[sciencemum]

Can children vaccinated against chicken pox still get shingles? I was wondering this in another thread (this one: http://www.mothering.com/forum/47-v...g-chicken-pox-his-older-brother-new-post.html) and @Deborah was kind enough to provide some suggested links to followup.

Here they are with some extracts from the abstracts (I read only the abstracts as they were all paid access articles).

http://www.ncbi.nlm.nih.gov/pubmed/25358998

The current varicella vaccine (v-Oka) is highly attenuated in the skin, yet retains its neurovirulence and may reactivate and damage sensory neurons.

childhood breakthrough herpes zoster affects a small population of vaccinated children

http://www.ncbi.nlm.nih.gov/pubmed/24687808

The introduction of varicella vaccination as part of childhood immunization programs has resulted in a remarkable decline in varicella incidence, and associated hospitalizations and deaths, particularly in the USA.

Although vOka is clinically attenuated, it can cause mild varicella, establish latency, and reactivate to cause herpes zoster.

http://www.ncbi.nlm.nih.gov/pubmed/24456962

Herpes zoster is uncommon in the pediatric population. We report a case of herpes zoster in a 2-year-old boy who received the live attenuated varicella zoster virus vaccination at his 12-month pediatric visit. The child was treated with acyclovir and recovered without complications.

http://www.ncbi.nlm.nih.gov/pubmed/23303966

Wild type (WT) VZV was found to be latent in many ganglia of vaccinated children with no history of varicella, suggesting that subclinical infection with WT-VZV occurs with subsequent viremic dissemination.

So that's saying that after you're vaccinated if you are exposed to wild virus you may get infected without being sick and that infection is what could reactivate as shingles. I guess this is relevant to my vaccinated daughter who spent 2 weeks living with a younger brother with wild CP….

So I saw a lot of "mays" and "cans" but not much about rates of incidence (except a unreferenced comment about a "small" population of children being affected). So I dug around a bit more and found this on the CDC website:

http://www.cdc.gov/shingles/hcp/clinical-overview.html

Only people who had natural infection with wild-type VZV or had varicella vaccination can develop herpes zoster. Children who get the varicella vaccine appear to have a lower risk of herpes zoster compared with people who were infected with wild-type VZV.

That last statement is linked (in the website) to the below studies:

Weinmann S, Chun C, Schmid DS, Roberts M, Vandermeer M, Riedlinger K, et al. Incidence and clinical characteristics of herpes zoster among children in the varicella vaccine era, 2005–2009. Journal of Infection Diseases. 2013;208(11):1859-68.
http://www.ncbi.nlm.nih.gov/pubmed/23922376

The incidence of laboratory-confirmed HZ was 48 per 100,000 person-years in vaccinated children (both wild-type and vaccine-strain) and 230 per 100,000 person-years in unvaccinated children (wild-type only).

So from that vaccinated children about 5 times less likely to get shingles than those who had chickenpox..

The CDC website also had this statement:

In a study of children with leukemia, those who got varicella vaccine had a 67% lower risk of herpes zoster compared with children who had natural infection with wild-type VZV. Data on healthy children show a similar pattern of reduced risk of herpes zoster in those vaccinated against varicella.

Hardy I, Gershon AA, Steinberg SP, LaRussa P. The incidence of zoster after immunization with live attenuated varicella vaccine. A study in children with leukemia. Varicella Vaccine Collaborative Study Group. N Engl J Med. 1991;325(22):1545-50.

http://www.ncbi.nlm.nih.gov/pubmed/1658650

Anyway thanks again to @Deborah for pointing me in a good direction to look into this more.

 

[95191]

As I posted in the other thread, there still is no long term data or data on those vaccinated for CP and the shingles vaccine.
I also posted in Kathy's thread the link that mentions it from the pharmacy site and the citations are listed there.

