicken pox”, is like saying, “bleeding is a complication of holding a knife in your hand”: each event is neither contingent nor a consequence of the preceding one. Their association is artificial; requiring specific actions to take place. Actions that are in accord and mandated by standard medical practice.

To promote the vaccine, the CDC proclaims that, “varicella (chicken pox) is the leading cause of vaccine-preventable deaths in children in the United States.” But while the deaths are certainly preventable, they have nothing to do with the vaccine.

Copyright 1999 by Gary Krasner


Hilary Butler on Chicken pox; Can we discuss Chickenpox and the vaccine please?

You said Two things recently - that additives in vaccines were to the rate of 1 part per million, and, at chickenpox kills.

First, Additives in the chickenpox vaccine. A nurse rang me yesterday, because she was threatened that if her child was not vaccinated against chickpox, she would lose her job in a old people's home. No, the logic of that escapes me too, but never mind. She had rung the local immunisation people and asked what was in the vaccine. She was told she didn't need to know, because it was perfectly safe, which annoyed her, so she rang me. I read to her from the Varivax sheet, because that is the one the doctor wanted her daughter to have. This sheet says:

"Each 0.5 ml dose contains the following; a minimu of 1350 plaque forming units of Oka/Merck varicella virus when reconstituted...12.5mg hydrolyzed gelatin, 3.2mg sodium chloride, 0.5 mg monosodium L-glutamate, 0.45mg of sodium phosphate dibasic, 0.08 mg of potassium phosphate monobasic, 0.08 mg of potassium chloride; residual components of MRC-5 cells including DNA and rotein; and trace quantities of sodium phosphate monobasic, EDTA, neomycin and fetal bovine serum." Firstly, she was surprised by the neomycin, because the manual says that this is never to be given internally -it is for external use only. I could not explain this rather obvious contradiction in the published literature. She wanted to know what MRC-5 was, and how much was trace quantities. I explained to her that each dose of arivax has 2 nanograms of "modified mammalian DNA (Pg 522, Journal of Paediatrics, Volume 127, No4, October 1995) and that this tissue came from aborted fetal tissue which was cultured (immortalised). I also explain that studies had showed that this tissue had a 7:12 chromosome translocation, but that the FDA's assessment was that the risk of MRC-4 DNA's inducing a malignant transformation in vaccinees was exceedingly low. What that meant, I did not know.

Then she asked what fetal bovine serum was, and whether  it was safe. I told her that it was blood from unborn  calves, removed at the meatworks, and could not be  guaranteed totally safe, because commercial lots used  in MMR were found to contain bovine diarrhoeal  pestiviruses which had been known to cause problems in  humans (Journal of Clinical Microbiology, June 1994, pg 1604-1605) and that usually it was not picked up in manufacture, because it didn't cause any cell changes  in the culture medium. I also read out from other known contaminants of fetal bovine serum from some WHO documents. I could not specify what trace amounts are.
 
  I also pointed out that medical literature was  indicating that allergic reactions to the MMR were now thought to be from modified gelatin, and since this one had 12.5 milligrams of that too, there was a very small theoretical risk from that, especially as her daughter was an asthmatic.  She asked where the Oka strain came from, and I told her it was obtained from a Japanese boy and made weaker by passage through human embryonic lung fibroblasts  (again, aborted fetal tissue), then guinea pig  embryonic cells, then two different human aborted fetal lines called WI-38 and MRC-5. the vaccine is then manufactured in bulk by infecting the aborted foetal line called MRC-5.
 
We also discussed the procedures involved in reducing the human DNA to 2 nanograms in each dose. These things are not 1 part per million, though I realise that your statement was a very broad generalised thought... but it was not fact, for any vaccine.
 
 This nurse considered all this, and decided not to vaccinate her allergic child. I guess she will have to have a few words with her boss. As a health professional, she chose not to do it.  My husband has three children from his first marriage. ( His first wife was killed in the Erebus aeroplane crash in Antartica a long time ago.) One family has three children, so we have three grandchildren. Two of them have been vaccinated with Varivax (the third is too young) - to them, vaccines are compulsory. So I was very surprised when her children came down with quite bad chickenpox, and she came around saying "Wasn't it wonderful that we had vaccines, because without them, her children would have died". We took out the photographs of our children when they had chickenpox which showed far less severe and fewer spots. We also pointed out that she was around at that time, in case she didn't remember, and neither of them were vaccinated. What's more we pointed out that neither of them had mild encephalitis as did her younger one. She just sat there. And then incredibly, said: "Well I think the vaccine saved my children's lives". What could we say? When people won't listen, they won't listen. Second - you said that recently, it has been shown that chickenpox can kill I have looked at all the recent cases of serious chickenpox cases, and in all cases the alert that I take from the literature is not so much to chickenpox, but the use of tylenol. Which I know, in your country, is what every nurse tells every mother to give every child with a temperature. In this country, we use a similar thing called Paracetamol. Some chickenpox cases got necrotising fasciitis, (Ped Infect Dis J 1995 jul;14(7): 588-94)again why? We all know that NSAIDS like tylenol and ibuprofen are implicated.
 
