Re: Chicken Pox and other immunizations

[Guest guest]

Hi ;

It's not clear from your message whether Noah has been immunized

against chicken pox? If he hasn't been, and is taking

immunosuppressants, then it would not be good for him to be exposed to

the virus (varicella). There have been reports of varicella in young

IBD patients taking immunosuppressants, and it can be quite serious

unless prompt action is taken:

Am J Gastroenterol. 1997 Sep;92(9):1534-7.

Management of varicella infection during the course of inflammatory

bowel disease.

Mouzas IA, Greenstein AJ, daki E, Balasubramanian S, Manousos ON,

Sachar DB

Department of Gastroenterology, University Hospital, Heraklion, Greece.

OBJECTIVE: To study the natural history and outcome of varicella

infection developing in steroid treated inflammatory bowel disease.

BACKGROUND: Varicella infection occurring in immunosuppressed or

immunocompromised patients is a common problem with a significant

mortality. Varicella infection during the course of inflammatory bowel

disease has been reported in a small number of patients with at least

one fatality. METHODS: Four young patients with inflammatory bowel

disease who developed varicella infection while on immunosuppressive

therapy, steroids, or azathioprine were studied. In each patient the

infection was severe, and the three most recently treated patients

received acyclovir. RESULTS: All four patients developed severe

varicella infection while receiving immunosuppressive therapy for their

disease. Three patients were treated with intravenous acyclovir with

concomitant reduction of steroid dosage and recovered completely. One

patient, treated in 1980 with antibiotics and reduction in steroids,

did not receive acyclovir and also survived. CONCLUSIONS: Varicella

infection is a relatively uncommon occurrence in inflammatory bowel

disease. If varicella infection occurs, prompt diagnosis and treatment

with acyclovir and concomitant reduction in immunosuppressive therapy

(reduction in steroid dosage and discontinuation of azathioprine)

should be initiated immediately to limit viremia and avoid fatal

complications. PMID: 9317080.

Best regards,

Dave

(father of (22); PSC 07/03; UC 08/03)

>

> Has anyone here been infected (pretx) with chickenpox? I am curious

> what the ramifications are. Has anyone here had trouble retaining

> immunizations? Or have your docs recommended having titers drawn to

> see if you are retaining them? I am just overly concerned? Noah was

> around a possible chickenpox kiddo and Pitt had told us to keep him

FAR

> from that situation... but that is just unreasonable for a child. I

> guess I am curious what could/would happen if he gets them. No TRUE

> answer from them. I thought I would ask here.

> I know post tx it is a whole different deal and much worse.

> Blessings,

> (mom to Noah-10 sclerosing cholangitis, IBD, PsA, osteopenia,

and

> depending on the day a crapper full of other fun stuff...

> migraines...etc)

>

[Guest guest]

,

Would your assumption then be that it would be okay to get immunized

while not on the steroids? ( is asymptomatic with both his PSC and

Crohn's at this time.) He's never had pox and has not been immunized.

wrote:

> Hi ;

>

> It's not clear from your message whether Noah has been immunized

> against chicken pox? If he hasn't been, and is taking

> immunosuppressants, then it would not be good for him to be exposed to

> the virus (varicella). There have been reports of varicella in young

> IBD patients taking immunosuppressants, and it can be quite serious

> unless prompt action is taken:

>

[Guest guest]

,

Noah has had the immunization. So hopefully he is retaining it. I

don't like the sound of that article as Noah isn't on steroids, but he

is on Imuran and most likely always will be since when they tried to

pull it this year he flared big time.

I don't know what the value then would be of running the titers to see

if he is retaining the immunizations... I think it just might be worth

knowing since this is the second time in 6 months he has been around

chicken pox and he has been around the mumps too. I would rather be

preventative than to be thinking about this after the fact wishing I

had acted. I also don't want to seem like a nervous nelly. Hard line

to walk.

Blessings,

[Guest guest]

,

I would highly recommend the book Maneater by Pamela H. Nagami, M.D. In

paperback there's a different publisher and the title of the book is The

Woman with a Worm in Her Head. She's an infectious disease doctor at Kaiser

Foundation Hospital in Woodland Hills, CA. She's also a professor at UCLA

medical school. She also happens to be a friend of mine.

The book is a memoir, but covers some of her more challenging infectious

disease cases. It's a quick read, and reads like a detective novel. In it,

she mentions that people with suppressed immune systems are more suceptible

to infectious diseases, and tend to have more serious illnesses when they do

get sick. The book covers a case of an adult who gets chickenpox.

