chickenpox

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Dead babies, critically ill kids: Pediatricians make moving plea for vaccines

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As federal lawmakers prepare to decide whether anti-vaccine advocate Robert F. Kennedy Jr. should be the next secretary of the Department of Health and Human Services, pediatricians from around the country are making emotional pleas to protect and support lifesaving immunizations.

The American Academy of Pediatrics (AAP) has assembled nearly 200 stories and dozens of testimonials on the horrors of vaccine-preventable deaths and illnesses that pediatricians have encountered over their careers. The testimonials have been shared with two Senate committees that will hold hearings later this week: the Senate Committee on Finance and the Senate Committee on Health, Education, Labor, and Pensions (HELP).

“I remember that baby’s face to this day”

In a statement on Monday, AAP President Susan Kressly noted that the stories come from a wide range of pediatricians—from rural to urban and from small practices to large institutions. Some have recalled stories of patients who became ill with devastating diseases before vaccines were available to prevent them, while others shared more recent experiences as vaccine misinformation spread and vaccination rates slipped.

In one, a pediatrician from Raleigh, North Carolina, spoke of a baby in the 1990s with Streptococcus pneumoniae meningitis, a life-threatening disease. “I remember holding a baby dying of complications of pneumococcal meningitis at that time. I remember that baby’s face to this day—but, thanks to pneumococcal vaccination, have never had to relive that experience since,” the doctor said. The first pneumococcal vaccine for infants was licensed in the US in 2000.

A doctor in Portland, Maine, meanwhile, faced the same disease in a patient who was unvaccinated despite the availability of the vaccine. “As a resident, I cared for a young, unvaccinated child admitted to the pediatric intensive care unit with life-threatening Streptococcus pneumoniae meningitis. This devastating illness, once common, has become rare thanks to the widespread use of pneumococcal conjugate vaccines. However, this child was left vulnerable…and [their parents] now faced the anguish of watching their child fight for their life on a ventilator.”

Kressly emphasizes that “One unifying theme of these stories: vaccines allow children to grow up healthy and thrive. As senators consider nominees for federal healthcare agencies, we hope these testimonies will help paint a picture of just how important vaccinations are to children’s long-term health and wellbeing.”

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More than half of chickenpox diagnoses are wrong, study finds

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coin flip —

Vaccination has dramatically reduced cases, making clinical diagnoses tricky.

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Chickenpox on a 1-year-old.

Enlarge / Chickenpox on a 1-year-old.

Thanks to the vaccination program that began in 1995, chickenpox is now relatively rare. Cases of the miserable, itchy condition have fallen more than 97 percent. But, while children have largely put the oatmeal baths and oven mitts behind them, doctors have apparently let their diagnostic skills get a little crusty.

According to a study published Thursday, public health researchers in Minnesota found that 55 percent of people diagnosed with chickenpox based on their symptoms were actually negative for the varicella-zoster virus, the virus that causes chickenpox. The study noted that the people were all diagnosed in person by health care providers in medical facilities. But, instead of chickenpox, lab testing showed that some of the patients were actually infected with an enterovirus, which can cause a rash, or the herpes simplex virus 1, which causes cold sores.

The study, published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, supports expanding laboratory testing for suspected chickenpox cases in the state’s program and highlights that diagnoses based on symptoms are “unreliable.”

For one thing, doctors simply see far fewer chickenpox cases these days because of the protection from vaccines. While chickenpox cases in the US previously reached 4 million each year, with 10,500 to 13,500 hospitalizations and 100 to 150 deaths, there are now fewer than 150,000 cases,1,400 hospitalizations, and 30 deaths each year, the CDC reports. Vaccination is more than 90 percent effective at preventing the disease. In the rare cases where a vaccinated person contracts chickenpox, the muted rashes are challenging to identify by eye. But even in unvaccinated children, chickenpox can be tricky to pick out; it can easily be confused with measles, insect bites, enterovirus, skin infections such as scabies and impetigo, herpes viruses, and hand, foot, and mouth disease.

Since 2016, the Minnesota Department of Health has been working to expand laboratory testing, including outreach to health care providers and the public on the importance of testing to confirm suspected chickenpox cases.

Between 2016 and 2023, 208 people who were diagnosed with chickenpox in person at a medical facility submitted specimens for testing to the state health department. Only 93 of the 208 (45 percent) were positive for the virus. The vaccination status was known for 203 of the people—100 were vaccinated, 103 were not. Of the vaccinated people tested, only 22 (22 percent) turned out to have chickenpox, while 68 (66 percent) of the unvaccinated people had it, reflecting the efficacy of vaccination.

In a larger group of 420 people, which included people who were self-diagnosed, the accuracy rate was unsurprisingly lower. Of the 420 suspected chickenpox cases, only 157 (37 percent) were positive for the varicella-zoster virus. Of the remaining 263 people, 47 were positive for enterovirus, 20 were positive for herpes simplex virus 1, 0 were positive for herpes simplex virus 2 (genital herpes), two people had indeterminate test results, and 194 were negative for all four viruses tested.

The authors highlight that the findings are significant because people suspected of having chickenpox are recommended to stay home from school and work longer than people with other viral infections. More testing can ensure appropriate clinical management.

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