Chickenpox and immune suppressed

[christine2715]

I take predisilone and Tocilizumab for GCA although Pred. now down to 3mg. So I am due to look after my 2 year old Grandson tomorrow for my daughters birthday treat to Thorpe Park and it looks like he has chicken pox. I have had chicken pox before and didnt get it again when my children got it but could I catch it as i am immune suppressed. Any suggestions?

[DorsetLady PMRGCAuk volunteer]

You cannot” catch” it again, but once you have had it the virus is still in your body, albeit dormant…but close contact with someone with CP could activate it in the form of shingles.

It also depends on what stage your grandson is with his CP….

Plenty of info in FAQs….

Guess you haven’t had Shingrix vaccination

[pugrescue in reply to DorsetLady]

I stopped pred for GCA in Dec 2020. Got shingles twice right after Christmas 2022. Horrible (had the optical form) I would definitely stay away unless you have been vaccinated with the shingrix (97% effective)

[PMRpro Ambassador]

How long has he had it? Are all the spots crusted over?

Theoretically, you should be OK as you have had CP in the past, You get it once and that is it. However, as DL has said, the virus is still in your body and could reactivate and cause shingles. And that is more common with a suppressed immune system and can be really nasty.

[christine2715 in reply to PMRpro]

He has only got it today. I did have shingles 4 months sgo. Not completely sure its chicken pox but lots cp going round

[PMRpro Ambassador in reply to christine2715]

If he only started yesterday, I confess even I would be reticent about looking after him so soon.

[DorsetLady PMRGCAuk volunteer in reply to christine2715]

Agree with PMRpro-maybe wise to say no..difficult in circumstances-but sometimes you have to put you first..

[christine2715]

Very many thanks for your kind replies.

[piglette]

I agree with the others, I would think twice about looking after your grandson so soon after you think he started chicken pox.

[HeronNS]

I would like to know where the evidence is for specifically exposure to someone else's CP infection triggering shingles in a person. Every time this question comes up I look for a source and have not found one yet.

It seems like a weakened immune system is the culprit, not the specific virus, so could exposure to a different infection cause same immune reaction (shingles) in the vulnerable?

[PMRpro Ambassador in reply to HeronNS]

In fact, exposure to CP results in a lower risk of shingles in the following 2 years. But that is an observational study in pressumably healthy adults.

bmj.com/company/newsroom/ad...

And without more certainty, I wouldn't risk telling someone with a poor immune system that exposure is going to be fine. Christine has recently had shingles - her immune system has been a bit wobbly. If he'd had it a bit longer and the viral load was weakening and the spots were crusting, I'd have said go ahead with no cuddles. But is that likely to be achievable with a (probably) poorly child?

[HeronNS in reply to PMRpro]

It seems, though, that exposure to anything contagious might cause the same response, that it's not specific to varicella zoster. In other words, avoid any little germ factory, no matter what they have, because any challenge to a compromised immune system could awaken a latent virus? I guess that makes things more, not less, challenging!

[DorsetLady PMRGCAuk volunteer in reply to HeronNS]

This is what UK NHS states -

You cannot get shingles from someone with chickenpox

You cannot get shingles from someone with shingles or chickenpox.

But you can get chickenpox from someone with shingles if you have not had chickenpox before.

When people get chickenpox, the virus remains in the body. It can be reactivated later and cause shingles if someone's immune system is lowered.

This can be because of stress, certain conditions, or treatments like chemotherapy.

[HeronNS in reply to DorsetLady]

Exactly. But not specifically the chicken pox virus, it could be anything which challenges the immune system. That was always the only kind of info I found, but I keep seeing people being told to avoid a kid with CP because it might cause a shingles flare. But it doesn't have to be CP, it can just as easily, maybe even more likely, be something else.

[DorsetLady PMRGCAuk volunteer in reply to HeronNS]

I always thought the connection was the virus itself -because both CP and Shingles are caused by the varicella-zoster virus (VZV).

But maybe I’m wrong.

[PMRpro Ambassador in reply to DorsetLady]

Part of the problem is that apparently there are a lot of people who haven't had CP or the vaccine for CP - when on immunosuppressants the risk is higher.

[HeronNS in reply to DorsetLady]

I always avoided people with chicken pox and shingles because I'd never had a symptomatic case of CP. Even when my kids had CP I didn't catch it, which should have been a heads up. Anyway I finally got tested before agreeing to get a shingles vaccination, and I must have had it sometime. My youngest child never showed symptoms, so I suggested at some time he might want to get tested himself, although he's much too young for shingles vaccine yet. But when I first got PMR I was in the process of lining up some volunteer jobs, being newly retired, prime of which would have been helping kids with reading. Decided it would not be prudent to be exposed to the little germ factories so never did that. But it wasn't because I even thought of shingles or chicken pox, but because I didn't want to catch every cold that was going around. Theoretically I suppose anything attacking my immune system could have led to shingles.

[HalleysComet in reply to HeronNS]

I developed shingles after a very bad dose of bronchitis many years before I developed PMR. I suspect I have always had a dodgy immune system, having had excema as a child, asthma & hayfever as an adult and urticaria on and off throughout.

Having had shingles, I would recommend anyone at risk to have the vaccination as it was the most intractable and painful disease I have ever had.

[HeronNS in reply to HalleysComet]

It was reading about people's experiences here which prompted me to finally get tested and then vaccinated!

[christine2715]

I have been told i cannot have shingles vaccine until 75. I am 70. In the end the spots didnt spread and she took him to pharmacist who thought not CP as would have developed by evening So he went to childminder and i just have the 4 month baby while she has her birthday outing. Picking the 2 yr old up at 5. Hey ho ... thanks to all

[PMRpro Ambassador in reply to christine2715]

WHO told you you can't have the shingles vaccine until 75 - because I am pretty sure they are wrong. And as a patient with an autoimmune disorder you are already entitled to the Shingrix one but as of September that will be the only one used.

This

england.nhs.uk/south/wp-con...

is aimed at increasing the uptake - if people are being misinformed then no wonder fewer people are getting it.

[HeronNS in reply to PMRpro]

I wonder why it's only people 70-80, though? Will that change to 50 with the introduction of Shingrix? It's too expensive to expect people to get it privately, but why not immunize people once they're eligible according to the standards developed by the manufacturer? They'd get 20 more years of protection. Data accumulating over the past few years shows that the immunity provided is long-lasting. I suppose a booster might be needed at some point, but so far it's shown it's good for 10 years, declining only slightly.

verywellhealth.com/shingles....

[DorsetLady PMRGCAuk volunteer in reply to HeronNS]

This contains information on updated Shingles advice for GPs in England -annex A paras 29-36 refer-

england.nhs.uk/wp-content/u...

[HeronNS in reply to DorsetLady]

Took me a while to find the pertinent paragraph, but good to see: 60 for the general public, 50 if immune compromised.

[christine2715]

I have been told i cannot have shingles vaccine until 75. I am 70. In the end the spots didnt spread and she took him to pharmacist who thought not CP as would have developed by evening So he went to childminder and i just have the 4 month baby while she has her birthday outing. Picking the 2 yr old up at 5. Hey ho ... thanks to all

[PMRpro Ambassador in reply to christine2715]

Whoever told you 75 is WRONG. The qualification date at present is 70.