OpenHealth Q&A

Considering Chicken Pox Vaccination for My Child with CKD in the UK

I find myself weighing the option of vaccinating my 6-year-old, who has chronic kidney disease (CKD), against varicella. Living in the UK, this vaccine isn't part of our standard immunization schedule. After attempting to gather information independently, I've encountered challenges. Our pediatrician hinted that immunity from natural infection might be superior, but refrained from providing definitive guidance. My deliberation is complex for several reasons, particularly due to the misinformation I've encountered, which largely comes from countries where vaccination is routinely administered, and my son's unique health circumstances. 1. **Background Information.** My son is adopted and faces significant and intricate healthcare needs, likely linked to genetic factors and fetal alcohol spectrum disorder (FASD), compounded by severe trauma. His kidney function is stable now, but he is likely to face kidney failure in his teen years. He suffers from substantial urinary complications, and although these might not be the central focus here, his previous consultant—who has retired—remarked that he had never encountered another child with such a constellation of issues. Generally, children with atypical developmental formations tend to manage adequately for a time, but suddenly, things can change for the worse. He noted that, as of now, there are no indications that my son wouldn't reach adulthood, and our treatment options appear promising based on current knowledge. My son has considerable behavioral challenges requiring constant support at school, often causing unintentional harm to those around him. While he is loved dearly by many, this journey is undoubtedly tough for us all. 2. **Vaccine Recommendations.** In my research of why the Joint Committee on Vaccination and Immunisation (JCVI) has not endorsed the varicella vaccine in the UK, it seems the rationale includes the fact that nearly all adults have experienced chickenpox, and without regular exposure to the virus, they are at a higher risk of developing shingles. Additionally, there's a concern about the potential for low vaccine uptake, resulting in many unvaccinated children lacking early exposure to a condition deemed relatively mild. Thus, the decision is aimed at promoting public health rather than focusing on individual vaccinations. 3. **Evaluating Immunity.** It appears that the immunity provided by vaccination is slightly less robust compared to that of the natural infection (though the safety of the vaccine itself is not in question). My main concern is how crucial this distinction is, especially since both transplantation and dialysis may be in my son's future. I understand he may experience a decline in immunity, so I wonder if the additional immunity from a natural infection would be advantageous for him. I have also read that chickenpox post-transplant carries a high mortality rate, potentially close to 100%. 4. **Risks of Shingles.** Given that varicella infection can lead to shingles later in life—especially among those with weakened immune systems—I've come across studies suggesting an increased incidence among dialysis patients. Shingles can be a painful condition, and I suspect the vaccine does not trigger the same risk factors. Though I hope to be mistaken, I also recognize that shingles predominantly affects older adults, and I am uncertain my son will reach that stage of life. 5. **Personal Considerations.** The prospect of him experiencing the discomfort of chickenpox is something I wish to avoid for both our sakes! The illness would not be enjoyable for him, and his daily challenges in managing heightened emotions often result in injury to me. We are fortunate to have a team of professionals aiding our family, along with numerous adaptations in our home to ensure safety. While protecting his long-term health is my utmost priority, I would prefer an approach that incurs the least disruption if feasible. I acknowledge that my understanding of these issues might not be complete. Having previously worked as a nurse—though I am no longer able to continue in that capacity—I possess some research skills, but this area exceeds my expertise. I appreciate any insights or guidance you might offer as I navigate this decision.

Answers (1)

4/3/2025, 9:50:51 AM

OpenHealth AI

Deciding whether to vaccinate your child with chronic kidney disease (CKD) against chickenpox is certainly a nuanced and important decision. Here’s a summary of the main points and considerations regarding the varicella vaccination for your son:

Main Points

1. Vaccination vs. Natural Infection: While natural infection may provide stronger immunity, the varicella vaccine is safe and can help prevent complications like chickenpox and shingles.
2. Your Child’s Health: Given your son's CKD and potential future risks associated with it, the decision should carefully weigh his current health status and future needs.
3. Public Health Considerations: The UK’s JCVI guidelines consider population immunity and potential risks associated with chickenpox; however, individual circumstances, especially in children with chronic health issues, should guide personal decisions.

Explanation

• Vaccination Benefits: The varicella vaccine significantly reduces the risk of severe chickenpox infection and its complications, which can be particularly serious in individuals with weakened immune systems.
• Natural Infection Risks: While chickenpox typically affects healthy children mildly, for those with CKD or who may be immunocompromised in the future, it can lead to serious complications, including pneumonia and meningitis. The risk of shingles later in life is also heightened in individuals who contract chickenpox naturally—especially among those with CKD or who undergo transplantation.
• Immunocompromised Considerations: After a transplant or during dialysis, the risk of severe illness from chickenpox increases, and the mortality risk due to varicella could be higher than expected, emphasizing the importance of vaccination as a preventive measure.

Next Steps

1. Discuss with a Specialist: Schedule an appointment with a pediatric nephrologist or infectious disease specialist who can consider your son’s specific health circumstances and provide tailored advice regarding the chickenpox vaccine.
2. Research the Vaccine: Look into reputable health resources about the varicella vaccine's efficacy and safety, focusing on children with CKD. The NHS website and organizations like the CDC or WHO are good places to start.
3. Monitor Current Health Status: Keep track of any changes in your son's health, especially as he grows and faces new challenges. This information can be helpful in future healthcare decisions.
4. Consider Emotional Support: Since both you and your son are managing a lot of stress, ensure you have access to support services—both for emotional health and practical aspects of caregiving.

By taking these steps, you can make a well-informed decision that prioritizes your son's health and well-being while addressing your concerns and the complexity of his situation. Stay connected with your healthcare team for ongoing support and guidance.