From: ((Steven B. Harris))
Subject: Re: Chickenpox infectious period???
Date: 14 Jun 1995

In <Pine.A32.3.91.950613231128.13177G-100000@srv1.freenet.calgary.ab.ca>
"Donna L. Alden" <alden@freenet.calgary.ab.ca> writes:

>Here in Alberta, our Public Health Act will be changing. I will now say
>that children with chickenpox need not be excluded from school no matter
>what their stage of the disease. The infectious period is several days
>before the vesicles actually appear so why bother having them stay out of
>school once they appear. They have already potentially infected people.
>However, I'm not sure what is going on in other Provinces here in Canada.
>
>Donna L. Alden
>**********************************************************************
>Donna L. Alden, RN, BScN, BScPsyc
>Public Health Nurse
>Regional Health Authority #5 (Alberta)
>Box 117
>Didsbury, Alberta
>Ph:(403)335-9300(home)
>   (403)335-3233(work)
>E-Mail: alden@freenet.calgary.ab.ca
>***********************************************************************


You have this wrong, for as has been pointed out here, kids START to be
infectious 2 days before the rash, but they REMAIN infectious until all
the vesicles have been crusted, which is typically at least 4 days after
the rash starts.  Anyone sending their kid to school in that time is
sadly mistaken.  Any public health nurse allowing such a child in,
should be re-educated.  If they argue, they should be fired.


                                               Steve Harris, M.D.

From: ((Steven B. Harris))
Subject: Re: Chickenpox infectious period???
Date: 14 Jun 1995

In <Pine.A32.3.91.950614092945.44014A-100000@srv1.freenet.calgary.ab.ca>
"Donna L. Alden" <alden@freenet.calgary.ab.ca> writes:

>
>> You have this wrong, for as has been pointed out here, kids START to be
>> infectious 2 days before the rash, but they REMAIN infectious until all
>> the vesicles have been crusted, which is typically at least 4 days
>> after the rash starts. Anyone sending their kid to school in that time
>> is sadly mistaken. Any public health nurse allowing such a child in,
>> should be re-educated. If they argue, they should be fired.
>>
>>
>>                                                Steve Harris, M.D.
>
>
>Well Steve Harris MD...is this your answer to all that ails the medical
>profession?...If a nurse argues...then just fire her/him. For your
>information, it was our Medical officer of Health who decided that the
>Public Health Act change to allow children with Chickenpox into schools.
>Public Health Nurses are very much against it because we DO know that
>children are infectious even after the vesicles appear. All that I stated
>in my last message was that that was to be the policy...you didn't bother
>to ask who made the policy....it was an MD!!!
>
>Donna L. Alden, RN, BScN, BScPsyc, EMT-A(S)
>
>***********************************************************************
>Donna L. Alden, RN, BScN, BSc(Psyc), EMT-A(S)
>Public Health Nurse
>Regional Health Authority #5 (Alberta)
>Box 117
>Didsbury, Alberta
>Ph:(403)335-9300(home)
>   (403)335-3233(work)
>E-Mail: alden@freenet.calgary.ab.ca
>***********************************************************************


Then the MD should be re-educated, and if he/she argues, should be
fired. I'm no respector of persons when it comes to simple questions of
reality.

                                            Steve Harris, M.D.

From: ((Steven B. Harris))
Subject: Re: Chickenpox infectious period???
Date: 16 Jun 1995

In <3rrp32$e0v@ixnews2.ix.netcom.com> jbaker16@ix.netcom.com (James
Baker) writes:

>Sorry Steve, she does not have it wrong.  There are many US
>pediatricians who share the view that chickenpox is a mild illness that
>80-90% of children catch and keeping them out of school does not make a
>lot of sense if they hare not febrile and too ill to be attending.
>This is not official policy but has been under serious discussion.

That's crazy!  You don't know what kinds of immune problems are in kids
that are attending that school, and whose parents are trusting you not
to send some sick kid in.  I've heard of chickenpox parties, but making
your local public school into one is a little much.  Especially with my
office down the road, having to see 50 miserable kids in the next week.


>Now the availability of varicella vaccine may change all of this, but
>who knows in which direction.


Hopefully we won't see this disease anymore.  That'd be nice.


                                             Steve Harris, M.D.