-Marie

>Has anyone here been infected (pretx) with chickenpox? I am curious

>what the ramifications are. Has anyone here had trouble retaining

>immunizations? Or have your docs recommended having titers drawn to

>see if you are retaining them? I am just overly concerned? Noah was

>around a possible chickenpox kiddo and Pitt had told us to keep him FAR

>from that situation... but that is just unreasonable for a child. I

>guess I am curious what could/would happen if he gets them. No TRUE

>answer from them. I thought I would ask here.

>I know post tx it is a whole different deal and much worse.

>Blessings,

> (mom to Noah-10 sclerosing cholangitis, IBD, PsA, osteopenia, and

>depending on the day a crapper full of other fun stuff...

>migraines...etc)

>

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[Guest guest]

Hi ;

Yes, I believe that it would be O.K., but you should check with

's doctor to be sure! Information about chicken pox vaccination

can be found at the center for disease control web site:

_______________

http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-varicella.pdf

" People should not get chickenpox vaccine if they have ever had a

life-threatening allergic reaction to gelatin, the antibiotic

neomycin, or a previous dose of chickenpox vaccine.

• People who are moderately or severely ill at the time the shot is

scheduled should usually wait until they recover before getting

chickenpox vaccine.

• Pregnant women should wait to get chickenpox vaccine until after

they have given birth. Women should not get pregnant for 1 month

after getting chickenpox vaccine.

• Some people should check with their doctor about whether they

should get chickenpox vaccine, including anyone who:

- Has HIV/AIDS or another disease that affects the immune system

- Is being treated with drugs that affect the immune system, such as

steroids, for 2 weeks or longer

- Has any kind of cancer

- Is getting cancer treatment with radiation or drugs

• People who recently had a transfusion or were given other blood

products should ask their doctor when they may get chickenpox vaccine.

Ask your doctor or nurse for more information. "

_______________

Best regards,

Dave

(father of (22); PSC 07/03; UC 08/03)

[Guest guest]

Got it, . Thanks for the link and info!

wrote:

> Hi ;

>

> Yes, I believe that it would be O.K., but you should check with

> 's doctor to be sure! Information about chicken pox vaccination

> can be found at the center for disease control web site:

> _______________

>

> http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-varicella.pdf

>

>

[Guest guest]

Hi ;

I think that you would be reasonable to assume that antibodies to the

virus would still be present (see abstract below), but you could always

ask for an antibody titer measurement if you are concerned. Noah's

doctors could then let you know whether it would be worthwhile to do

so. I honestly don't know whether it would be unsafe to give Noah

another vaccination given that he is taking an immunosuppressant! Only

Noah's doctors would be able to answer this question for you.

Pediatr Infect Dis J. 2004 Feb;23(2):132-7.

Ten year follow-up of healthy children who received one or two

injections of varicella vaccine.

Kuter B, s H, Shinefield H, Black S, P, B,

Reisinger K, Kim LL, Lupinacci L, Hartzel J, Chan I; Study Group for

Varivax

Merck Research Laboratories, PO Box 4, West Point, PA 19486, USA.

barbara_kuter@...

BACKGROUND: The rate of varicella and persistence of varicella antibody

after a one dose vs. a two dose regimen of varicella virus vaccine live

Oka/Merck (VARIVAX; Merck & Co., Inc., West Point, PA) in approximately

2000 children were compared during a 9- to 10-year follow-up period.

METHODS: Children 12 months to 12 years of age with a negative history

of varicella were randomized in late 1991 to early 1993 to receive

either one or two injections of varicella vaccine given 3 months apart.

Subjects were actively followed for varicella, any varicella-like

illness or zoster and any exposures to varicella or zoster on a yearly

basis for 10 years after vaccination. Persistence of varicella antibody

was measured yearly for 9 years. RESULTS: Most cases of varicella

reported in recipients of one or two injections of vaccine were mild.

The risk of developing varicella >42 days postvaccination during the 10-

year observation period was 3.3-fold lower (P < 0.001) in children who

received two injections than in those who received one injection (2.2%

vs. 7.3%, respectively). The estimated vaccine efficacy for the 10-year

observation period was 94.4% for one injection and 98.3% for two

injections (P < 0.001). Measurable serum antibody persisted for 9 years

in all subjects. CONCLUSIONS: Administration of either one or two

injections of varicella vaccine to healthy children results in long

term protection against most varicella disease. The two dose regimen

was significantly more effective than a single injection. PMID:

14872179.

Best regards,

Dave R.

