Speaker 1 00:00:02 Hello and welcome back to a Wonder Care podcast with me, Sheena Mitchell, pharmacist and mom, bringing you practical healthcare advice to support you on your parenting journey. I'm really grateful to say that this podcast is kindly supported by Salon Plus, and I will talk more about that later. This is part two of a chickenpox podcast. I separated these two episodes because there are many people who just wanted to know about vaccination, and then there are another group of people who just wanted to know how to treat the symptoms of chickenpox if they're in the household now. So if you're in that group that is dealing with chickenpox right now and you want to know how to treat it and have plenty of advice on how to manage it at home, when to see the doctor or what to do if you're pregnant, then do have a look through the podcast. Speaker 1 00:00:50 The one just before this contains an overall view of chickenpox. This episode is going to focus just on the vaccination. Weirdly, when I started trying to record my opinion on the chickenpox vaccine and present all the information, I found myself very conflicted and I found that I had to go through a lot of information to try and provide you with a completely balanced view. Remember, my personal opinion is not important here. I'm a healthcare professional and while I'm a parent and I've always tried to make healthcare relatable, it's very important to say that this is a personal choice and I can't fully guide you on it. But what I can do is explain all of the debates in every direction and explain the vaccine when it's appropriate and when it's not. I hope you find this really, really helpful and if you do, it is actually such a huge, huge help. Speaker 1 00:01:48 If you could go on and review this podcast, I would really, really appreciate it. I know it takes a few minutes or well even a few seconds depending on how quick you are on your device, but literally any comment you have, whether positive or negative, I would love to hear the feedback on Apple Podcasts. You can rate it with stars or whatever, and in either case, please do give it a little follow or subscribe to ensure that you're kept up to date on all new podcast releases. This season I'm gonna be covering a whole load of topics like this. Next week's episode is going to be all about hand foot milk disease and ways to help ease the symptoms and to understand the aftermath, which <laugh> is actually quite shocking. I wasn't expecting it myself when we had hand, foot mouth in the house. So yeah, all of that, all of the reviewing and all the rating really, really does help me. Speaker 1 00:02:39 So here we go. Here is part two of the Chickenpox podcast and it is all about vaccines and there are answers to many of the listeners' questions here. Okay, the chickenpox vaccine, which is called Varivax, that's V A R I V A X, is not on the childhood schedule of vaccines in Ireland. I did contact the H P R A and NAAC to try to see was there any imminent plans to include the chicken box vaccine on the routine childhood immunization schedule. And I didn't get any indication that this was currently being considered. They just referred me back to the guidelines from October, 2022, which state that those who choose to have themselves or their child immunized should consult with their gp. However, I did see some info online that shows that hwa who are the health Information and Quality Authority in Ireland are actually to begin an assessment, a hta, it's called a health technology assessment in relation to the addition of the chickenpox vaccine to the routine schedule. Speaker 1 00:03:51 So this basically means that they're going to assess the clinical effectiveness, cost effectiveness, the budget impact, ethical and social aspects and organizational changes associated with the expansion of the childhood immunization schedule to include chickenpox. The findings of the assessment will inform a decision by the Department of Health, so it does look like it is being examined. I think that was instigated because the World Health Organization have advised that routine chickenpox immunization for children should be considered in countries where chickenpox is an important public health burden and there are sufficient resources to vaccinate at least 80% of the population on an ongoing basis. And the European Center for Disease Prevention and Control who are known as the EC D C also recommend introducing the childhood immunization for chickenpox, but only after countries have conducted their own assessments. So hopefully we'll get more information on that soon. As I said, there's basically nothing concrete that health technology assessment was reported on the 23rd of June, 2022. So I don't know if it's even actually started or where it's at. Speaker 1 00:05:11 It's a little bit tricky because the duration of protection from the chickenpox vaccine is unknown. However, several studies have shown that people vaccinated for chickenpox have antibodies for at least 10 to 20 years after vaccination, but we do need more information on this. And the complicating factor of this, I'll discuss a bit more. You do have to remember that if you're vaccin a five year old now in 20 years, they're gonna be 25 and you know of childbearing age, even for example, if they have their first child at 35, that's 30 years since they'll have had their vaccination. So I can't say whether or not it's worthwhile them being vaccinated now if it's going to be worn off by the time that they're at the riskiest part of their life for contracting chickenpox. But there may be ways around that like assessing your level of antibodies before trying to conceive and you know, there is the potential that an additional booster potentially could be rolled out. Speaker 1 00:06:18 Truly, I