A chickenpox-related stroke in a previously healthy 11-month-old boy serves as a scary reminder the childhood disease is not as benign as many parents would like to believe.
The boy’s mother sought medical care after noticing he had developed weakness on his right side. Doctors determined the stroke was a complication of a chickenpox infection most likely caught from the child’s older siblings, who had been unvaccinated and had developed chickenpox around the same time the little boy had, according to a recent report published in the Journal of Pediatrics.
The case highlights the dangers — both to one’s own children and to those of others — that are associated with skipping vaccinations. Widespread vaccination protects kids who can’t get vaccinated either because they are younger than 1 year, like the boy in the report, or because they have immune system problems. In recent months, there have been numerous chickenpox outbreaks around the country, a result of pockets of parents who have opted not to vaccinate, assuming either that their kids won’t get the disease or will simply tough it out if they do.
Part of the problem may be that parents aren’t familiar with the disease.
As chickenpox cases became increasingly rare, fewer people remembered how dangerous they could be, said Dr. Tina Tan, a professor of pediatrics at Northwestern University’s Feinberg School of Medicine and a pediatric infectious disease specialist at the Robert H. Lurie Children’s Hospital.
“Everyone thinks it’s a minor illness,” said Tan, who is also chairwoman of the section on infectious diseases for the American Academy of Pediatrics. “There are a number of serious complications.”
Though relatively rare, stroke is one of them, Tan said. “Basically, the chickenpox virus infects the large blood vessels in the brain and causes inflammation in them,” she explained. “The blood vessels can scar and that can decrease blood supply to the brain, which can lead to stroke.”
There’s often a delay between the time a child develops chickenpox and when a stroke hits. Studies have shown children are most at risk of stroke in the six months following infection with chickenpox.
While some people recover with rehab, others live with permanent disabilities, Tan said. “They can have paralysis or seizure disorders,” she explained. “It all depends on which blood vessels are involved.”
In the case of the boy in the report, prospects looked grim. “My read on this is that he will have some type of permanent neurologic sequelae (consequences) from his disease,” Tan said. “And it is possible that he might have another stroke if his arterial disease continues to worsen.”
Strokes aren’t the only possible complications from a chickenpox infection. Anyone who has recovered from chickenpox can develop shingles, also called herpes zoster, a blistering painful skin rash.
“You can get chickenpox meningitis, which is an infection of the spinal fluid around the cord or the brain,” said Dr. Nina Shapiro, a professor at the University of California, Los Angeles, School of Medicine, director of pediatric otolaryngology at UCLA, and author of “Hype: A Doctor's Guide to Medical Myths, Exaggerated Claims, and Bad Advice — How to Tell What's Real and What's Not.”
“Chickenpox can also lead to encephalitis, pneumonia and severe dehydration,” Shapiro said. “Occasionally, you can get pox lesions in your mouth that prevent you from eating and drinking.”
If those complications aren’t scary enough, sometimes the chickenpox sores get infected with bacteria, Tan said, adding “some of these can be quite severe and turn into necrotizing fasciitis.”
With little cultural memory of those nasty complications, it can be hard for parents to shut out the continuous drumbeat of anti-vaccine messages out there, said Dr. Aaron Milstone, an associate professor of pediatric infectious diseases and epidemiology at the Johns Hopkins Health System.
“The risks associated with vaccines are very, very, very small,” Milstone said. “But the anti-vaccine community is very loud, especially on social media. They generate a lot of anxiety in those who have not seen the horrors of preventable diseases.”
Parents also need to remember they are vaccinating not just to protect their own children, but also to protect vulnerable members of society who can’t be vaccinated either because they are too young or because they have compromised immune systems, Shapiro said. Herd immunity, which is what occurs when the vast majority is vaccinated, is the only way to protect the vulnerable, she added.
“We don’t drink and drive not just because we don’t want to hit a tree with our car, but because we don’t want to kill anybody,” Shapiro said. “It’s a public health decision, as is getting vaccinated.”