Past Issues

Invasive Pneumococcal Disease Prevention In Adults

This content was created by Everyday Health Media on behalf of an advertiser. More Information.

Content on this page was created by the Everyday Health Media team and is funded by an advertiser. The content conforms to Everyday Health Media's editorial standards for accuracy, objectivity, and balance. The advertiser may select the specialty area but does not edit or approve the content.

Chickenpox In Adults

Although chickenpox is often thought of as a childhood disease, adults are still susceptible and symptoms tend to be more severe. However, if you've had chickenpox as a child, you're unlikely to get chickenpox as an adult.

Also known as varicella, chickenpox is caused by the varicella-zoster virus (VZV). It is most often recognized by a rash of itchy red blisters that appear on the face, neck, body, arms, and legs.

People who've had chickenpox typically have an immunity to the disease. So, if you had chickenpox as a child, it's unlikely you will get chickenpox as an adult.

Chickenpox symptoms in adults typically resemble those in children, but they can become more severe. The disease progresses through symptoms that start one to three weeks after exposure to the virus, including:

Flu-like symptoms such as fever, fatigue, loss of appetite, body aches, and headache. These symptoms typically start a day or two before a rash appears.

Red spots appear on the face and chest, eventually spreading over the entire body. The red spots develop into itchy, fluid-filled blisters.

Blisters weep, become sores, form crusts, and heal. As some of the blisters form crusts, it's not unusual for more red spots to appear, for a total of 250 to 500 blisters.

For adults, new chickenpox spots often stop appearing by the seventh day. After 10–14 days, the blisters scab over. Once the blisters are scabbed over, you are no longer contagious.

As an adult, you are at risk of getting chickenpox if you didn't have chickenpox as a child or haven't had the chickenpox vaccine. Other risk factors include:

living with unvaccinated children under the age of 12

working in a school or child care space

spending more than 15 minutes in a room with an infected person

touching the rash of a person infected with chickenpox or shingles

touching something recently used by an infected person such as clothing or bedding

You are at a higher level risk of experiencing complications from the disease if you are:

a pregnant woman who hasn't had chickenpox

a person who is on medication that suppresses your immune system, such as chemotherapy

a person whose immune system is impaired by another disease, such as HIV

a person who is on steroid medications for another condition, such as rheumatoid arthritis

a person with an immune system weakened by a previous organ or bone marrow transplant

Chickenpox is normally a mild, but uncomfortable, disease. However, this condition can lead to serious complications, hospitalization, and even death. Some complications include:

Chickenpox and pregnancy

If a pregnant woman develops chickenpox, she and her unborn child are at risk for serious complications including:

If you have chickenpox, your doctor will treat the symptoms and let the disease run its course. Recommendations typically include:

calamine lotion and colloidal oatmeal baths to relieve itching

a pain reliever to reduce fever

In certain circumstances, your doctor may also prescribe drugs such as acyclovir or valacyclovir to combat the virus and prevent complications.

Chickenpox vaccine

There is a two-dose chickenpox vaccine (Varivax) that's about 94 percent effective at preventing the disease for your lifetime. Adults who haven't had chickenpox will get two doses about one month apart.

Your doctor may advise against receiving this vaccine if:

you have a moderate or severe illness

you plan to become pregnant in the next 30 days

you have an allergy to any ingredient in the vaccine, such as gelatin or neomycin, or if you had a serious allergic reaction to a previous dose of the chickenpox vaccine

you have undergone chemotherapy or radiation for cancer

you have been taking steroid drugs

you have a disease that compromises your immune system, such as HIV

you recently received a blood transfusion

Are there risks with the chickenpox vaccine?

Your doctor will recommend the chickenpox vaccine if they believe the risks associated with it are much lower than the risks associated with the disease itself.

While some people may develop a low-grade fever or mild rash after being injected with the chickenpox vaccine, the most common side effects are redness, swelling, or soreness at the vaccination site. Other very rare severe side effects include:

If you've had chickenpox, then you still have the varicella-zoster virus in your nerve cells. It never goes away and it can lie dormant for years. Even though you are now most likely immune to reinfection from the chickenpox virus, you're at risk of another disease: shingles.

Shingles is a painful viral infection that is characterized by a blistering skin rash that forms in a band in a specific location of the body. It most often appears on the left or right side of your torso, sometimes around one eye or on one side of the face or neck.

Shingles is most likely to appear in older adults and people with weakened immune systems. Two shingles vaccines — Zostavax and Shingrix — are available and many doctors recommend them for their patients who have had chickenpox and are age 50 and older.

