Child Health ALERT

Chicken Pox Vaccine-More Reasons To Use It

A vaccine to prevent chicken pox (also known as varicella) became available in the United States in May, 1995. Both the American Academy of Pediatrics and the U.S. Public Health Service have recommended that all infants 12 to 18 months of age receive this vaccine, and that it also be given to older children who might be susceptible to chicken pox. However, there have been questions about how long the immunity from the vaccine lasts and whether, in fact, children really need to be vaccinated against an illness that seems as mild as chicken pox.

Another question is whether the vaccine will work as well in the ..real world" as it did when it was being studied under strict experimental conditions. Because the vaccine has to be kept frozen and then injected within 30 minutes after it has been mixed, some doctors worried that conditions in the typical health care provider's office or clinic might not be ideal, so the vaccine might not be very effective.

However, when researchers recently studied use of the vaccine under just these kinds of conditions, they found it was "highly effective" in preventing chicken pox during an outbreak of this illness at a childcare center in Georgia. (Izurieta HS et al: Journal of the American Medical Association, November 12, 1997, pp. 1495-1499)

An editorial that accompanied this latest study reviewed other questions about the vaccine and attempted to provide some answers. A common question concerns how long immunity lasts. Though the vaccine only became available for the general population in 1995, it was under study for many years before that, and the latest information indicates that immunity lasts at least 20 years.

Another concern is that people who receive the vaccine might be at higher risk for shingles (also called zoster), a very painful skin condition related to chicken pox but occurring in adults. The best evidence indicates that, if anything, the vaccine may actually reduce that risk.

In their conclusion, the editorial writers ask "Do the benefits of universal immunization outweigh the risks?" They answer that chicken pox is not a trivial illness. and wonder "why would we deny children protection from a disease that at best is an unpleasant rite of passage when the preponderance of evidence about the benefits of vaccination are so favorable? The time has come to stop the procrastination and just do it!" (Shapiro ED & LaRussa PS: Journal of the American Medical Association, November 12, 1997, pp. 1529-1530)

COMMENT: The writers of the above editorial are highly respected experts in the field of children's vaccines, and their perspective and opinions are important. We would offer three additional points:

First, many parents and doctors think of chicken pox as a mild and even trivial illness. That may be true in most cases, but among the millions of children each year who get the disease, there are still quite a few who suffer serious complications.

Second, though immunity has been estimated to last at least 20 years, it's important to know that people who were among the first to get the vaccine still have immunity from it-it's just that the vaccine hasn't been studied for much more than 20 years. Most experts predict immunity will last well beyond 20 years, and even if it doesn't, a second ("booster") shot of vaccine would be a simple way to solve the problem.

Third, there is a growing practical reason to have all children get the chicken pox vaccine. As more and more children receive it, there will be less chicken pox around in the community. A child who isn't vaccinated, therefore, may not come in contact with chicken pox until adulthood. At that point, he or she would not have immunity, and chicken pox in adults is a much more serious illness than it is in children.

For all these scientific and practical reasons, then, we think the recommendations for universal use of the chicken pox vaccine in children are worth taking seriously. 

INFECTIONS/ILLNESS

One of the most frustrating things facing parents and other child care providers is head lice, and for that reason we've devoted much attention to preventing the spread of head lice and treating children who become infested with them.

Most treatment approaches involve one or another pesticides which are applied to children's hair. Parents may not be comfortable using these chemicals on the scalps of young children, and health experts have recently identified another concern-head lice are becoming resistant to many of the pesticides that are currently available.

In response, a growing number of physicians have suggested an unusual but possibly effective alternative - petroleum jelly (Vaseline and other brands). Parents must first use a fine-tooth comb to remove the lice eggs (nits) that are attached to hair shafts. Next, they apply two palmsful of petroleum jelly to the child's scalp at bedtime, and cover his/her head with a shower cap. The next morning, shampoo the child's hair, though it will take about a week to really remove this sticky material. Some even suggest applying baby powder before shampooing, to help absorb the petroleum jelly.

It's believed that the jell), suffocates both the lice and any eggs. As one researcher suggests, "Try it. It's a huge mess, but it works." (Parenting, September 1997, p. 35)

COMMENT: We've discussed this approach with our consultant head lice experts, and there is no clear evidence that petroleum jelly works. On the other hand, it would appear to be safe, and particularly to frustrated parents with children who have repeated episodes of lice, this unusual and messy method may be worth the trouble. 

I MMUNIZATIONS

Hair Loss After Routine Immunizations

In early 1994, a concerned mother called the U.S. Food and Drug Administration to report that her young daughter had lost nearly all the hair on her head after her second and third doses of hepatitis B vaccine. This prompted FDA researchers to review national vaccine safety systems, and they found a total of 60 cases in which adults and children had lost varying amounts of hair; while a number of different vaccines had been blamed as the cause, in over 75% it was the hepatitis B vaccine.

