~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This message is from PedTalk! To reply to the group, use "" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ At 09:11 AM 11/26/97 -0800, Andrew M. Eisen, MD wrote: >> >My child had varicella twice, once at 9 months and once at 2 years, both >> >times while I was in residency and money was tight. (Incidentally, it is not >> >unusual for a child to have a second attack when the first came prior to >> >their first birthday.) > >I guess I phrased this poorly. Second cases of varicella are extremely >rare as a rule. They are, however, more likely in children who had >their first episode prior to one year of age. This is most likely due >to the overall immaturity of the immune system. I would certainly agree >that the most likely outcome for a child who has chickenpox as an infant >is that they will develop lifelong immunity, but this is less certain >than with an older child. Could this be residual maternal antibodies interfering with the development of a permanent immune response? Incidently, does anyone know how many months an infant's protection from Varicella by maternal antibodies (acquired through the placenta) normally lasts. And does nursing affect this time frame? > >As far as your personal experience with a 10-month-old who had a very >mild case, consider yourself lucky. My son at 9 months had a pretty >rip-roaring infection, and it's awfully hard to console a kid that age >who itches like all hell. We realize we were very lucky. When I've been asked by parents if I gave my own kids the vaccine (and admit that we intentionally exposed them because the vaccine was not yet available), they then ask if I would make the same decision today. I admit I'm not certain. Since they had such mild cases, of course I'm glad I exposed them, but if they'd had more severe symptoms I'd of course regret it. And that's one of the arguments I use in favor of the vaccine - you don't know in advance what kind of case a child will get. > >To once again put in a pitch for the vaccine, although the failure rate >is higher than with wild disease, the infections that do occur after >immunization tend to be much milder. No one has yet studied immune >status after infection after vaccination, though; it is possible >(however unlikely) that immunity will still be incomplete. Time will >tell. This brings up another question which was raised a while back but I'd like to ask again (maybe a new list member has a good answer): With a possible long-term failure rate as high as 20%, when the girls getting vaccinated now reach childbearing age, there could be a whole lot of pregnant women developing post-vaccine varicella infection. Is there any data (or guesses) regarding what kind of risk this poses to the fetus in a previously vaccinated woman compared to fetal varicella in an unvaccinated woman? Michael Sachs, M.D. General Pediatrician