 

[suschi]

Check the VAERS data base, there are many reports of adverse events (from varicella vaccine) that include shingles in not only the child that was vaccinated, in some cases it occurred in a close family member (sibling, parent, grandparent and in at least one case, a sibling AND the parent). Also this paper,

http://www.news-medical.net/news/2005/09/01/12896.aspx

suggests shingles is on the rise in adults due to the lack of "natural" boosting of being exposed to children with chicken pox. And what is the answer? Another vaccine. The amount of vaccines being recommended for children (and adults) has increased exponentially as an unintended consequence of the vaccines being given. For example, the Hib vaccine (first licensed in 1985) creates the need for the Prevnar (PCV7) vaccine (licensed in 2000), which creates the need for the Prevnar 13 (PCV13) vaccine (licensed in 2010), which will create the need for ???? Are you seeing the pattern here?

per CDC: http://www.cdc.gov/meningitis/bacterial.html There are vaccines for three types of bacteria that can cause meningitis:

Neisseria meningitidis (meningococcus),
Streptococcus pneumoniae (pneumococcus), and
Haemophilus influenzae type b (Hib).

It appears that vaccinating against a small set of strains is giving the weaker strains a foot hold, and this will continue to cause more infections by strains not currently included in the vax, and with over 90 serotypes, well, I am sure you can see where this is leading. There are many unintended consequences of vaccines, of which we are just witnessing the tip of at this point.

 

[ss834]

I have to look through some of the studies again, but it seems contradictory to say, on one hand, that viral shedding is a problem from the CP vaccine and then on the other, to complain that there is no source of virus to boost adult immunity.

I wonder how frequently the average adult was exposed to chickenpox before the vaccine. It seems like only if they had children themselves, or worked in a school, would they get significant exposure.

ETA- I know this is slightly OT, but this study was done to compare the increased incidence of shingles with the immunization program, and looked at the data state by state to account for higher and lower varicella vaccination rates. They didn't find that the vaccine is driving the increased rate of shingles.
http://www.ncbi.nlm.nih.gov/pubmed/24297190

 

[mamakah]

I have to look through some of the studies again, but it seems contradictory to say, on one hand, that viral shedding is a problem from the CP vaccine and then on the other, to complain that there is no source of virus to boost adult immunity.

I wonder how frequently the average adult was exposed to chickenpox before the vaccine. It seems like only if they had children themselves, or worked in a school, would they get significant exposure.

People were probably exposed throughout adolescence from younger siblings or cousins, neighbors, etc.
Then again as parents and possibly again as grandparents.

Anyone who worked with children, teachers, pediatricians, babysitters, camp counselors, were likely exposed throughout the years too.

I know I've been exposed to chicken pox at least 3 times since having them in 1986, the last time was in the early 1990s when my junior high friend got it from her little brother. I don't think I've been exposed as an adult though.

I imagine repeat exposures pre-vaccine were very common.

 

[ss834]

Here is a systematic review of the incidence of shingles, and several studies were included that looked at an association between the introduction of a varicella vax program and the rate of shingles in the population. Full text.

Kawai et. al 2014
http://bmjopen.bmj.com/content/4/6/e004833.long

 

[ss834]

People were probably exposed throughout adolescence from younger siblings or cousins, neighbors, etc.
Then again as parents and possibly again as grandparents.

Anyone who worked with children, teachers, pediatricians, babysitters, camp counselors, were likely exposed throughout the years too.

I know I've been exposed to chicken pox at least 3 times since having them in 1986, the last time was in the early 1990s when my junior high friend got it from her little brother. I don't think I've been exposed as an adult though.

I imagine repeat exposures pre-vaccine were very common.

So I wonder if those people who were more likely to be exposed were also less likely to develop shingles. I know a lady who was a teacher her entire life and developed a horrible case of shingles.

