The only practical way of making sure children do not die or develop severe complications as a result of becoming infected with chickenpox (varicella) is to routinely vaccinate them against the virus, according to an article in Archives of Disease in Childhood (British Medical Journal).
Currently, the only people who are routinely vaccinated against chickenpox in the UK are healthcare workers and those likely to be at higher risk of passing on or contracting the infection, the authors explain. However, such countries as the USA, Canada, Australia and Finland have introduced vaccination programs for kids.
After pediatricians actively monitored children up to the age of 16 who were admitted to hospital with severe complications as a result of contracting chickenpox throughout the UK and Ireland, the authors conclude that a vaccination program is the best route to take.
The British Pediatric Surveillance Unit received 188 reports of cases during the 13 month period which ran from 2002 to 2003. Of these, 112 children met the criteria, giving a case rate of 0.82 per 100,000. They were aged 3 years on average.
Complications includedЧѓ
- septic shock
- pneumonia
- encephalitis
- ataxia (uncoordinated movement)
- toxic shock syndrome
- necrotizing fasciitis ('flesh eating' bacterial infection)
Six of the children died, one died in the womb. Although some of the children had pre-existing conditions, none of them were in groups currently targeted for immunization.
After leaving hospital 40% of the children had ongoing problems as a result of the chickenpox, such as ataxia and skin scarring. Their hospital stays ranged from 1 to 68 days, the average stay being 7 days.
The authors explain that the majority of these children were healthy before they contracted chickenpox. If all children had been routinely immunized the complications would have been prevented as most of the patients had been old enough to receive the vaccine when they became ill.
Accompanying Editorial
"Chickenpox has traditionally been viewed as an irritating but inevitable infection to be endured during childhood, a rite of passage during the preschool years. This benign view persists despite evidence that certain groups, including neonates, adults, pregnant women, and the immunocompromised have higher risks of severe disease," an Accompanying Editorial comments.
Incidence of chickenpox in the UK and Ireland among pre-school children has been rising, explain the authors. Out of every 1,000 children who become infected between two to five of them will be admitted to hospital.
The simplest route would be to include chickenpox immunity in the triple MMR vaccine, the authors write. However, unfounded fears about MMR will make it hard to implement. Teenagers who have not yet been infected could be offered the vaccine. "This could prevent cases of severe disease in adults and pregnant women and raise public awareness of the potential and desirability of primary prevention," the authors conclude.
"Severe complications of chickenpox in hospitalised children in the UK and Ireland"
Claire Cameron, Geraldine Allan, Fiona Johnston, Adam Finn, Paul Heath and Robert Booy
Arch Dis Child. Published Online First: 8 November 2007. doi:10.1136/adc.2007.123232
Click here to view abstract online
"Should the UK introduce varicella vaccine?"
Marion Roderick, A V Ramanan and Adam Finn
Arch Dis Child. Published Online First: 8 November 2007. doi:10.1136/adc.2007.130518
Click here to view abstract online
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