From: ((Steven B. Harris))
Subject: Re: Chickenpox infectious period???
Date: 24 Jun 1995

In <3rsjse$dre@boris.eden.com> via@eden.com (via) writes:

>>                                             Steve Harris, M.D.
>
>i thought you were a geriatric physician?



I'm board certified in geriatrics and internal medicine.  Recently I've
done a lot of family medicine/ urgent care stuff, as it is part time,
interesting, and keeps me from getting rusty.  Flu season can be brutal
in that kind of a setting.  The thought of 200 miserable kids with
chickenpox....

                                              Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Chicken Pox and Contagious period and Shingles
Date: 15 Jan 2000 18:44:59 GMT

In <85q8ue$lio$1@news1.mpx.com.au> "Alan Beall"
<alan_beall@dingoblue.net.au> writes:

>Can anyone confirm, given the circumstances above, that it is possible
>for: a) Contracting Shingles from some who has Chicken Pox lesions or
>being near someone who has lesions.


First, the lesion are infective until they well into healing.  Pull
crust off anything with fluid underneigh, and there's probably virus
there which can wiped on something.

People who've already had chickenpox are immune to later infection by
others, unless their immune systems have completely bloken down (ie,
late AIDS, not getting old).   Shingles is a product of the same virus
you were infected with years before, not a new infection.  We don't
know that in every case, but we have proved it in those cases where we
could, and we also know that the vast majority of shingles cases have
no new source for the virus.  So forget this as a reasonable danger.



>b) Infect an adult of 45 years who has had the Chicken Pox (not as an
>infant).

  Not one with an immune system in working order.

>c) Any possibility of infection from a non symptomatic sibling who has
>had chicken pox.

   No, unless the kid carries sticky fluid from some other kid's
lesion, on his hands, and gets it from here to there pretty fast <g>.



>Can there be ANY truth to what this "person" states, or are we talking pure
>mythology here?



Yep. Myth.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Chicken Pox and Neuralgia
Date: 1 Sep 2000 06:18:10 GMT

In <8on7ji$5p8$5@slb7.atl.mindspring.net> "CBI"
<c_ishnospam@mindspring.com> writes:
>
><antegna@bigfoot.com> wrote in message news:wkzolulftf.fsf@bigfoot.com...
>>
>> Jeffrey Peter, M.D. <drkid@my-deja.com> writes:
>>
>>
>> Thanks for the reply. Just a minor point of clarification. Isn't it
>> true that for Shingles, the lesions tend to concentrate on one side of
>> the body? Mine appear to be evenly distributed over both my left and
>> right sides.
>>
>
>Usually, yes. There can be exceptions.
>
>--
>CBI, MD
>
>


   This guy probably has primary chickenpox. And no, it's not true that
primary chickenpox doesn't produce neuralgia.  Of course it can.  It
is, after all, the same virus infecting nerves in the primary syndrome
too.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Chicken Pox and Neuralgia
Date: 1 Sep 2000 19:36:04 GMT

In <0vvvqsgv2j5slmo4a4frsafb2d8a15hhnv@4ax.com> Polar
<smeric@mindspring.com> writes:
>>
>BTW - A family member had the most HORRIBLE shingles (post
>-transplant).  Looking into this, I learned that shingles can come on
>years after chicken pox.  T or F?


  Generally true-- the time is often in decades (probably after the
immune system response to the original virus weakens with age; shingles
then acts like a booster vaccine dose, and the person never has another
problem in their life).

  But there have been a few shingles cases with short enough intervals
that the virus could be genotyped for both primary (chickenpox) and
secondary infections (shingles).  No question: it's the same original
chicknpox viral infection, just hiding all of that time in the nerves.
The vericella-zoster virus, remember, is a herpes virus.  It acts a lot
like herpes I and II, except that one or two symptomatic infections per
lifetime only, is the norm.