Another one (Infect Med 16 (5):307, 1999 noted severe Group A beta-hemolytic strap in children who had had antipyretic medication. MMWR, May 15, 1998, Vol 47 No 18 listed chickenpox cases too.But these parents don't appear to have been asked about Nonsteroid anti-inflammatories, or - tylenol. Pediatrics Vol 103, No 4, April 1999, pg 783+ again noted the association of ibuprofen with serious complications - and elsewhere in the same issue. We have on file medical articles which show that if you take these things you can
 
1) Prolong the flu
 
2) Worsen the outcome of malaria.
 
3) Induce pneumonitis
 
4) Acta Paediatri Jpn 1994 Aug;36(4):375-8 shows that administration of any antipyretic drugs in children with infectious diseases worsens their illnesses. We also have evidence on file to show that it is a major factor in serious meningococcal meningitis. Why? Because it appears that anti-pyretics down- regulate the immune response. This is only natural, since the reason for a fever is to switch on certain cytokines, and push the immune system up from the fourth gear to the tenth (prely as an imagery picture, here), to help deal with the problem. There is very clear evidence that tylenol creates an ineffective immune system in some children, and as Ped Infect Dis 1996:15: 355-53 points out about the immune system in general - not in particular to Tylenol - "an ineffective immune response to certain organisms can result in life-threatening infection." Better yet, a Journal called Family Practice, Volume 13, No 2, 1996 stated:
 
"Paracetamol prescribing is reaching epidemic proportions and the potential dangers of hepatotoxicity and the inhibition of the immune response in children are discussed."
 
He goes on to say: "Despite our lack of knowledge about its therapeutic mechanism, it has been claimed to be a safe frug, especially for children...there is mounting evidence that paracetamil is not the benign drug that it was formally thought to be... We would question the whole rational of prescribing the drug in near epidemic proportions...there is little concern about its use in the short term as an ANALGESIC, there is considerable controversy over its use as an  antipyretic...paracetamol may decrease antibody response to infection and increase morbidity and mortality in severe infections....too many parents and health workers think that fever is bad and needs to be suppressed by paracetamio, when indeed, moderate fever may improve the immune response."
 
In another earlier study in the Lancet March 9, 1991 pg 591 it was stated "Studies have clearly shown that fever helps laboratory animals to survive an infection whereas antipyresis increases mortality (death). Moreover, there is considerable in-vitro evidence that a variety of human immunological defences function better at febrile temperatures than at normal ones."
 
It is a natural thing to say that if your child was vaccinated against chickenpox, they won't get it (....? maybe) so you then wouldn't have to worry about the use of tylenol.
 
My feeling is that tylenol should never be used in any case of infectious disease, for several reasons -first, it suppresses the immune system. Second it makes most children sleepy. Third - the combination of those two factors can mask critical symptoms which would alert a parent to a problem, so that as in the case of many if not most of the recent chickenpox cases - by the time they get to hospital, the situation is very severe indeed.
 
 Do you think then, in the light of the literature, all parents should be warned that while they can use Tylenol, or paracetamol as as ANALGESIC - or pain relief, that they should never use it for infectious diseases? And also, why is it that nurses always tell mothers to do this? Is it to shut them up? It is always Give them tylenol, and if you are still worried tomorrow, ring the surgery...." This is a poor substitute for good clinical management, don't you think?
 
 Secondly, in the context of the cases where the use of ibuprofen or tylenol has changed chickenpox into serious secondary fatal bacterial infections, isn't that a case, not for a vaccine, but for iatrogenic mistakes to be investigated? After all, it wasn't the parent's fault.
 
thirdly, since I cannot find any evidence to show that all the ingredients in the Varivax vaccine are safe, will not cause problems, and will not cause cancer, I think that before anyone used these vaccines, they should know exactly what is in them, that this research has not been done, and the long-term dangers are therefore unknown. Don't you?
 
What I want to discuss here is the need for all facets of issues to be discussed. So often your posts are very simple, but this might not always reflect the complete picture.
What do you think?

http://www.wfsb.com/Global/story.asp?S=1025686

COLCHESTER -- State health experts are investigating an outbreak of chicken pox in Colchester. 65 students at the Jack Jackter Elementary School got chicken pox last year. It was one of the largest outbreaks in the state. The Centers for Disease Control is also involved in the investigation. That's because some of the students who got sick were vaccinated against chicken pox.

The chicken pox vaccine has a 20-percent failure rate.

http://abcnews.go.com/wire/US/reuters20021211_602.html

Double Chickenpox Vaccine May Be Needed: Experts

Dec. 11

— By Gene Emery

BOSTON (Reuters) - Doctors may need to give two doses of the chickenpox vaccine instead of one, experts said on Wednesday after a study showed a single dose of the vaccine has a far higher failure rate than previously thought. Karin Galil of the U.S. Centers for Disease Control and Prevention calculated that the vaccine failed to protect 56 percent of children who got the shot. In previous studies, the failure rate ranged from 0 to 29 percent.