In a small number of the reports, the evidence that a vaccine was the cause seemed clear, since in 4 cases (including the patient above) the hair loss happened again when the vaccine was given again. Among these four were two adults and two infants. The authors conclude that these cases suggest that vaccines might rarely lead to hair loss. While no one knows how this might happen, these experts reinforce that "FDA has learned of fewer than 5 cases per year during a decade in which Americans received roughly I billion vaccine doses. Even when hair loss occurs after vaccination, it is often mild or moderate and self-limited." (Wise RP et al: Journal of the American Medical Association, October 8, 1997, pp. 1176-1178)

COMMENT: The authors point out that there are probably 50,000 cases of hair loss (a condition called alopecia areata) each year in the U.S., so the possibility that some of these might occur, by chance, following one or another vaccines can't be dismissed. Nonetheless, the four cases where hair loss followed vaccination (especially hepatitis B) on more than one occasion seem to indicate that hair loss may be an extremely rare result of certain vaccines. Since press reports might exaggerate the risk (as they typically do), those who care for children should bear in mind that many millions of infants have received hepatitis B vaccine, but in only 2 babies can we be reasonably sure that the vaccine really caused the hair loss. The bottom line is that this new information should be kept in perspective. and should not be seen as a reason to avoid having infants and children fully vaccinated.

CHILD SAFETY

December is a time when holidays are in full swing, with a wide range of decorations creating a festive mood in homes, schools, and childcare settings. However, when plants are involved, the risk of poisonings can be increased for many reasons. There may be more plants than usual, and at the same time adults may be more distracted with activities and visitors, giving a child more opportunity to chew on an "attractive" plant. By knowing the hazards involved, we can help prevent plant poisonings.

The Massachusetts Poison Control System has generously provided a list of plants that can cause problems. Readers should keep in mind that many plants are poisonous if parts of them are chewed or swallowed; most cause only vomiting and diarrhea, but some can be far more toxic, causing convulsions and even coma. Toxic plants include the following:

Mistletoe: All parts are toxic, but the small white berries are particularly dangerous.

Jerusalem Cherry: The fruit is very toxic.

Yew: All parts are toxic.

Boxwood: Leaves and twigs are especially toxic.

Holly: Berries and all parts of the plant are toxic.

Poinsettias: The American Poinsettia, which is the more common variety found in the U.S., is mildly toxic, causing intestinal problems; however, there are European varieties that may be more toxic, so it's a good idea to keep all poinsettias out of children's reach.

Parents should try to avoid bringing potentially poisonous plants into a home with small children, and they should also be aware of the names of the plants that they do have. But if there is any doubt and a poisoning is suspected, call your local poison control center (if the telephone number isn't already attached to your telephone, this would be a good time to make sure it is, the number is also listed in the front of your phone directory). 

PARENT/CHILD

A Respite From Holiday Excitement

The weeks from Thanksgiving to New Year are filled with festivities, and it's easy for children to get caught up in the excitement and become overwhelmed. Meals are off schedule, routines are disrupted, and there are many visits, visitors, and parties to attend. Last month, we reviewed an audio tape designed to help children relax. and we asked the creator of that tape, Dr. Roxanne Daleo, to offer readers some further suggestions on how parents and others who care for children might encourage them to calm down and refocus.

Dr. Roxanne Daleo Comments: Inevitably, children are going to get overexcited and hyperactive during the holidays. If you notice your kids getting all wound up, here are some simple suggestions that might help. Show them how to give the gift of a smile to themselves and others. We can teach them that a smile is something that you can see, feel, and show, and is a gift of love that brings cheer to ourselves and to those who receive it. Children can be encouraged to 1) give themselves a smile (which they can see in a mirror); 2) give a smile away by smiling at someone and notice the look on the person's face-it makes them smile back and makes them feel happy; 3) draw a happy face and send it to someone they might not see for the holidays. While it might not seem so important, actively teaching a child to smile can be a lifelong gift that brings valuable feelings and contributes to development of their self-esteem.

(Dr. Daleo is a child therapist and health educator specializing in stress management and relaxation techniques; for additional information on her relaxation tape, see CHILD HEALTH ALERT, November, 1997 or contact her at Mindworks for Children, RO. Box 2493, Cambridge, MA 02238-2493, telephone 617 876-5585.) 

Child Health ALERT

1997 INDEX

By Month & Page

Products
Carter's infant carriers, Jun 6
Century Travel play yards, Feb 6
Dex wipe warmers, Nov 5
Evenflo play yards, Nov 6
First Alert safety gate, Nov 5
Graco entertainers/repair kit, Nov 6
Gymboree umbrellas, Sep 6
Li'l Napper Swings, Nov 5
paperweights & pens, Sep 6
Right Start play sets, Jan 6

Sports Equipment
Lacross stick/Titanium plus, Jul/Aug 6

TOYS
Charming Shoppes necklace, Jul/Aug 6
Fisher-Price toy police car, Sep 6
Klutz Chinese jumprope, Nov 5 Teddy-Precious, Jul/Aug 6 Tonka Walkin Wheels, Apr 5 toy telephones, Mar 6 water batons, Mar 6
Relaxation tapes & behavior, Nov 2
Ringworm scalp, May 2

Safety baby walkers, Nov 3 bacterial contamination poultry, Nov 4 bee sting removal, Jun 3 carbon monoxide, Nov 3 de-icing salt, Feb 3 window cord, Jul/Aug 3
Salmonella pets, May 3
SIDS bedsharing, Mar 3
Sorbitol diarrhea, Sep 2
Sulfites canned tuna, Jun 2
Sun Protection flyer, Jun 4

Television education for viewers, Sep 3
Twins on the increase, Mar 4
Tuna sulfites, Jun 2
Tylenol overdose warning, Nov I

Vaccine CDC hotline, Oct 3
Varicella vaccine, Dec 2

Whooping Cough vaccine, May I
Window Cord safety flyer, Jan 3
WinterHint indoor temperature, Jan 6
World Wide Web medical information Sep 5

The articles above are available in back issues, which can be ordered at a cost of $3 each.

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