Nell has chicken pox and you’re invited …

Dear Mamas,

Now I’ve heard everything.

I recently struck up a friendship with the mom of one of my daughter’s preschool classmates. We’re in the ‘getting to know you’ phase — that period when you’re feeling each other out for similarities and differences. Like red or white, chocolate or vanilla, latte or espresso? And in our case, what’s your parenting style, since conflict there can suck the air right out of a friendship. Let’s call her Chloe.

Yesterday Chloe called all excited to announce that little Nell has chickenpox. She’d just come from the pediatrician where the diagnosis was confirmed (after her doc called in 2 partners to offer an opinion, it’s so rare these days). No, Nell never had the vaccine, Chloe preferred to take her chances with the natural bug. Now she’s glad that her strategy worked and is calling to invite us to a “pox party”. Would I care to jump on this opportunity to infect my Gigi?

There are a couple things about this situation that have me wondering (Gigi’s already had the chicken pox vaccine, so we’re declining the invite): First, if Nell hasn’t been vaccinated against chicken pox, isn’t it likely she hasn’t been immunized against other things like whooping cough or measles that could be dangerous for Gigi? Second, is there benefit in letting natural immunity take its course with some childhood infections? Should I have thought twice before I let her get that shot? Finally, is it common for parents to have these kind of gatherings for their friends’ children? What if one of the children gets seriously ill?

As a mom, I couldn’t live with that.

I like Chloe and want to continue our friendship, but now I don’t know. This stuff sounds crazy to me, but maybe I’m just out of the loop. What do you think?


Dear Barb,

What a timely question! Just last week we were reading about the increasing popularity of this trend, which now includes sending varicella (the name of the virus that causes chicken pox) infected lollipops through the mail to children of family and friends who live too far away to attend the party.

More and more parents, wary of unnecessary vaccinationsare opting for their children to earn immunity to chickenpox the old-fashioned way. A kiddo who has chickenpox can spread the virus for up to 48 hours before the small blisters appear, and they remain contagious until all the spots crust over. After a child catches chickenpox the body creates antibodies that are effective and confer immunity for a lifetime.

Once the virus enters the body it begins to replicate, stealthily gaining steam until 1-3 weeks later when fever and flu-like symptoms appear. This is the time when a child is most contagious — before the tell-tale blisters show up, but he’s already starting to feel yucky — and he will continue to pass on the virus until all the pox have crusted over.

Usually the illness is mild, requiring only a few days home from school and some topical soothing for itchy skin, but about 10% of cases are severe and possible complications include vomiting, dehydration, infection and pneumonia. Even death.  The American Academy of Pediatrics recommends two doses of the vaccine (to reach 95% effectiveness) because the consequences of contracting the virus are much worse than those of the vaccine.

Does immunization confer lifelong immunity? We don’t know for sure, but most pediatricians now recommend a booster at kindergarten time (the first dose is commonly given at 12 months) to avoid waning protection. There has been some concern that immunity may begin to wear off during adulthood, in the 30’s and 40’s when a full-blown case of chicken pox tends to be far more severe, sometimes requiring hospitalization. For adults who contract the virus, especially pregnant women and those with compromised immune systems, chickenpox can be dangerous or even deadly.

So does it make some sense to skip the vaccine and take your chances with the wild virus? Most docs believe the risk of that strategy is too high; both for the child and for other innocent bystanders who may be infected.

An example I like to use is the check-out clerk at your local market. You could be completely unaware that she’s receiving radiation therapy for breast cancer, which suppresses her immune system. And, as luck would have it, she never had chicken pox as a child and has zero protection. Along comes your kiddo who recently attended one of those pox parties and is brewing a whoppin’ case of the yuckies. He happened to sneeze all over that box of animal crackers before it landed in the cart and is about to give her the gift of a lifetime. Not okay.

Since the vaccine is 80% effective after the first dose, and 95% after two, the odds are pretty good that it will prevent catching and passing on the illness. Those who do get breakthrough chicken pox after immunization will have much milder cases, usually limited to just a few itchy lesions and minor upper respiratory symptoms.

As for your friendship, we might suggest a philosophy of live and let live. By all means ask Chloe which immunizations Nell has had, and if they’re up to date. Then discuss with Gigi’s doctor whether any missing shots put her at risk if the girls are in close contact. Job one is keeping your child safe from preventable health threats, and once that’s handled you’ll be wise to leave space for other moms to follow their own rules. You’ll avoid lots of land mines and wrecked friendships that way.

For more info about chicken pox and the varicella vaccine, check out the American Academy of Pediatrics here.

Good Luck!

~ The Mamas


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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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One response to “Nell has chicken pox and you’re invited …”

  1. Ann

    My colleague worked at the CDC on the varicella vaccine. Statistically, until age 12 it is LESS dangerous (to the child) to get the virus than to get the immunization. The reason they’re requiring it for school admission is the inconvenience to the SCHOOLS when there is an outbreak, and there is better compliance for early childhood vaccination.

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