Newton County Times' Outhouse Companion

LIVE ATTENUATED VARICELLA VACCINE: USE IN HEALTHY ADULTS

We administered live attenuated varicella vaccine to 187 healthy adults seronegative to varicella-zoster virus (VZV); 176 have been followed at least 2 mos. 121/176 (69%) received 2 doses about 3 months apart. Side effects after 1 dose were: local reactions in 18 (10%), rash in 12 (7%), & fever in 4(2%). Side effects were less frequent after the 2nd dose. Vaccine associated rash was mild (mean 14 lesions, range 1-100). Vaccine type virus was isolated from 1 adult with a total of 8 lesions, 1 mo. After vaccination; there was no spread of vaccine virus to others. Seroconversions to VZV, measured by fluorescent antibody to membrane antigen (FAMA) were: after 1 dose 136/169 (80%), & after 2 doses 114/121 (94%). 22 seroconverted only after the 2nd dose; 7 (6%) failed to seroconvert after 2 doses. Positive antibody responses have been detected after 1 yr in 44/67 (66%), after 2-3 yr.In 19/28 (68%), & after 4-6 yr in 10/13 (77%). Ten have had a household exposure to varicella after as long as 7 years (mean 3 yrs); 6 (60%) developed at least some evidence of clinical varicella with 1-40 lesions (mean 16) but no toxicity. Seropositives (5/10) rarely developed clinical symptoms; 1 had 1 vesicle. There were a total of 10 cases of mild varicella in adult vaccinees with 1-58 lesions, (mean 10), 4-72 months after immunization. Wild type virus was isolated from 2 MDs, but there was no spread. Clinical infection was likely to occur in those seronegative at exposure (7/8, 88%) but the illness was still very mild. Varicella vaccine has the potential to control but not prevent nosocomial varicella. Varicella vaccine is less protective for healthy adults than for healthy children, but it modifies the illness even if VZV antibodies are no longer detectable.

Is Shingles Contagious? Plus, How It Spreads

Shingles is not contagious, but a person can transmit the virus when the shingles rash is in the blister phase.

Shingles — also known as herpes zoster — is caused by the varicella-zoster virus, the same virus that causes chickenpox.

Shingles itself is not contagious, but the virus is. If you have shingles, you can pass the virus to another person, which could then cause them to develop chickenpox.

The varicella-zoster virus stays in that person's nerve tissue indefinitely. It may be inactive for most of a person's life but can reactivate and cause shingles.

Read on to learn more about shingles and how to prevent the transmission of the varicella-zoster virus.

The varicella-zoster virus can be transmitted through contact with open shingles blisters. It typically passes from someone with shingles to someone who has never had chickenpox. If a person has had chickenpox, they usually have antibodies against the virus in their body.

You cannot contract the virus through contact with the saliva or nasal secretions of someone who has shingles, except in rare cases. That means you usually can't acquire the virus if someone who has it coughs or sneezes on you.

Most people have the varicella-zoster virus in their bodies, but it only reactivates in around one-third of people. Experts do not know why some people develop it, and others don't.

The chance of this happening increases as a person gets older. Around half of all cases occur after the age of 60 years, and the risk increases significantly from age 70 onward.

You might also have a higher risk if you:

have a health condition that affects the immune system

are taking medications that affect the immune system

have too much sun exposure

Even a common cold can affect the immune system and trigger shingles in some people.

The most noticeable symptoms are blisters and pain.

Blisters

The outward symptoms of shingles look similar to chickenpox. Both diseases cause raised blisters that open, ooze fluid, and crust over.

But unlike the chickenpox rash, which can occur on different parts of your body, shingles usually affect one area of your body. Shingles blisters are most prevalent on your torso, which wraps around your waist on one side of your body. In fact, the word "shingles" comes from the Latin word for "belt."

The shingles rash may also appear on one side of your face. If this happens, contact a doctor immediately.

Learn more about what shingles looks like on the skin with our overview article here.

Pain

Shingles travels along a nerve path, causing pain and strange sensations. Your skin might tingle or feel like it's burning before the blisters appear. Itching and sensitivity to touch are also symptoms of shingles.

Shingles pain varies in severity. It can be challenging to treat with over-the-counter pain relievers.

Some people experience nerve pain after the visible symptoms of shingles clear. This is known as postherpetic neuralgia. Approximately 10–18% of people with shingles develop postherpetic neuralgia, and the risk increases with age.

Other symptoms

The virus can cause symptoms unrelated to rashes, including:

headache

fever and chills

generally feeling unwell

upset stomach

tingling, burning, numbness, and pain in the skin

Learn more about shingles without a rash here.