Galil's study found that chickenpox spread rapidly through vaccinated children in a New Hampshire day-care center. "This outbreak constitutes a warning signal," Anne Gershon of the Columbia University College of Physicians and Surgeons in New York wrote in a commentary in the New England Journal of Medicine, which also published the CDC study.

She said a second shot may be necessary to provide meaningful protection, although Gershon noted that studies were needed to see if the cost was worth the benefit. "The time for exploring the possibility of routinely administering two doses of varicella (chickenpox) vaccine to children seems to have arrived," she said. Chickenpox causes headache, fever and, eventually, a rash that leads to itchy red spots that are filled with fluid before they crust over and disappear.

While parents often view it as a benign disease, chickenpox can lead to pneumonia, inflammation of the brain, and skin infections. Before the vaccine was licensed in 1995, chickenpox sent 11,000 people to the hospital each year and killed 100. Half of the fatalities were children. Since then, the number of hospitalizations for chickenpox has plummeted by 80 percent, according to the CDC researchers. Chickenpox spreads easily through the air and a child can be contagious three days before symptoms appear.

About 75 percent of U.S. children have received the chickenpox vaccine. It is required for school-age children in at least 26 states and four others -- Louisiana, New Hampshire, Nevada and New York -- will require it next year. It is not unusual for children to get multiple vaccines -- it takes two doses of measles vaccine to control that disease, for instance, and several doses for polio, hepatitis and other viruses.

Copyright 2002 Reuters News Service

Kids may need two chicken pox shots, study says
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1039651448621_35060648/?
hub=Health
CTV News Staff
A new study is suggesting that children who've been vaccinated against chicken pox may need a second dose to guarantee complete protection from the disease. The study, to be published Thursday in the New England Journal of Medicine, cited several examples of outbreaks that infected children who had been vaccinated for chicken pox, including a day-care centre in New Hampshire where 16 of 25 children infected had been previously been given a shot for chicken pox.

"They had some immunity, but it wasn't completely protective," said Dr.Karin Galil of the U.S. Centers for Disease Control and Prevention, the study's lead author. "It stopped them from getting a bad case of chicken pox but it didn't protect them from getting infected with the chicken pox virus."

The varicella zoster virus causes an itchy, blister-like rash that covers the head and trunk. It is accompanied by headache, fever and tiredness. The disease is a simple annoyance for most children, but those with a suppressed immune system can develop serious complications. About five or six children die from complications each year in Canada. The vaccines' effectiveness against chicken pox is supposed to range between 77 per cent and 100 per cent but Galil found the single dose was only effective in 44 per cent of cases.

"We are taking very seriously the possibility that we might not have the right optimal vaccination level yet," said Galil. "And if there's evidence that we need to change it, that will be a priority." The good news is that most children infected after receiving the vaccine developed only mild symptoms, with one child in the New Hampshire study being diagnosed with just a single blister. In fact, doctors credit the vaccine with cutting the total number of cases of the nasty disease across North America. In the U.S., chicken pox cases have dropped 80 per cent since the vaccine was introduced in 1995. Health Canada says the rate of chicken pox per 100,000 people had fallen to 135.69 in 1999 from 301.7 in 1993.

"Since we have been using chicken pox vaccine the number of admissions to hospital for severe disease, the amount of chicken pox in the community and the severity of that chicken pox have decreased significantly," said Dr. Stanley Read of the Hospital for Sick Children in Toronto. In Canada, only Alberta, Prince Edward Island and the Northwest Territories pay for its use. Nova Scotia announced Wednesday it intends to vaccinate all babies against chicken pox before they turn one year old.

Other provinces are considering bringing the vaccine under their health coverage, but some doctors fear the study will prompt some health ministries to opt away from paying for the vaccine until more studies are completed. "I hope it's not used by the government as ammunition to say we don't know enough about it so we should not pay for it," said Dr. Tony Barozzino of St.Michael's Hospital in Toronto. "There is lots of evidence to say, if anything, we need to give more of it."

U.S. health authorities are pushing states to adopt mandatory chicken pox vaccinations, saying the vaccine reduces the costs related to the disease, including the costs of missed work, school, and childcare. Meanwhile, the are also concerns that the vaccine could result in an increase in adult chicken pox and shingles, a disease linked to the varicella zoster virus.