   People who are immunosuppressed for other reasons (AIDS, transplant,
chemotherapy, etc) can get shingles over and over.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Help! Prevention of Scar (Chicken Pox) formation?
Date: Fri, 9 May 2003 12:01:52 -0700
Message-ID: <b9gu13$5b5$1@slb5.atl.mindspring.net>

"Andybaby" <privacy_101@hotmail.com> wrote in message
news:cb21d812.0305081737.513c8f67@posting.google.com...
> "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
wrote in message
news:<b9efkt$42d$1@slb2.atl.mindspring.net>...
> > Hopefully you got treated with antivirals early while you had the
> > disease.  If not, you can blame any scarring you get on the system
> > that decided to save money by not treating you for a "usually
> > harmless" disease.
> >
>
> Hi there,
>
> Thanks for your response.
>
> There was no treatment except for me taking paracetemol to reduce the
> fever.
> 
> It was a public holiday, I was feverish so i went to a public hospital,
> where a doctor looked at my blisters and said 'its chicken pox', and
> didn't suggest any medicines. I told him I was taking paracetemol to
> reduce the fever, and he said thats ok.


There you are. If you're using the word paracetamol (here in
the US we say Tylenol or acetominophen) that means you're in
the British, Canadian, or Australian semi-socialist medical
system that may not want to pay for expensive acute oral
Zovirax when 24 year olds get a potentially scarring disease
like chickenpox. Yes, you have a right to be damn angry
about this. But on the other hand, you did buy into the
socialist medical system, and people do more or less get
what they deserve in democracies. Please remember this
episode when you next have reason to debate the goodness of
public healthcare in your own country.


>
> Anyway, I'm going to make an appointment to see a dermatologist, but as
> I said, he will probably see me in 4 weeks. Damn, that receptionist was
> bloody persistant about how it was 'impossible' for me to just ask the
> dermatologist a question. I guess that would be a bad 'business policy'.

Yes, though that's true in every country. Nobody pays for
phone time, and it's just as draining on the doctor as
face-to-face time. In this case, necessity for expensive
secondary care might have been partly alieviated by appropri
ate primary care.

Oral Zovirax early in the course of chickenpox decreases
severity and duration of the disease.  In my own experience,
adults started on it almost immediately stop forming new
skin lesions. The older you are with this disease, the more
likely scaring is.  Small children usually don't get
scarred, but a day or two of antiviral is nice even for them
while they're in the acutely febrile and worst phase of the
disease. I suspect it prevents some of that small fraction
of chickenpox cases that go on to pneumonia and
encephalitis.


>
> Anyway, I did ring and speak to a GP who said that after the scabs fall
> off, any pits are then permanent, and that theres nothing I can do. Is
> this true?

Possibly. Though after your scars have matured and are
stable (a few months)any plastic surgeon will be able to
remove any remaining large pitd with a eliptical incission
and replace each it with a thin scar line. How much better
that looks depends on how good your surgeon is, and how much
you scar. Suggest you try ONE with your surgeon of choice in
a non-vis area, to see how it's going to go.


> Anyway, I dont know who is competent, and who is telling me the truth,
> who is being sloppy, who is covering their arse by avoiding potential
> lawsuits..

I think either your GP or your system (whoever decided
Zovirax is too expensive for cases like yours) screwed up.
I'd be glad to hear from anybody who thinks differently.

SBH

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Help! Prevention of Scar (Chicken Pox) formation?
Date: Fri, 9 May 2003 13:58:26 -0700
Message-ID: <b9h4pg$g7g$1@slb6.atl.mindspring.net>

"Beverly Erlebacher" <bae@cs.toronto.edu> wrote in message
news:2003May9.153933.4863@jarvis.cs.toronto.edu...

> In Ontario, and most or all other provinces of Canada, drugs other than
> those administered to hospital inpatients are not covered by provincial
> health insurance except for people on social assistance and senior
> citizens.  People pay for drugs out of their own pockets or with private
> drug plans through their employers or otherwise.


However, this guy said he WENT to the hospital and I assumed
he'd been admitted. But perhaps not. If not, perhaps I
shouldn't have included Canada. We need more info.


> So if a physician here wishes to prescribe Zovirax for an appropriate
> condition, and the drug is licensed here, there's no problem for her to
> write a prescription and hand it to the patient.  It's up to the patient
> to pay for it.


Unless the patient has Green Cross and the doc is a Green
Cross PPO and is being looked at to see how much he costs
the non-profit (but also not government) Canadian system in
Rx costs.

However, the same problem exists in the US.