Shingles is not contagious. But if someone comes into contact with the rash at a certain stage, they may contract the varicella-zoster virus and develop chickenpox. If they have chickenpox, shingles can develop later in life.

To prevent transmitting the virus, keep shingles rashes covered. Cover the rash from when the blisters appear to when they crust and scab over.

This usually takes 7 to 10 days, and the broader rash will usually clear after 2 to 4 weeks.

The varicella-zoster virus is typically less likely to be transmitted with shingles than with chickenpox. However, the varicella-zoster virus can be passed on from when your symptoms start until your rash and blisters have crusted dry.

If you have shingles and are otherwise healthy, you can still go out in public or to work. But be sure to follow these tips:

Keep the shingles rash clean and covered: This can help prevent other people from coming into contact with your blisters.

Wash your hands often: Also, try not to touch the blisters.

Avoid being around pregnant people: The varicella-zoster virus can cause serious health risks for both pregnant people and their babies.

Avoid other at-risk people: Do not go into proximity to premature babies, infants with low birth weights, and children who haven't yet had chickenpox or its vaccine. Also, avoid proximity with people who have weakened immune systems.

Doctors recommend the chickenpox vaccine for children. Preventing chickenpox will also prevent shingles.

For adults, a different vaccine called Shingrix is available to help prevent shingles. Health experts recommend the vaccine for all healthy adults ages 50 years and older. A healthcare professional will give two doses, 2 to 6 months apart, as an injection in your arm.

A double dose offers over 90% protection. The protection level stays above 85 percent for at least 4 years.

You can get the vaccine even if you:

have previously had shingles

do not know if you've had chickenpox

have already had the Zostavax vaccine, an older shingles vaccine in use before 2020

The vaccine is not suitable if you are currently experiencing shingles.

A shingles outbreak usually lasts 3–5 weeks. Most people experience pain and discomfort for a short period and then fully recover. People usually only have one episode of shingles in their lifetime.

Shingles outbreaks are temporary, but they can affect your health and well-being.

Shingles nerve pain can linger, lasting for weeks or even months in some cases. Generally, shingles pain is more persistent and longer lasting in older adults. Younger people usually show no signs of the disease once the blisters have cleared up.

Shingles is a rash that can affect people who have had chickenpox, even if they had it years ago. The varicella-zoster virus causes it. The virus remains dormant in the body, but in some cases, it can reactivate and cause shingles.

The shingles rash is not contagious. But the virus can be passed on to another person through contact with the rash when blisters are present. Then that person may develop chickenpox.

There is less chance of passing on the virus if the rash is covered, and transmission can only happen from the time blisters form to when they scab over.

Having the shingles vaccine can help protect you from shingles.

Taking The Sting Away From Chickenpox

Chickenpox (also called varicella) is a common childhood disease. It is usually mild, but can be serious, especially in young infants and adults. It is not possible to predict who will have a mild case of chickenpox and who will have a serious or even deadly case of the disease. Children with chickenpox miss an average of five-six days of school, and parents or other caregivers miss three-four days of work to care for sick children. Compared with children, adults are at increased risk of complications related to chickenpox.

Vaccination is the best way to prevent infection with varicella—the virus that causes chickenpox. Widespread vaccination also reduces the risk of exposure to infection for persons at risk for serious disease who cannot be vaccinated because of illness or other conditions. The vaccine is safe and effective, and should be used to prevent as many cases as possible.

Who should get chickenpox vaccine and when?

Anyone who is not fully vaccinated, and has never had chickenpox, should receive two doses of chickenpox vaccine. The timing of the doses depends on the person's age:

Children who have never had chickenpox should get two doses of chickenpox vaccine:

1st Dose: 12-15 months of age2nd Dose: 4-6 years of age (may be given earlier, if at least 3 months after the 1st dose)People 13 years of age and older (who have never had chickenpox or received chickenpox vaccine) should get two doses at least 28 days apart.Chickenpox vaccine may be given at the same time as other vaccines.

How important is it for adults to be vaccinated?

Adolescents and adults are at increased risk for more severe disease from chickenpox. Adults without immunity who might be at increased risk for exposure or transmission should receive special consideration for vaccination. These include:

Health care providers

Household contacts of immune-com- promised persons Persons who live or work in environments in which chickenpox transmission is likely (e.G., teachers, day-care employees, and residents/staff in institutional settings)

Persons who live or work in places where chickenpox transmission can occur (e.G., college students, inmates and staff of correctional institutions, and military personnel) Non-pregnant women of childbearing age (women should avoid pregnancy for one month following each vaccine dose)Adolescents and adults living in households with children International travellers

Is the vaccine effective in preventing all cases of chickenpox?