Because multiple exposures of chicken pox boost immunity throughout their lives, people who suffered a bout of chicken pox as a child almost never get it again as an adult. Also, between 10 and 20 per cent of people who had chicken pox as a child eventually develop shingles as an adult. Because of the vaccine, those who had it as a child will not be exposed as often, potentially making adult chicken pox and shingles more common. Several U.S. studies are underway to detect any evidence of faltering immunity associated with the varicella vaccine.

http://www.nytimes.com/2002/12/12/national/12BRFS6.html?tntemail1
December 12, 2002
National Briefing: Washington
New York Times

STUDY OF CHICKEN POX VACCINE
A chicken pox outbreak two years ago found vaccinations surprisingly ineffective and may suggest that children should get two shots instead of one, some researchers say. Seven earlier studies found the vaccine protected at least 71 percent of the children who got shots from developing chicken pox. But the latest study, the results of which were published in today's New England Journal of Medicine, tracked the worst performance of the vaccine since its introduction in 1995. At a day care center near Concord, N.H., a boy who had been vaccinated three years earlier came down with the illness. Within six weeks, the virus spread to 24 other children, including 17 who had also been vaccinated. Dr. Karin Galil, the study's lead author, said it was still too early to suggest that more than one vaccination was needed. "When there are 20 or 30 estimates, we'll have a better measure of how well it's truly working," she said.
(AP)

An Imperfect Vaccine
Chickenpox Cases Stir Call for Booster
By Sandra G. Boodman, Washington Post Staff Writer
Tuesday, December 24, 2002; Page HE06
http://www.washingtonpost.com/wp-dyn/articles/A31300-2002Dec23.html

When her 7-year-old daughter awoke with a fever recently, her torso blanketed by an itchy rash, Trudi Boyd was perplexed. "I thought, 'She's had the vaccine -- this can't possibly be chickenpox.' "

That's exactly what it was, according to the pediatrician who told Boyd her daughter was the third chickenpox patient he'd seen that day -- all of them from St. Mary's Catholic School in Old Town Alexandria. Since Dec. 9, 11 cases of chickenpox have been diagnosed among students at the school and confirmed by a pediatrician. Eight of these cases involve students who, like Boyd's daughter, had been vaccinated against the disease as babies.

An elementary school in Loudoun County has been hit much harder: 47 cases of chickenpox, half among vaccinated children, have been reported since the end of November, according to Virginia Health Department epidemiologist Denise Sockwell, who declined to identify the school. No recent outbreaks have been reported in the District or suburban Maryland, officials there said.

The phenomenon of what doctors call "breakthrough" chickenpox infections highlights what some health officials say may be a limitation of the varicella vaccine, administered as a single shot to babies between the ages of 12 and 18 months. Most states require vaccination for entry to kindergarten or day care, and it is estimated that 75 percent of children under 3 have been innoculated.

But several recent studies, the most recent of which was published Dec. 12 in the New England Journal of Medicine, suggest that the single-shot regimen may be insufficient to prevent outbreaks of chickenpox among vaccinated children. Some vaccine experts, among them Anne A. Gershon of Columbia University, are suggesting that a second dose of chickenpox vaccine, like the one given for measles, be added to augment protection.

It is a suggestion that federal health officials say they are pondering. "We know the vaccine works, especially in preventing severe disease," said Jane F. Seward, chief of childhood vaccine-preventable diseases at the Centers for Disease Control and Prevention (CDC). "We always knew the vaccine wasn't 100 percent effective. There's certainly a consideration of adding a second dose . . . and we would like to understand what places some children at higher risk of a breakthrough infection" while others do not succumb.

Seven studies of the effectiveness of the varicella vaccine, licensed in 1995, have found that the shot is 71 to 100 percent effective in preventing chickenpox of any severity and 95 to 100 percent effective against moderate to severe disease -- the most contagious form, which can result in hospitalization or death. The disease is spread through exposure to an infected person and typically develops 14 to 21 days later.

Officials at Merck, which manufactures the vaccine, said that the New England Journal study differs from earlier reports, which showed that the vaccine was significantly more effective. "Other investigations need to be done," said Richard M. Haupt, senior medical director for pediatric vaccines at Merck. "We will continue to look at this and the CDC will, as well. But the important thing to remember is that you may not be completely protected, but the chances are you'll be protected from severe disease."

Before the advent of the vaccine, 11,000 Americans were hospitalized annually with complications from chickenpox and 100 of them died. The vaccine has led to an 80 percent drop in both complications and deaths, health officials said. Although people with impaired immune systems are most at risk from the virus, some deaths have occurred in otherwise healthy children who developed pneumonia, toxic shock syndrome or necrotizing fasciitis, more commonly known as "flesh-eating bacteria."

The New England Journal report involves a chickenpox outbreak at a Concord, N.H., day care center that affected large numbers of vaccinated children and resulted in an unusually low overall effectiveness rate for the vaccine -- 44 percent. Officials at the CDC and the state health department found that the vaccine was 86 percent effective in preventing severe cases, defined as more than 500 lesions.

The New Hampshire outbreak involved 25 of 88 children who attended the same day care center between Dec. 1, 2000, and Jan. 11, 2001. The first child to contract the disease was an otherwise healthy 4-year-old boy who had been inoculated three years earlier. He subsequently infected more than half his classmates.

Investigators found that children who had been vaccinated three or more years before the outbreak were twice as likely to contract chickenpox as those inoculated more recently. Of the 25 children affected, 17 had been vaccinated. These children all had mild cases and fewer than 50 lesions. Investigators did not find that the outbreak was caused by an improper dose of vaccine or by a problem with the way it had been stored or administered "Although policy cannot be established on the basis of one outbreak," the investigative team led by Karin Galil, formerly of the CDC, wrote, "the findings in this investigation raise concerns that the current vaccination strategy may not protect all children adequately."

