Primary care physicians seldom receive the accolades of other specialties. TV shows are about neurosurgeons or cardiologists, not primary care doctors. But what we may miss out on in glamour, we more than make up for with the satisfaction of having the opportunity to prevent so many illnesses from occurring or worsening.
I have been asked more times than I can remember, “Did you become a doctor to help sick people?” My answer to that is always: “Yes, but the main reason I became a doctor is so that I can help people before they get sick.” Prevention of disease is the main goal of primary care medicine, and keeping patients healthy and free of major illnesses is my primary objective as a physician. One of the main ways to accomplish this goal is with vaccinations.
The Varicella Vaccine
The varicella vaccine is given to prevent chickenpox – a highly contagious viral infection caused by the varicella- zoster virus. The vaccine has been invaluable in decreasing the incidence of childhood chickenpox. As of 2007, childhood deaths from chickenpox had been cut by 97%. Prior to the introduction of the vaccine in 1995, 50 children in the U.S. died each year and thousands more were hospitalized.
Knowing that the vaccine is made up of “live-attenuated virus” sometimes causes people to worry that they could catch chickenpox from being vaccinated. A varicella-like rash may develop in 1-6 percent of people following vaccination, but the more common reaction is fever and pain, redness or swelling at the site of injection. Except for individuals who have some sort of immune deficiency or are allergic to the vaccine, its benefits far outweigh the risks for the overwhelming majority of people.
While most people know that it is important to vaccinate children, many do not realize that it is also important for adults to get the vaccine and booster. This is especially true for people who had chickenpox in childhood but show no immunity to it in adulthood. For older people and those with weakened immune systems, shingles is also a concern. Caused by the reactivation of the chickenpox virus, shingles manifests as a painful rash. There are vaccines available to reduce the risk of shingles.
Chickenpox Transmission and Course of the Disease
Chickenpox can be transmitted either by directly touching the fluid in a lesion on someone’s skin or by breathing in the secretions from an infected person’s nose. After exposure to the virus, it takes approximately 10-21 days before the initial signs of infection, which include fever, fatigue, sore throat and loss of appetite. The rash develops approximately 24 hours after these symptoms appear and presents itself in “crops,” typically on the face, trunk, arms and legs. Because new lesions develop each day for approximately four days, both fluid-filled lesions and scabbed lesions may be present at the same time. Approximately six days after the initial signs and symptoms, all the lesions will scab over and will no longer be infectious.
As benign as all of this may sound, chickenpox can unfortunately become more serious for some patients. Severe complications from the virus include secondary bacterial skin infections, pneumonia and encephalitis, which is a swelling of the brain. The primary method for preventing the most serious aspects of chickenpox is through vaccination. While it is reported to be 44% effective in preventing chickenpox, the vaccine is 86% effective in preventing severe complications.
I recall having chickenpox when I was five years old and being covered from head to toe in lesions that caused such a severe itch. Luckily, I did not develop any complications. When my parents were children, they were brought to visit friends who had chickenpox so they could get the virus and later overcome it. There was no vaccine at that time, and this was simply the only way to build immunity.
Prior to the implementation of the varicella vaccine in 1995, the natural course of chickenpox immunity was this: You got chickenpox as a child and developed immunity. Then, in adulthood, you were exposed to young children with chickenpox, and that provided your immunity with a boost. Through this process, you developed a lifelong immunity to chickenpox. However, now that children are being vaccinated, adults are no longer being re-exposed to chickenpox, so the boost does not occur.
Who Should Get the Vaccine
Vaccination is recommended for all children between the ages of 12-15 months who have no evidence of immunity, and a second dose is given between the ages of four and six years old. Experience has taught us that with just one dose, children can still become infected with chickenpox, which is why the second dose is needed.
All adults should be tested by their doctor to see if they have immunity to the virus, even if they had chickenpox as a child. If immunity is not detected, a varicella booster is recommended. Adults should receive two doses of the vaccine four to eight weeks apart. Protection against chickenpox is especially important for adults who work in healthcare or daycare or who are exposed to people with weakened immune systems. In addition, women of childbearing age who show no immunity should be vaccinated; however, they should not get pregnant for at least four weeks after receiving the vaccine.
With my patients, I stress the importance of getting the varicella vaccine, not only to protect themselves but also those around them. In fact, outbreaks can be prevented by something called “herd immunity,” whereby a critical portion of a community is immunized against a disease, and any cases that crop up cannot spread among the people who have been vaccinated. A tragic example of what can happen when large numbers of people fail to be vaccinated occurred in 2012, when a four-year-old girl with leukemia died after being exposed to a cousin with a rash that turned out to be chickenpox. She could not get the varicella vaccine because she was undergoing chemotherapy and her immune system was too weak. Sadly, she could have been protected if herd immunity had prevented her cousin from becoming sick.
While we have nearly eliminated chickenpox with vaccination, recent news shows us how viruses can re-emerge. Vaccinations can become a victim of their own success – by being so effective, people undervalue their benefit and fail to get vaccinated. The truth is that the vaccine is vital, not only to keep you safe, but to keep your loved ones safe as well.
I became a primary care physician to prevent illness, and vaccines allow me to do that – for chickenpox and many other diseases. I believe my most important role is to educate my patients about vaccines and the many other steps they can take to protect their health.
Jillian Elliott, MD, is an internal medicine physician and a member of Phelps Medical Associates. Board certified in internal medicine, Dr. Elliott received her medical degree from New York Medical College and completed a residency in internal medicine at Montefiore Medical Center. She sees patients on the Phelps campus in suite 417 of the 755 North Broadway Building (914-366-5490).