don't have the answers, but it's just something that I want you to have in the back of your mind. There isn't a guarantee of high level of immunity for life, but we do know that live vaccines do give very good protection. I think with anything you need to be balanced. And the most important thing would be that your child should know if they've had chickenpox or the vaccine and they should know when they had it, so that if they're in a position where they're able to do family planning, they can discuss with their GP at that point whether or not they need to have their immune systems checked to ensure that they have adequate protection going into their childbearing years gets complicated because not everyone tries to conceive. Some people just conceive <laugh> and some people conceive much earlier than they expect and it takes people by surprise. Speaker 1 00:07:14 Some people also conceive much later than they expected. So yeah, it's a, it's a bit of a tricky one in general. These are obstacles that I think can be overcome by remaining aware and ensuring your child is aware. So doing them the service of ensuring that they know their medical records and they know that it's something that they should look at again in the future. The more people are vaccinating, the less that chickenpox will circulate in the community. And so the less risk in childhood there will be for those in our communities who are susceptible to severe illness, which is obviously a good thing. But there's also a thought that increasing the number of people who are vaccinated could actually increase the number of adult cases of chickenpox as unvaccinated people will be less likely to come across the illness in childhood as it'll be less common. Speaker 1 00:08:13 So basically to sum that up at the moment, children are very likely to catch chickenpox and thus very unlikely not to get it until they're an adult. If a large portion of children are vaccinated, then any children who are not vaccinated are more at risk of developing chickenpox in adulthood. And we know that the diseases more severe in adults. However, to balance that argument in America, they do routinely vaccinate all children for chickenpox. They brought that in in 1995 and it's important to note that the number of hospitalizations and death from chickenpox has decreased markedly. The chickenpox vaccine contains a weakened amount of the varicella virus, so it is a live vaccine and it stimulates an immune response in the patient's body so that they'll be able to defend themselves from future exposure. It's such a weak dose that most patients won't have any symptoms at all afterwards. Speaker 1 00:09:16 So that's 98% of people, but in a very small minority, they may show mild symptoms of disease and even develop a very, very mild rash. And we're talking no more than five or six blisters in this case. I just want to take a little break for a second to say that I'm delighted to partner again with one of my all-time favorite products. Salon Plus, this is the world's first hundred percent natural dry salt therapy device. It's clinically proven to relieve a wide range of allergens and respiratory conditions. The salt therapy method has been trusted for generations and is now hugely popular worldwide. As more and more people recognize the superb results achieved from a natural and non-invasive method, this device will help you breathe easier and sleep better. Speaker 1 00:10:05 It's suitable from 12 months of age. It's given in two doses with at least one month between the first and the last. It's okay to be given with some of the other vaccines like Hep B and the six and one and it is okay with the MMO so long as they're given at the same time, if they're not given at the same time, you need to leave a month gap in between. People who should not receive this live vaccine are those who are currently receiving immunosuppressive therapy or who have immunodeficiency, also people who are sick. So if you have a fever over 38 and a half degrees, then you should postpone vaccination. Pregnant women shouldn't receive vaccination and you should not conceive until a month after you've received your vaccine breastfeeding. Mums talk to your GP because that one just isn't black and white. And obviously if you had any allergy to vaccines in the past, particularly ones that contain gelatin or neomycin, if you choose to have your child vaccinated, try to avoid close contact with people who are at high risk of suffering from severe illness with chicken pox like immunocompromised patients. Speaker 1 00:11:18 Say for example, someone going through chemotherapy for cancer or those who have received a transplant et cetera. Also, maybe avoid close contact with women who are pregnant if they haven't had the chickenpox before and newborn babies. But obviously if you are pregnant and have had the chickenpox before, then it's absolutely fine for you to get your other children vaccinated. The length of time you need to avoid the at-risk groups would be about six weeks after vaccination. It's not always possible because you know your child will have to live their life and you don't always know what's going going on with the other people in the world around you. But it's just something to be aware of and try to be conscious of it when it's possible. So if you or your child have come in contact with chickenpox and it was within the last 72 hours and you want to get your child vaccinated for whatever reason, it could be that they are in a household with someone who is severely immunocompromised and you don't want them to be exposed to it, well, you can actually still get vaccinated. Speaker 1 00:12:25 So even if you find out that a child in their class has chickenpox and they were sitting next to them practically licking them at school for the