tkr_checken_pox_round_2My Chicken Pox Story

” It’s 102.5.”

“Whoa babe! That’s quite a fever! I am so sorry. Can I get you anything?”

“Maybe another wet towel” comes my congested and slightly coarse answer.

“Wouldn’t it be crazy if I got the chicken pox again!” I yell after Clayton while he is running cold water on a wash cloth in the bathroom.

“Whaaaat?! I can’t hear you babe. Do you need anything else?”

“I said wouldn’t it be funny if I got…. ah never-mind… No! I don’t need anything!”

“Ok!”

Two weeks ago one of our dear friends, Julian, got the chicken pox. I was one of the people who took him to the doctor, brought him food, and ran errands while he was quarantined.  “For most people”, according to CDS, “getting chickenpox once provides immunity for life. However, a few people, can get chickenpox more than once, although this is not common.” In fact most medical journals explain that a second infection may occur only in immunocompromised people (source). Since one of  my first memories is of me trying to scratch the itchy red blisters off my forehead, I figured I would be fine. A phone call to my mother confirmed I had it as a child. Was I nervous? Maybe a little, but I figured that was the hypochondriac in me.

So two weeks later when I started feeling achy and tired and then developed a high fever, I assumed I was just getting a 24 hour cold. Still, the fear was creeping in that these symptoms were unusual. I don’t get a fever often. After taking 1500 mg of Acerola Powder and 500 mg of cayenne pepper pills I went to bed with a 102.5 fever.

The next morning I woke up feeling great! The fever was gone, so I got ready for a busy day. A few hours later I was telling a friend: “And then I inspected myself in the mirror and for a second I freaked out that a scab I’ve had since my last backpacking trip turned into chicken pox. I am telling you, I am such a hypochondriac! I mean does this look like chicken pox to you?!” I continued laughing and  lifting my shirt enough to show her how overly paranoid I was.

I let out a gasp. My belly had three dainty looking, pink water blisters with red circles around them. “Ummm! I need to see a doctor now! I ll talk to you later. You should stay away from me…” I stammered, walking away from my friend.

In my naivete, I decided to walk three blocks to the urgent care where I took my friend. Bad move on my part. Ten steps into my walk I became so dizzy and nauseous that I just had to sit down in the middle of the sidewalk holding my head in my hands. After a few minutes I felt better so I continued my epic walk to urgent care, with frequent  sidewalk breaks.

When I finally made it there and was seen by a doctor he confirmed my fears and asked whether I would like some Vicodin, since the virus tends to get pretty ugly in adults. I refused the  pain meds but I welcomed the antiviral medication that is supposed to help with the severity of the outbreak. In retrospect, I would not have taken it –  after I did more research I found out that reinfection with chicken pox is in most cases pretty mild.

Although I took the antiviral medication, Acyclovir 800 mg, five times a day, I also took 1500 mg of acerola powder and L- Lysine, known to act as an antiviral by blocking the production of herpes viruses. Did you know chicken pox is part of the herpes family, along with herpes simplex, eppstein barr, cytomegalovirus, and others? To read more about the herpes family tree go here. Fun stuff!

According to the CDS  “the virus spreads easily from people with chickenpox to others who have never had the disease or received the chickenpox vaccine. The virus spreads in the air when an infected person coughs or sneezes. It can also be spread by touching or breathing in the virus particles that come from chickenpox blisters.” Unfortunately, someone is contagious up to two days before the first blisters surface.

So I camped out at a friend’s house for the first 36 hours when I was the most contagious. I have 20+ housemates, including an infant, and I didn’t want to take any chances. During the next 48 hours, tiny red water-filled bumps covered my entire back, torso, and scalp, with a few creeping  into my ears, thankfully leaving my face mostly clear besides a couple on my forehead and two on my upper lip.

Can you get chicken pox twice?

When I posted on the Facebook page that I got chicken pox for the second time, a few readers tried to correct me and explain that I must be talking about shingles. While that absolutely makes sense and shingles is a more common occurrence after a first infection with chicken pox, reinfection with varicella is not as rare as we have been led to believe. Most experts and medical journals state that it is almost impossible to get it twice and that it happens only to immunecomprised individuals. I am a living proof that it is not the case. I have no health conditions to put me in that category.

In fact, more and more studies are surfacing indicating that clinical varicella infections may occur more commonly than mainstream medical journals let on.  For example:

US studies conducted from 1995 to 1999 found that 4.5 to 13% of people diagnosed with chickenpox reported that they’d had the condition before.

Other US studies have found that, after having chickenpox, some people don’t develop the antibodies needed to protect them against reinfection.

From a report in 1996: tests on adults who reported having chickenpox showed that 97 to 99% of them had developed antibodies.

From a report in 2007: tests showed that, after having chickenpox, 75% of children aged one to four had developed immunity, compared with 100% of adults aged 20 to 29. Source

How?

First off, I would like to address the skeptics who are shaking their heads, thinking I must  not have had chicken pox as a child. Sure, maybe I was misdiagnosed when I was about four.  Keep in mind that I went to public schools where we had no running water for a few years (the effects of living in a post soviet country) and I worked for about five summers as a teenager  in a children’s orphanage. So I am rather skeptical that I was never exposed to the varicella virus.

Now that we learned that reinfection can occur not only in immuno-compromised people, let’s try to figure out why this is happening. Here are three theories that I came across in my research. This theory is the most popular one.

1. Some people don’t develop the antibodies against chicken pox if they get a mild case as children. Basically, the virus is not threatening enough to force the body to create antibodies. This leads to a reinfection with varicella at a later date.