[Guest guest]

My whole life I've been easily sick. I had all my childhood

immunizations (I was born in 1982) and I got chickenpox as a child as

well. But I still managed to get chickenpox again the the mumps

twice!!! I guess I just have a crummy immune system. :-( I was dx

with PSC 4 weeks ago.

, 24, from NE

PBC 10/06 (probably)

PSC 8/07 (ERCP confirmed)

[Guest guest]

Chicken pox vaccine wears off with time in normal individuals. Below

is an extract from a New England Journal of medicine article that

showed that the risk re-activation increases 9 fold after 10 years

compared to the first year after vacination. A second dose is

recommended in all children. For the last year there has been an adult

vaccine that is about 15 times stronger than the child's dose that is

indicated for adults over 50 to prevent shingles. Before my

transplant I recieved the vaccine. It is unstudied in

immunosupression but it seemed like a good $250 investment to try to

prevent shingles.

Volume 356:1121-1129 March 15, 2007 Number 11

Loss of Vaccine-Induced Immunity to Varicella over Time

S. Chaves, M.D., M.Sc., Gargiullo, Ph.D., X. Zhang,

Ph.D., Civen, M.D., Dalya Guris, M.D., M.P.H., e Mascola,

M.D., M.P.H., and Jane F. Seward, M.B., B.S., M.P.H.

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ABSTRACT

Background The introduction of universal varicella vaccination in 1995

has substantially reduced varicella-related morbidity and mortality in

the United States. However, it remains unclear whether vaccine-induced

immunity wanes over time, a condition that may result in increased

susceptibility later in life, when the risk of serious complications

may be greater than in childhood.

Methods We examined 10 years (1995 to 2004) of active surveillance

data from a sentinel population of 350,000 subjects to determine

whether the severity and incidence of breakthrough varicella (with an

onset of rash >42 days after vaccination) increased with the time

since vaccination. We used multivariate logistic regression to adjust

for the year of disease onset (calendar year) and the subject's age at

both disease onset and vaccination.

Results A total of 11,356 subjects were reported to have varicella

during the surveillance period, of whom 1080 (9.5%) had breakthrough

disease. Children between the ages of 8 and 12 years who had been

vaccinated at least 5 years previously were significantly more likely

to have moderate or severe disease than were those who had been

vaccinated less than 5 years previously (risk ratio, 2.6; 95%

confidence interval [CI], 1.2 to 5.8). The annual rate of breakthrough

varicella significantly increased with the time since vaccination,

from 1.6 cases per 1000 person-years (95% CI, 1.2 to 2.0) within 1

year after vaccination to 9.0 per 1000 person-years (95% CI, 6.9 to

11.7) at 5 years and 58.2 per 1000 person-years (95% CI, 36.0 to 94.0)

at 9 years.

Conclusions A second dose of varicella vaccine, now recommended for

all children, could improve protection from both primary vaccine

failure and waning vaccine-induced immunity.

[Guest guest]

Interesting read . Noah is just now 10 and would have

gotten vaccinated at… what?... 12 months? So he would be at the 9 year

point anyway… so would you take from this article that the immunity from

the vaccine might be declining even in a healthy person? That was what I took

from it. I did talk to our allergy CRNP today. She is the one who finally got

off the asthma bandwagon and referred Noah to a GI in Hershey where he was dx’d.

(her daughter plays soccer in the crazy 100+ heat with mine on days like

today) When he was seen there the thing that finally prompted THAT referral was

the elevated IgA, IgG, and IgM levels… she didn’t know right off

the bat, but when she looked it up I think her book said… it could mean

something with the bone marrow, or something in the GI tract or liver, or

something like that. So, she was thinking that we may have in fact run the

titers on him for all his immunizations at that time. That sounds a tad

extreme to have been doing, but who knows. She isn’t at that office

until Thursday, so she will check then and if they weren’t run she said

she will have them drawn. Sure can’t hurt! Like Carolyn said… I

really don’t need this right now… as I try to set out as a single

parent for my first school year… working 3 jobs… J Did I

mention I am exhausted?

Pox would be a disaster. (heck, if he ever needs a tx that’ll

be a disaster… what happens to my other kids… going off on a

schpeal… sorry…. LOL!)

Anyway…bless you for finding this stuff. I

honestly don’t know how you do it. I spent last night just researching

Noah’s diagnosis of autoimmune Sclerosing Cholangitis as someone was

questioning that… and I wanted to explain it on his CB site, but there is

nothing out there… except a tiny bit from the doc in the UK who diagnosed

him…hmm imagine that.

Gotta love Mieli-Vergani. Seriously… you have got to

love her!

Blessings,

Mom to Zoe, Noah and Aidan