The New Hampshire outbreak is considered by epidemiologists to be an "outlier" because the effectiveness rate is so much lower than has been found in previous studies. This case alone will not lead to a change in immunization policy, CDC officials said. The decision of whether to add a booster probably won't be made until after experts examine data from a long-term study of 90,000 children.

In the past seven years the CDC has been called in by local health officials to investigate chickenpox outbreaks in 10 states, including Maryland. An investigation conducted in January 2001 by CDC investigators at a Montgomery County elementary school placed the vaccine's effectiveness rate at 59 percent, according to CDC's Aisha Jumaan, who directed the probe.

The outbreaks in New Hampshire and Loudoun County and the recent cluster of infections in Alexandria appear to be increasingly common, health officials say. "These are happening all the time, and we don't usually get called," said Jumaan, noting that chickenpox won't become a reportable disease in all states until 2003. Sometimes, she said, parents call the CDC to report cases and CDC officials then call state health departments to alert them to a possible outbreak. "The issue for us is: Is this a random event or is it really telling us something about the vaccine?" Jumaan said.

There is not much parents can do to prevent infections in vaccinated children. Many schools require that children with chickenpox stay out of school until all lesions crust over, a process that can take about five days. Because chickenpox lesions resemble insect bites, mild cases may be overlooked or misdiagnosed.•

© 2002 The Washington Post Company

If these vaccines worked kids would need one.

Julie Maguire figured the dots on her son's face and belly must be heat rash. He was too young for acne, and he had been vaccinated against chickenpox almost five years ago. She sent him to the showers.

But the bumps didn't disappear, and they persisted the next morning -- tiny red welts, round and a little itchy. Maguire became suspicious as she perused the Internet for culprits, then heard one of M.J.'s classmates was home with the chickenpox. There was no doubt about it. And she couldn't have been more surprised.

"Since he had the vaccine, it was the last thing on my mind," Maguire said last week from her St. Petersburg home. "And he wasn't really sick. He didn't feel bad." M.J., who is 10, and his mom discovered an emerging fact about the varicella vaccine, which is now required for all children when they enter school: It may not be as good at preventing chickenpox as was previously thought.

In an article published this month in the New England Journal of Medicine, researchers revealed that during an outbreak of chickenpox at a large New Hampshire day care center, more than half the children who had been vaccinated still got the disease -- a prevention rate of just 44 percent. And the more time that had passed since they were vaccinated, the more likely the children were to get sick.

Earlier studies had suggested the vaccine was 70 to 90 percent effective. The new finding has prompted federal health officials to begin studying whether a booster shot may be needed. "Figuring out the best (vaccination) schedule takes time," said Dr. Karin Galil, the article's lead author. "Once a vaccine is licensed, and millions of children and adults use it, you learn a lot more about it. There's a natural process of evolution that occurs."

Galil and other experts stressed the study also confirmed the vaccine's ability to prevent severe cases of chickenpox, one of its chief benefits. Of vaccinated children who still got chickenpox at the New Hampshire day care center, 88 percent had a mild case, which was characterized by having less than 50 bumps. Among those who had not been vaccinated, only 25 percent had a mild case.Overall, the vaccinated children missed less day care, had lower fevers and didn't feel as bad as the unvaccinated children, Galil said.

"That's far, far better than taking the risk of getting natural disease," said Galil, who led the investigation as a medical epidemiologist with the U.S. Centers for Disease Control and Prevention. She now works for a private drug company.

Dr. Daniel Van Durme, vice chairman of the department of family medicine at the University of South Florida in Tampa, who has given thousands of varicella shots, agreed. "Your kid still has a lot of protection," he said. Although most people who get the chickenpox simply spend two weeks in misery, it can be dangerous. About 100 adults and children die from varicella each year in the United States, and most don't have some other medical condition that puts them at more risk, Galil said. Thousands more are hospitalized. "Most children are going to be very well protected, but most of all they're going to be protected from the really bad things that can happen from this virus," Galil said.

Florida requires incoming prekindergarten and kindergarten students to be vaccinated or show they've had chickenpox. About half the states have similar rules, and about 75 percent of American toddlers were vaccinated last year, the CDC says. State and local health officials don't keep track of chickenpox cases, but it's most common in winter and early spring. Jan Herzik, principal at the Canterbury School of Florida in St. Petersburg, where M.J. Maguire is a student, said three children had contracted chickenpox so far this year.

M.J. and one other had been vaccinated, while the third had not. These were the first chickenpox cases there in at least two years, she said. Before the vaccine became widely available in 1996, outbreaks were a yearly occurrence, and infected students usually missed two weeks.

"I was saying, gosh, we're lucky, and then here we go," Herzik said. "But I tell you, the outbreak is not as severe as it's been in the past, so that's great." But because her son was probably contagious before she realized he had chickenpox, Maguire said she worries it may spread. "I think it's important for parents to be on the lookout," Maguire said. "With that vaccine, I didn't expect it at all, and I'm afraid he did infect other children because I wasn't aware."