 

[kathymuggle]

ETA- I know this is slightly OT, but this study was done to compare the increased incidence of shingles with the immunization program, and looked at the data state by state to account for higher and lower varicella vaccination rates. They didn't find that the vaccine is driving the increased rate of shingles.
http://www.ncbi.nlm.nih.gov/pubmed/24297190

I read a study (will find later) that said that having a child in the house equalled about 20 years of protection in terms of immune boosting. One would not expect vaccination to lead to an immediate increase in shingles…it could take years.

As an aside, the study, as most studies being bandied about in relation to shingles, only look at people age 65 plus. I am not sure we can draw any widespread conclusion when only one demographic is studied.

ETA:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563790/

Shingles is caused by reactivation of latent varicella zoster virus, which is thought to occur when specific cell mediated immunity declines. The lifetime risk of shingles is 10%–30% and increases with age, affecting up to half of people who live to 85 years.3,4,5 We know that exposure to chickenpox can significantly prevent or delay shingles (by exogenous boosting of immunity).6 Increased annual chickenpox rates in children under 5 are associated with reduced shingles in the 15–44 age group. Having a child in the household reduced the risk of shingles for about 20 years, the more contact with children the better, and general practitioners and paediatricians have a statistically significant lowering of risk,7 possibly because of their contact with sick children (teachers did not have a significantly reduced rate).8,9

 

[DahliaRW]

And we don't know what will happen when children vaccinated for CP hit the more common age for getting shingles (65 and older). And we won't know for years and years....

 

[Deborah]

My conclusion is two part:
1) insufficient data
2) a push to claim that the vaccine is not having an effect on shingles, even though the data is incomplete and some of the trends in the US may be muddling the situation.

In the US the separation between the elderly and children has been deeper and more complete than in many countries. I know I'm unusual in my circle of grandparents in living only 20 miles from my grandkids. I was very definitely exposed to chickenpox when they had them! But if your grandchildren live hundreds of miles away, your chance of exposure goes way down, unless you spend a lot of time with other people's children.

Thus, even before the vaccine was released, elderly people in the US would have generally had less exposure to CP.

 

[ss834]

The studies that have looked at shingles rates were looking at the specific reasons for an increased rate of shingles that has already been observed. While many of you are repeating that we wont know the impact of the vaccine schedule for years to come, we can still look at the cause for the increased rate of HZ that has already occurred. That's what those studies have done and some have found that the rate of shingles was increasing in some countries before the varicalla vax was introduced.

It's a significant observation in itself, and one that doesn't necessarily attempt to predict no impact of the vaccine on the rate of shingles. It is possible that rates of shingles were already increasing for other reasons and we'll see an down the road due to varicella immunization. For that we'll have to see. But I am curious, if the rates of shingles were increasing prior to varicella immunizations, then why?

 

[Deborah]

I already said why in the US. Isolation of the older population from children. Retirement communities and neighborhoods. Grandparents who live hundreds or thousands of miles away from their grandchildren.

 

[MyFillingQuiver]

I already said why in the US. Isolation of the older population from children. Retirement communities and neighborhoods. Grandparents who live hundreds or thousands of miles away from their grandchildren.

Exactly.

In not-too-long-ago history, we were very involved with our extended families, and grandparents were often living with, or largely cared for by family members with children. Children were part of every day life, and not segregated as much by age. Large families also meant sometimes one of the older children was just becoming a parent while the parents were still having children of their own..lots of exposure by multi-generational family members.

 

[DahliaRW]

I agree, age segregation is probably the main reason.

 

[mama24-7]

I'm guessing it's a combination of the segregation of our society and declining gut health. We're going to see more & more illness as this decline continues, of the infectious & non-infectious kind. It is why I do not believe it when it's said that our average life expectancy is going to climb to 100. I think it's going to decline.

Sus

 

[EMRguy]

I wonder how frequently the average adult was exposed to chickenpox before the vaccine. It seems like only if they had children themselves, or worked in a school, would they get significant exposure.

Or grandkids, or malls, shopping centers, or farmer's markets, or bathrooms...