the few days before, once it's within three days, you can still get them vaccinated and that can actually help to prevent or reduce the impact of infection. There is some data to say that even up to five days it may be beneficial to get vaccinated. What are the potential side effects? Well, usually they're fairly mild. In fact, in most cases they're very mild. But obviously with any injection, sometimes you can have a bit of tenderness around the injection site and as I said, there you can get a very, very mild chick chickenpox rash, but you're literally talking less than a handful of spots. Sometimes children will be a bit irritable or have a bit of a cough. Speaker 1 00:13:10 I think we're all okay with a lot of the normal vaccine side effects. Now, after the pandemic, as I said, people ask me should they or shouldn't they? And I can't seem to form an opinion on this myself at the moment and I'm lucky I don't have to cuz all my three children have had chickenpox. But in terms of pros and cons, chickenpox is mostly very uncomfortable, but it is a mild illness in children. Most people just have some mild flu-like symptoms and varying degrees of rash. But there is a minority who will suffer a severe form of the illness and can become really unwell and even need hospital. It can even be life-threatening in very small number of cases. And the people most at risk of these kind of life-threatening complications like pneumonia or encephalitis are those with a really weak immune system or very young uh, babies or those who are pregnant and haven't had the chickenpox before. Speaker 1 00:14:11 Another practical side of it is that if your child has chickenpox, they're gonna be a good five to 10 days outta school. And look, this isn't a medical aspect of it, it's a practical one. You know, if you don't know when your child is gonna get chickenpox and all of a sudden you have to take a dramatic two weeks outta work, that can be costly and difficult. So some people may decide that they'd rather the predictability of the vaccine and not to have that risk hanging over them. Chickenpox can of course lead to severe skin infections and scarring. Hopefully they would be reduced by the tips I gave you earlier, vaccinating your child. Those provide them with with immunity without the risk of getting the severe complications of the disease. So really just it comes down to a bigger picture really it comes down to on whether we want all of our children vaccinated. Speaker 1 00:15:06 Bearing in mind that there will be a group of people who obviously won't vaccinate their child and then those children as they get older will be more at risk of severe disease when they come in contract with it as an adult. And if you're more concerned about your own household, which is fair enough, no judgment here, then don't know how long at the moment that your child is gonna remain immune. So at the moment they're saying 15 years your vaccine will work for 15 years. So I'm not gonna say that that's a complete negative because you can do something about that in 15 years time. Look, <laugh> set a reminder on your phone, maybe go check in and see how that immunity is going for you. See do you need to maybe talk to the doctor about an additional vaccination? And for men the risk is that they'll get severe disease as an adult if their immunity completely wanes. Speaker 1 00:16:04 Um, you know, if you have someone who's vaccinated when they were six and suddenly they're 46 and they have a severe dose of chickenpox, what's that gonna look like? And then for women it's more complicated because I would just urge that any woman does do that check-in on their immunity before they conceive. And family planning isn't always at the top of all of our agenda. So just bear all of that in mind when you're making your decision. I'm sorry if I'm leaving you more torn, but it's not my role to make these decisions for you. I'm not a dictator and all I can do is give you the evidence and the advice that I am currently aware of and from my research that's as far really as I can take it. I know. Sorry, <laugh>. Speaker 1 00:17:00 Okay, so now I'm gonna address some of the listener questions. I'm just gonna start off by saying that a whole heap of people <laugh> messaged in on WhatsApp and on Instagram to ask about the vaccine. So I won't say any more on that. I hope I have given you all the information that you need to make an informed decision. Someone asked if you can be unwell but just have one spot. So I would question there whether it's definitely chickenpox and I wouldn't be assuming immunity from illness with one spot because it could be that it's an extremely mild dose with very low viral load. But you know, it's tricky. You'd actually, the only way to know know if it was actually chickenpox or if the child developed any immunity from the infection would be a blood test from the doctor. Funny someone said there that they spoke to three GPS about getting the vaccine and a lot of the gps aren't recommending it. Speaker 1 00:18:08 I don't, I don't, I don't feel that strongly either way on it to be honest. Um, I can't see any reason other than what I've outlined why you wouldn't get it. But it's just the reasons for getting it aren't hugely compelling when you think about the fact that it's, you know, generally a mild childhood illness and it's not usually a big problem if your child gets it and at least then they have lifelong immunity. Huh? Look, here I am again talking about the vaccine. Okay, gonna move on. Someone is asking if <laugh>, they'd recommend the va. Clearly I'm not moving on from vaccine. If you get the vaccine for a baby, it's not really recommended till 12 months but it is possible to give it from nine months. So you know on the information you have there, you can talk to your GP