The New England Journal of Medicine study was based on an outbreak at a rural New Hampshire day care between Dec. 1, 2000, and Jan. 11, 2001. Because the school thought to call the health department, and the health department thought to call the CDC, epidemiologists were given a rare chance to study the vaccine's effectiveness in a controlled setting where children were certain to have been exposed.

Past studies gauging the vaccine's effectiveness relied heavily on people who simply may have been exposed to the virus, said Galil, who has studied varicella for almost eight years. They traced the outbreak to a 4-year-old boy who had been vaccinated three years earlier. He infected 24 other children at the day care, including 16 who had been vaccinated. Children who were vaccinated more recently were the least likely to become infected.

Van Durme and Dr. Juan Dumois, chairman of pediatric infectious diseases at All Children's Hospital in St. Petersburg, said the study was too small and too new to begin recommending booster shots, but it should inspire more research.

Health officials had a similar experience with another, more dangerous childhood disease, the measles. After tracking occasional outbreaks in the two decades after the measles vaccine was introduced in 1963, federal health officials decided in 1989 that children should get a booster shot. That's why children today get a measles shot -- typically given with mumps and rubella shots -- as toddlers, then a booster just before starting school. "We're pushing nearly 30 years before we realized you needed a second measles shot," Van Durme said.

"Because we have better surveillance, because we are aware of what happened with measles, we have a higher level of surveillance or suspicion that we might have to do the same thing with this virus." But, he added, measles is much more dangerous. "With chickenpox, if it takes a few years to figure out we need a booster, that's not a big deal."


http://abcnews.go.com/wire/US/reuters20021211_602.html

Double Chickenpox Vaccine May Be Needed: Experts

Dec. 11

— By Gene Emery

BOSTON (Reuters) - Doctors may need to give two doses of the chickenpox vaccine instead of one, experts said on Wednesday after a study showed a single dose of the vaccine has a far higher failure rate than previously thought. Karin Galil of the U.S. Centers for Disease Control and Prevention calculated that the vaccine failed to protect 56 percent of children who got the shot. In previous studies, the failure rate ranged from 0 to 29 percent. Galil's study found that chickenpox spread rapidly through vaccinated children in a New Hampshire day-care center.

"This outbreak constitutes a warning signal," Anne Gershon of the Columbia University College of Physicians and Surgeons in New York wrote in a commentary in the New England Journal of Medicine, which also published the CDC study. She said a second shot may be necessary to provide meaningful protection, although Gershon noted that studies were needed to see if the cost was worth the benefit. "The time for exploring the possibility of routinely administering two doses of varicella (chickenpox) vaccine to children seems to have arrived," she said. Chickenpox causes headache, fever and, eventually, a rash that leads to itchy red spots that are filled with fluid before they crust over and disappear.

While parents often view it as a benign disease, chickenpox can lead to pneumonia, inflammation of the brain, and skin infections. Before the vaccine was licensed in 1995, chickenpox sent 11,000 people to the hospital each year and killed 100. Half of the fatalities were children. Since then, the number of hospitalizations for chickenpox has plummeted by 80 percent, according to the CDC researchers. Chickenpox spreads easily through the air and a child can be contagious three days before symptoms appear.

About 75 percent of U.S. children have received the chickenpox vaccine. It is required for school-age children in at least 26 states and four others -- Louisiana, New Hampshire, Nevada and New York -- will require it next year. It is not unusual for children to get multiple vaccines -- it takes two doses of measles vaccine to control that disease, for instance, and several doses for polio, hepatitis and other viruses.


If this vaccine worked you would need one.....


Kids may need two chicken pox shots, study says
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1039651448621_35060648/?
hub=Health

CTV News Staff
A new study is suggesting that children who've been vaccinated against chicken pox may need a second dose to guarantee complete protection from the disease. The study, to be published Thursday in the New England Journal of Medicine, cited several examples of outbreaks that infected children who had been vaccinated for chicken pox, including a day-care centre in New Hampshire where 16 of 25 children infected had been previously been given a shot for chicken pox. "They had some immunity, but it wasn't completely protective," said Dr. Karin Galil of the U.S. Centers for Disease Control and Prevention, the study's lead author. "It stopped them from getting a bad case of chicken pox but it didn't protect them from getting infected with the chicken pox virus."


The varicella zoster virus causes an itchy, blister-like rash that covers the head and trunk. It is accompanied by headache, fever and tiredness. The disease is a simple annoyance for most children, but those with a suppressed immune system can develop serious complications. About five or six children die from complications each year in Canada. The vaccines' effectiveness against chicken pox is supposed to range between 77 per cent and 100 per cent but Galil found the single dose was only effective in 44 per cent of cases. "We are taking very seriously the possibility that we might not have the right optimal vaccination level yet," said Galil. "And if there's evidence that we need to change it, that will be a priority."