No vaccine is 100% effective in preventing disease. For chickenpox vaccine, about 9 out of every 10 people who are vaccinated with two doses are completely protected from chickenpox. In addition, the recommended two-dose regimen is virtually 100% effective in preventing severe disease.

If a vaccinated person does get chickenpox, it is usually a very mild case lasting only a few days and involving fewer skin lesions (usually less than 50, which may resemble bug bites more than typical, fluid-filled chickenpox blisters), mild or no fever, and a quicker recovery.

Is there a blood test available to determine whether or not a person has had chickenpox?

A blood test is available to check immunity, but if it is not available, it is still safe to receive the vaccine even if you have previously had chickenpox.

Is there anyone who should not receive the chickenpox vaccine?

Yes, certain persons should not receive the chickenpox vaccine. These persons are those who:Have had a serious allergic reaction to any component of the vaccine, including gelatinCurrently have moderate or serious illness (note: vaccine may be given to persons with a mild fever, cold, or diarrhoea) Are pregnant, Are unable to fight serious infections because of:

any kind of cancer or cancer treatment with x-rays or drugs (note: if your child has leukaemia in remission and has been off chemotherapy for at least three months, he/she may be eligible to receive the vaccine; ask your doctor) a disease that depresses cellular immune function (note: if your child has HIV infection but has sufficient immune functioning he/she may receive the vaccine; ask your doctor)treatment with drugs such as long-term steroids Have received blood products (such as immune globulin or a blood transfusion) during the past 3-11 months,depending on dosageHave a family history of congenital hereditary immunodeficiency, unless they are known to be immunocompetent.

The vaccine manufacturer also recommends that persons receiving the chickenpox vaccine avoid using salicylates (aspirin products) for six weeks after receiving vaccination because of the association between aspirin use and Reye syndrome following chickenpox.

What problems can occur after taking the chickenpox vaccination?

Soreness, redness, or swelling where the injection was given is the most common side effectAbout 1%-4% of vaccine recipients develop a mild rash or several small bumps following chickenpox vaccination. (In very rare instances, it may be possible for someone who gets a rash from the chickenpox vaccine to transmit vaccine virus chickenpox to another person. Persons developing a rash after vaccination should take extra precautions to avoid contact with anyone whose immune system is not working properly.

Mild fever two weeks after the vacci- nation.In rare cases, a seizure (jerking and staring spell) usually caused by fever. This may not be related to the vaccine.

If a woman was recently vaccinated and then found she was pregnant, what should she do?

If she discovered she was pregnant when she got the chickenpox vaccine, or got pregnant within three months after getting the vaccine, she should contact her doctor. There is a theoretical risk that when administered one month prior to or during pregnancy, the vaccine may cause birth defects similar to those that can occur from natural chickenpox.

Can a child vaccinated two-three years ago still develop a mild case of chickenpox?

After vaccination, some persons do not develop enough protection to completely prevent them from developing chickenpox. When they come into close contact with a person with chickenpox, they may develop a mild case of disease.

Children who were vaccinated in their early childhood years may have their first close contact with another child with chickenpox in child care or school settings several years after vaccination. This is why they may come down with mild chickenpox several years after they were vaccinated. This form of chickenpox is also called "breakthrough" disease.

Can a vaccinated person who devel- ops a mild case of chickenpox still spread the disease?

Yes. Vaccinated persons who get this milder form of chickenpox may still spread the disease to others who are not protected. Therefore, these individuals should stay at home until the blisters have formed scabs or if there are no blisters present, until no new spots or bumps are forming.

If a person who has never had chick enpox or the vaccine comes into close contact with someone with chicken pox, could receiving the vaccine prevent this person from getting chicken pox?

For healthy adolescents and adults (persons aged 13 years and older) without evidence of immunity, varicella vaccination within 3-5 days of exposure to rash is beneficial in preventing or modifying chickenpox. Studies have shown that vaccination administered within three days of exposure to rash is greater than or equal to 90% effective in preventing varicella while vaccination within five days of exposure to rash is approximately 70% effective in preventing varicella and 100% effective in modifying severe disease.

If there are chickenpox cases at school is it too late to have a child vaccinated?

No, it is not too late if the child has not had chickenpox or has not had two doses of the vaccine. At any stage of an outbreak, all susceptible children and adults should be vaccinated and those who previously only received 1 dose of the vaccine should receive the second dose.

(The writer, a Consultant Family Physician is Head, Department of Family Medicine, University of Sri Jayewardenepura,Nugegoda and a Member of the Vaccine Forum)

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