In one article, WebMD says “After you have had chickenpox or the vaccine, you become immune to the virus. It is possible that you may have a slight reaction after re-exposure, such as a few spots and a slight fever. But you are not likely to get chickenpox more than once.” Then on the next page  it claims that “After you have had chickenpox, you are not likely to get it again. But the virus stays in your body long after you get over the illness. If the virus becomes active again, it can cause a painful viral infection called shingles.” Source

This confusing explanation made me do some research and find another theory on chicken pox that frankly makes a lot of sense.

2. Due to chicken pox vaccines, we are very rarely exposed to individuals fighting classic cases of varicella. Thus re-exposure may causes a slight reaction in individuals who are in close contact with someone infected.

Natural immunity following chickenpox is largely protective against clinical reinfection. Although recurrent chickenpox is difficult to prove, a study reported that 13% of children presenting with chickenpox had experienced a well-documented previous episode, suggesting that clinical recurrence may be more common than previously thought [6]. Asymptomatic reinfection and isolation of virus from the nasopharynx of mothers exposed to a child with chickenpox have previously been described [7]. Together with the evidence that cellular and humoral immunity are boosted in household contacts of individuals with chickenpox [89], this implies a role for local reinfection in maintaining VZV immunity. Asymptomatic latent reactivation of endogenous virus may also contribute to persistence of immunity [10]. Source

There is one more rather obscure theory about reinfection with varicella that requires more studies and investigation, but I found it to be fascinating.

3. Reinfection may occur due to different genotypes of the varicella virus.

Until recently  there was a certain geographical segregation of various varicella genotypes. However in the last fifty years people have become more mobile spreading  varicella genotypes in areas that have not been exposed before.

The possibility of asymptomatic super infection with a second virus and establishment of colatency was suggested by our finding that, of 23 adult immigrants to the United Kingdom whose primary infection occurred in Africa or Asia, 30% experienced reactivation of a Bgl-negative UK strain not normally found in those regions [1]. Although other explanations for these data are possible, the case presented here provides support for these previously circumstantial findings.

At least 4 distinct genotypes of VZV have been described [1]. Differences in nomenclature remain; however, the robustness of single-nucleotide polymorphism typing in distinguishing these groups is accepted, especially in view of the low levels of nucleotide substitution found in VZV and its low mutability. Geographical segregation of genotypes is well described, and data from ourselves and others suggest that Bgl 1-positive viruses of genotype A are more prevalent in non-European populations [1]. An increase in Bgl 1-positive viruses has occurred in east London with increasing immigration from Asia and Africa [1]. This natural experiment of viral mixing has provided insights into the molecular epidemiology and pathogenesis of VZV, which might otherwise not have been possible in the highly homogeneous European viral population. Thus, reinfection and establishment of colatency may occur, but homogeneity of strains in most geographical regions, the lack of genotyping studies in such patients, and the rarity of recurrent zoster make it difficult to recognize this phenomenon. Source

I read through these theories while I was stuck at home and decided that really only time and more case studies will tell why reinfection with chicken pox and  more frequent episodes of shingles seem to be on the rise, and whether it is due to vaccination, increased traveling and emigration to geographical regions carrying a different varicella genotypes, or simply not developing antibodies during the first infection. But then something else happend…

An Unusual Occurrence

“Hey babe come look at this?”chicken pox

“What?” I ask while I am trying to itch around the periphery of a newly acquired scab.

“I think I have a chicken pox blister!”

My husband, who had chicken pox as a child, developed a small pink water blister on his knuckle while I was sick. We were terrified he was getting the chicken pox. He called in sick and he spent most of the day in bed with flu-like symptoms. We checked for more blisters for the next 48 hours but he never developed any new ones. We assumed that maybe he got Poison Oak on our last hike, but a Google search convinced us that it doesn’t tend to express itself in this way. In fact, it looked more and more like one of the blisters I was covered in. He never developed new blisters, and this one began to recede within about three days, around the time when Clayton started feeling better.

(The picture above was taken while we were in quarantine.)

Could my husband have developed a weird blister and the flu at the same time, just as I was covered in chicken pox, with no relation to varicella? Absolutely. Or according to the second theory he could have also had a minor reinfection since he was re-exposed to chicken pox twice in less than four weeks first through our friend and then through me.

In fact could my case have been a simple re-infection?

Unlike our friend who had chicken pox for the first time and needed about two weeks to recover, my pox spread for two days and started scabbing  on the third. I also had a lot less blisters and they were much smaller. My biggest complaint from the whole affair is cabin fever and itchiness.

Conclusion:

Before my husband developed that one blister I admit I was not really inclined towards one theory over the other.  While there might be different genotypes of varicella out there, I think that in our situation we simply got reinfected with the same varicella virus we had as children. Since everyone gets a vaccine against chicken pox now-a-days, we are rarely if ever directly exposed to the wild form of the virus. I believe that both our bodies received a much needed boost in antibodies. A strong immune system, supported by good nutrition, will weather a second bout of chicken pox quite well. Unless you are immuncompromied, pregnant, or older, a reinfection with chicken pox wont hurt you.  It will re boost those antibodies and make you itch really bad!

P.S. Speaking of itching. Here is a little tip for those suffering from chicken pox. If oatmeal baths, baking soda baths, and vinegar baths don’t give you relief… a fan blowing on your calamine-lotion-covered body will 🙂

 

This post is featured on Fat Tuesday,