The good news is that most children infected after receiving the vaccine developed only mild symptoms, with one child in the New Hampshire study being diagnosed with just a single blister. In fact, doctors credit the vaccine with cutting the total number of cases of the nasty disease across North America. In the U.S., chicken pox cases have dropped 80 per cent since the vaccine was introduced in 1995. Health Canada says the rate of chicken pox per 100,000 people had fallen to 135.69 in 1999 from 301.7 in 1993. "Since we have been using chicken pox vaccine the number of admissions to hospital for severe disease, the amount of chicken pox in the community and the severity of that chicken pox have decreased significantly," said Dr.Stanley Read of the Hospital for Sick Children in Toronto.

In Canada, only Alberta, Prince Edward Island and the Northwest Territories pay for its use. Nova Scotia announced Wednesday it intends to vaccinate all babies against chicken pox before they turn one year old. Other provinces are considering bringing the vaccine under their health coverage, but some doctors fear the study will prompt some health ministries to opt away from paying for the vaccine until more studies are completed. "I hope it's not used by the government as ammunition to say we don't know enough about it so we should not pay for it," said Dr. Tony Barozzino of St. Michael's Hospital in Toronto. "There is lots of evidence to say, if anything, we need to give more of it." U.S. health authorities are pushing states to adopt mandatory chicken pox vaccinations, saying the vaccine reduces the costs related to the disease, including the costs of missed work, school, and childcare. Meanwhile, the are also concerns that the vaccine could result in an increase in adult chicken pox and shingles, a disease linked to the varicella zoster virus.

Because multiple exposures of chicken pox boost immunity throughout their lives, people who suffered a bout of chicken pox as a child almost never get it again as an adult. Also, between 10 and 20 per cent of people who had chicken pox as a child eventually develop shingles as an adult. Because of the vaccine, those who had it as a child will not be exposed as often, potentially making adult chicken pox and shingles more common. Several U.S. studies are underway to detect any evidence of faltering immunity associated with the varicella vaccine.


http://www.ama-assn.org/sci-pubs/amnews/pick_03/hlsc0120.htm

Chicken pox vaccine's staying power questioned

A disease outbreak in a New Hampshire day-care center may indicate the need
for periodic boosters.

By Victoria Stagg Elliott, AMNews staff. Jan. 20, 2003. Additional
information

The 4-year-old boy was healthy and had received all of his shots, including the one for varicella three years before. But one morning at a day-care center in a small town near Concord, N.H., his body erupted in a rash and he was sent home.

The boy had chicken pox and had infected more than a dozen of his classmates with the illness, even though most had also received the vaccine. Within two months, another dozen would also be diagnosed with what was, until the 1995 licensure of the varicella vaccine, one of the leading causes of morbidity among children.

This was not supposed to happen, according to a case study published in the New England Journal of Medicine last month. "They were so healthy as a group," said Karin Galil, MD, MPH, the lead researcher who investigated the outbreak while a medical epidemiologist at the Centers for Disease Control and Prevention. "And a lot of the risk factors associated with vaccine failure, such as asthma, just weren't present."

Dr. Galil and her fellow CDC investigators found the vaccine still prevented the most severe forms of chicken pox, but that children who had received it more than three years earlier were most at risk for developing mild or moderate forms of the disease.An editorial accompanying the article suggests considering whether a booster shot may be needed a few years after the initial dose. The chicken pox vaccine was approved in 1995.

"This outbreak constitutes a warning signal," wrote Anne A. Gershon, MD, director of the infectious disease division at Columbia University College of Physicians and Surgeons in New York. " The time for exploring the possibility of routinely administering two doses of varicella vaccine to children seems to have arrived."

Infectious disease experts and the authors of the paper say, however, that it is far too soon to recommend additional doses. Other studies have not found waning efficacy, although time will tell.

Although first approved in 1995, it took a couple of years for kids to receive the vaccine in great numbers and, consequently, for the disease's mortality and morbidity to decline. If vaccine efficacy really does wane, more evidence will surface in the next few years.

"It's an important study, but one study does not policy make," said Harry Keyserling, MD, professor of pediatrics at Emory University School of Medicine in Atlanta. "We might have to wait another three or four years until we're dealing with a highly immunized cohort of first-graders to determine if a booster is needed."But experts also suggest that there may be other reasons for this outbreak. The vaccine, which must be kept frozen, may have been mishandled. And the kids may not have received it at the ideal time.

"This study may be an indication that we need an extra dose," said Tina Tan, MD, an infectious disease specialist at Children's Memorial Hospital in Chicago. "It may also just be one of these fluke situations."

Critics of the study also say that the method of using parents to report illnesses rather than laboratories to confirm them leaves the question open as to whether the children really had chicken pox or a rash from some other cause. But, experts said that if a booster was needed, parents would be amenable to it, especially because a vaccine combining measles, mumps, rubella and varicella is expected in the next couple of years.

"This would improve immunization coverage, as well as making it easier on the primary care physician, family and most importantly the child," said Alan Shapiro, MD, medical director of the South Bronx Health Center for Children and Families in New York.A spokeswoman for Merck & Co. Inc, the vaccine's manufacturer, said they were looking at the study to determine its implications.