Have you had chickenpox? Have you received the chickenpox vaccine? Answer those questions and follow these recommendations:

If you've had chickenpox or the chickenpox vaccine, you should be immune and have little to worry about regarding catching chickenpox.

If you haven't had chickenpox, you should talk to your doctor about getting the vaccine.

If you've had chickenpox, you should talk to your doctor about the shingles vaccine, especially if you are over 50 years old.

If you think you have chickenpox, contact your doctor for a full diagnosis and treatment recommendations.

Singapore First Country In Asia To Get New Pneumococcal Vaccine

SINGAPORE, March 19 (The Straits Times/ANN): Singapore will be the first country in Asia to get Pfizer's new pneumococcal vaccine, which has a broader range of protection and could replace the two that are now in use here.

The vaccines protect against the more common bacterial strains responsible for pneumococcal disease, which causes a range of infections including pneumonia, meningitis, sinus and middle-ear infection. It can lead to very severe illness and even death.

In fact, pneumonia, or inflammation of the lungs, is the third major cause of death here.

These vaccines do not protect against all causes of pneumonia, since that can be due to a range of bugs including other types of bacteria, virus or even fungi.

But they do provide protection against the more common strains of the Streptococcus pneumoniae bacteria, which is why the Government encourages and subsidises pneumococcal vaccination for Singaporean children and seniors.

For seniors, the recommendation is to get the pneumococcal conjugate PCV13 vaccine first, followed by the pneumococcal polysaccharide PPSV23 vaccine a year later.

The new vaccine, PCV20, covers seven more bacterial strains than the PCV13, also manufactured by Pfizer. The PPSV23 is by Merck Sharp & Dohme and covers 23 strains of bacteria.

Professor Julio Ramirez, chief research scientist at the Norton Infectious Diseases Institute at Norton Healthcare in the United States, who was the principal investigator in studies of the PCV13 vaccine, was brought in by Pfizer for the launch of the PCV20 here on Saturday.

He said that unlike polysaccharide vaccines, conjugate vaccines, aside from getting the body to produce antibodies that protect against infection, also prime T cells and memory B cells, which can mount a response against invasive bacteria even after the level of antibodies has waned.

Professor Ooi Eng Eong, a microbiologist at the Duke-NUS Medical School, also said the immune responses from a conjugate vaccine "would theoretically be broader and more lasting than what is elicited by polysaccharides alone".

Associate Professor Lim Poh Lian, who heads the Travellers' Health and Vaccination Clinic at Tan Tock Seng Hospital and is also a senior consultant at the National Centre for Infectious Diseases, said: "Conjugate vaccines like PCV13 or PCV20 are better able to stimulate an immune response compared to the polysaccharide vaccine PPSV23, which was the reason conjugate vaccines were developed."

Associate Professor Hsu Liyang, an infectious diseases specialist at the National University of Singapore Saw Swee Hock School of Public Health, said the newer vaccine can certainly replace the PCV13.

"It is also possible that the use of this vaccine can obviate the need for the use of the 23-valent polysaccharide vaccine," he added.

Agreeing, Prof Lim said: "For those who have not had the PCV13 and PPSV23 combination yet, having a single dose of PCV20 greatly simplifies the vaccination regimen for patients and families. Instead of trying to sequence two vaccines with all the other health visits, this vaccine allows them to just get 'one and done'."

While Dr Asok Kurup, who chairs the Chapter of Infectious Disease Physicians, agrees that the wider coverage from PCV20 can mean just a single dose for the vast majority, he said people at higher risk, such as the immunocompromised, should still get the PPSV23 as well, as it covers more strains.

The Ministry of Health (MOH) told The Straits Times that while the new vaccine has been approved for use here since November 2022, a review is on to decide "whether the vaccine should be recommended for inclusion in the national immunisation schedules".

If it is not, there will be no subsidy for its use.

Prof Lim said the Expert Committee on Immunisation is assessing the clinical- and cost-effectiveness of PCV20 and how it should be used.

Dr Kurup said that in the private sector, the PPSV23 costs just under $100 and PCV13 about $200. The price of PCV20 should be about the same as that of PCV13, he added.

An MOH spokesman said those who have been recommended to receive the PCV13 and PPSV vaccines under the National Adult Immunisation Schedule are advised to do so. The PCV20 is currently not for use in children.

The infectious diseases experts ST spoke to agree that people who have received the two pneumococcal vaccines do not need to get the PCV20 as well.

Professor Paul Tambyah, a senior infectious diseases consultant at the National University Hospital, said: "The big question to me is whether PCV20 will be replaced by PCV25."

An ongoing study for a 25-valent pneumococcal conjugate vaccine, which started in 2022, is expected to be completed by 2025.

---