about it. Someone is asking if it's a bad thing if your child has never had the chickenpox and he's 15 now, hmm, it's not a bad thing. Speaker 1 00:19:05 It's like what could you do about it if he didn't catch chickenpox? He didn't catch chickenpox. What I would say is that he is kind of out of childhood really and more at risk of having a severe infection if he gets it. However, he may not have a severe infection, so it's just something to watch for and it's something for him to be conscious of in life going forward, you know that he isn't immune and maybe to be aware of that because we can be around people who have chickenpox if we've had chickenpox and it doesn't really matter. But obviously if you haven't had it you're gonna have to be more cautious. Someone else asked, does the chickenpox vaccine completely remove the risk of them getting them? So the answer is no, it's about 90%. Someone else saying that they're 39 years of age and they haven't yet had chickenpox, how should they avoid contracting them from their kids when they do? Speaker 1 00:20:09 Well that is a scenario where I would definitely be talking to the doctor about vaccination. Someone else asking about the complications of chickenpox, which I described during the episode. Um, part one, but really pneumonia and encephalitis are quite severe complications and this person is also asking about eczema during chickenpox. So what I would say with eczema is that you should continue to use your normal skincare routine, so your normal emollient and then treat any individual spots with something like the calamine cream or the LAN moose. But with the lan, as I said in part one of the episode, ensure you do a patch test first someone is asking who is advised to get the very va, so the chickenpox vaccine now. So they're saying they have a child with neurological issues and currently on the NIAC guidelines, the people who are advised to get the chickenpox vaccine include healthcare workers, um, particularly those working in hematology oncology, obstetrics pediatric or neonatal patients who don't have immunity. Speaker 1 00:21:30 Also lab staff who are exposed to varice in the course of their work. Some immunocompromised patients. So for example with leukemia and transplant recipients, another group who should consider vaccination are those who are close household contacts of someone who is immunocompromised. Also some children infected with hiv. Another group that should consider it would be children in residential units with physical and intellectual disabilities. And then finally non-pregnant women of childbearing age. So if you have a blood test that shows that you haven't had chickenpox, then you should be vaccinated at a minimum of one month before you conceive. And that really comes from a place of what I was talking about earlier. Another question is that there's a chickenpox outbreak in this person's daughter's playschool and her two kids now have colds. Is this the start? Is this the start of it? And it could be, um, often before the rash appears you'll get mild flu-like symptoms or even flu-like symptoms to include a temperature of over 38 degrees. Speaker 1 00:22:50 So with that, you're obviously doing a lot of watchful waiting and keeping an eye on them and in the meanwhile keeping them away from immunocompromised people. And then yeah, a load more questions, but I think I've answered most of them in the episode already. When I get my child vaccinated, will I get my child vaccinated over and over again? Which is very, very understandable. And look, I think I have given you all of the information that I can to help you make an informed decision and help you to make a decision that you're comfortable with. One thing I want to clarify is that earlier in the episode I said there'll be a portion of parents who will not get their children vaccinated. And I didn't mean that in an anti-vaxxer way if it's brought in on the childhood schedule. I was more talking about people who cannot get their children vaccinated because they're extremely immunocompromised and the vaccine is contraindicated them for them. Speaker 1 00:23:52 So there are other people who will fall into that boat, like people who have allergies, like severe allergies like anaphylaxis to any of the vaccine constituents. Also children who have parents and a family history with congenital or hereditary immunodeficiency. So unless their, their doctors can kind of establish immune competence in that child, they won't be getting vaccinated. So when I say that it's the people who are not getting vaccinated, that will be vulnerable in adulthood. If a mass rollout is brought out, they're the group I'm talking about. I'm not talking about the group who choose not to vaccinate. So yeah, I just wanted to be clear on that because it may have come across as a little unfair or as an assumption of an anti-vax movement and that is not what I was referencing at all. If you have found this episode helpful in your decision making process, I'd be hugely grateful if you could pop a review on the podcast and give it a follow or a like, or stars or whatever it is on whatever particular streaming platform you use to listen to your podcasts. Speaker 1 00:25:06 That helps the podcast to be shown by the streaming platforms more often and it allows more people then to have access to healthcare advice at a time that suits them. So thank you so, so much for listening. And don't forget next week it'll be all about hand, foot and mouth disease and the aftermath. So keep an eye on Wonder Care i l on Instagram for some question boxes and you can get involved in that episode as well. We also have our WhatsApp number, which is oh 8 6 0 3 5 3 4 6 2. And yeah, I'd love loud voice note or two. They're very exciting. <laugh>. Talk to you next week. Bye.