"We agree the article should be taken seriously but it does diverge from previously published studies," said Kelley Dougherty, company spokeswoman.

ADDITIONAL INFORMATION: Follow-up on a rash of pox

Objective: Determine the cause of a chicken pox outbreak among a group of vaccinated children at a day-care center in a small town in New Hampshire. Method: Parents, physicians and other health care professionals filled out questionnaires about the children's medical and vaccination history. Results: Varicella developed in 25 of the 88 children attending the day-care center over a six-week period. The vaccine provided 44% protection against any form of chicken pox and 86% protection against moderate and severe forms of the disease. Children who had received the vaccine more than three years earlier were at higher risk of developing chicken pox. Conclusion: A longer interval since vaccination is associated with a higher rate of vaccine failure, although it still provides good protection against more severe forms of the disease.

Source: New England Journal of Medicine, Dec. 12, 2002

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Weblink

Article, "Outbreak of Varicella at a Day-Care Center Despite Vaccination,"
New England Journal of Medicine, Dec. 12, 2002
(http://content.nejm.org/cgi/content/full/347/24/1909)

Article, "Varicella Vaccine -- Are Two Doses Better Than One?" New England
Journal of Medicine, Dec. 12, 2002
(http://content.nejm.org/cgi/content/full/347/24/1962)


http://www.hoinews.com/news/features/1/232566.html
Kids Count
HOI 19 News

Chicken Pox Vaccines

A new study is raising questions about the effectiveness of the chicken pox vaccine. While the vaccine offers a lot of protection, the study finds that a lot of kids who have been vaccinated are still getting the chicken pox. The vaccine was supposed to be 77 to 100 percent effective, but researchers here in the U.S. found that it only offered about a 44 percent protection rate. The study could be a sign that immune protection might not last in some kids and that they might need booster shots.

The good news is that the kids that have been vaccinated get a milder form of the disease.

Disputed childhood vaccine rule could affect adults, too
Maura Lerner, Star Tribune
http://www.startribune.com/stories/484/3729394.html
Published Mar. 3, 2003VAC03


Most people don't worry about college kids getting chickenpox. But Edward Ehlinger, director of the University of Minnesota's Boynton Health Service, says that's just what may happen if more children are not vaccinated against the disease while they're young. "I predict that we will be experiencing a major outbreak of chickenpox on college campuses," Ehlinger told a public hearing in St. Paul on Friday. The hearing, before an administrative law judge, was held to determine the fate of a Health Department proposal to require two more immunizations for Minnesota school kids -- the chickenpox and pneumonia vaccines. For almost six hours, Judge Kathleen Sheehy listened to impassioned comments from doctors, nurses, lawyers and parents, arguing the benefits and dangers of childhood vaccines. Ehlinger, however, noted that children won't be the only ones affected by the decision. if the policy doesn't change, he said, adults may pay a hefty price as well.

Right now, the chickenpox vaccine is voluntary in Minnesota, and about 62 percent of Minnesota children are immunized, Ehlinger said. That means fewer kids are getting sick, and more kids are growing up without coming into contact with chickenpox naturally. If they haven't been vaccinated, they may not get the virus until adulthood -- when it's far more dangerous. Unless the vaccine is mandatory, Ehlinger said, "the number of students who get to college without immunity will increase." Adults are much more likely to be hospitalized and suffer life-threatening complications from chickenpox.

Dr. Richard Andersen, a pediatrician at Children's Hospital in St. Paul, agreed. "The great paradox to me is that by taking a half-hearted approach . . we're creating exactly the scenario we're trying to avoid." Both said they strongly supported the Health Department recommendations. But opponents argued that the state shouldn't require any new vaccines while many people believe the safety of the old ones is still in question. "Government should get out of the business of mandating vaccines," said Barbara Loe Fisher, president of the National Vaccine Information Center in Washington, D.C. "It's illogical and scientifically irresponsible to assume that there's no connection between the ever increasing numbers of vaccines that we mandate for our children, and the ever increasing rate of chronic disease." Her group represents families who believe their children's illnesses or disorders such as autism, and even deaths, were caused by vaccines.

But Health Department officials and several physicians defended the vaccines, saying they can reduce the risks of potentially life-threatening diseases and complications. And they noted that families can get waivers to avoid the vaccines. "My heart goes out to these parents," said Dr. Clifford Wu, a pediatrician from New Ulm. "But they're looking for answers; they're looking for scapegoats." Judge Sheehy has two months to rule on the proposed vaccine requirement.
-- Maura Lerner is at mlerner@startribune.com.

http://www.idinchildren.com/200302/frameset.asp?article=philed.asp

The other pox

Recent findings concerning the efficacy of varicella vaccine are disturbing.

by Philip A. Brunell, MD
Chief Medical Editorò �×ò
February 2003Many of you probably have had calls and much discussion about the article in The New England Journal of Medicine (2002;347: 1909) concerning the poor performance of varicella vaccine (Varivax, Merck) in a day care center. I am certain this has been viewed as validating the beliefs of parents who elected not to give their children the vaccin