> A while back you were railing at MDs who order MRIs for conditions that
> can be effectively diagnosed and treated with less expensive tests, and
> you seemed to feel obliged to give "socialized medicine" a ritualistic
> kick at the same time.  You decided that since this is a bad practice,
> those bad guys ipso facto must practice it.  I think you'll find more
> prudent use of expensive tests in Canada and other western countries
> than in the US.

I admit it. Decoupling expensive medical stuff from
patient's costs leads to either over or under utilization,
depending on who then DOES get to make the decission, and
what their own incentives are.  And yet some people cannot
pay. The old dilemma.  Except to require some kind of copay
for everything for everyone, I have no perfect answers.
Didn't pretend to.

Will be interesting to see where Mr. Chickenpox lives. Might
be UK where the public health service would be expected to
provide the acyclovir he didn't get, though.  What would you
say then?

SBH

From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med
Subject: Re: Need advice on chickenpox immunization
Date: Tue, 07 Sep 2004 20:09:17 -0400
Message-ID: <chlijj$426$1@reader1.panix.com>

Griffin wrote:
> On 2004-09-07 08:14:57 -0400, bae@cs.toronto.no-uce.edu.yyz said:
>
>> In article <2004090620593916807%nospam@herenet>,
>> Griffin  <nospam@here.net> wrote:
>>
>>> On 2004-09-06 20:13:36 -0400, George <nospam@verizon.net> said:
>>>
>>>> I've also read that if the mother has had chickenpox(as in the
>>>> actual illness)at any time in her life, the immunity that results is
>>>> passed on to her offspring during pregnancy.
>>>
>>>
>>> That's incorrect.
>>
>>
>> To be fair, mammals do acquire some of their mother's antibodies
>> through the placenta and colostrum which provide a transient passive
>> immunity, but it only lasts for a few months at most.  This gives the
>> young infant some resistance to local pathogens while its own immune
>> system is developing.  It would also apply if the mother had a
>> reasonable titre from vaccination.
>
>
> Neonatal zoster is a disaster. Maternal antibodies provide no protection.

Yes it can be a disaster, but neonatal zoster occurs as the result of
antenatal exposure of a non-immune mother to VZV. Neonates exposed to
zoster usually do okay, and part of the decision about how to manage
such exposure is whether the mother has antibodies to VZV. Neonatal
zoster wouldn't occur with an immune mother.

--
David Rind
drind@caregroup.harvard.edu

From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med
Subject: Re: Need advice on chickenpox immunization
Date: Tue, 07 Sep 2004 22:12:35 -0400
Message-ID: <chlpqq$64l$1@reader1.panix.com>

Griffin wrote:
> On 2004-09-07 20:09:17 -0400, David Rind <drind@caregroup.harvard.edu>
> said:
>
>> neonatal zoster occurs as the result of antenatal exposure of a
>> non-immune mother to VZV. Neonatal zoster wouldn't occur with an
>> immune mother.
>
>
> That's one scenario, but it's not uncommon for infants to be exposed to
> VZV perinatally from a non-maternal vector (technically, you're
> referring to congenital or perinatal infection, while I was thinking of
> postnatal infection, as the OP's question implied an immunocompetent
> mother with antibodies to VZV). In the case of postnatal infection,
> maternal antibodies do not confer immunity.

I guess I would agree that almost by definition if postnatal infection
occurred then maternal antibodies did not confer immunity. Are you
saying, though, that in the case of postnatal exposure (of an infant
born to a mother who is immune to VZV), that maternal antibodies do not
provide any protection? Here's are several abstracts that certainly
suggest the opposite:

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2004
Jan;47(1):10-5.  Related Articles, Links


[Antibodies against vaccine-preventable diseases in pregnant women and
their offspring. Measles, mumps, rubella, poliomyelitis, and varicella]

[Article in German]

Sauerbrei A, Prager J, Bischoff A, Wutzler P.

Institut fur Virologie und Antivirale Therapie,
Friedrich-Schiller-Universitat Jena, Jena, Andreas.Sauerbrei@med.uni-jena.de

In the eastern part of Germany, the age of primigravid women has clearly
increased since 1990. This may change the protection provided by
antibodies in pregnant women as well as their newborns. The objective of
the present study was to assess antibodies against vaccine-preventable
viral infectious diseases in pregnant women and their offspring to draw
conclusions about their protection. Maternal and cord blood samples of
290 women from the eastern part of Germany with a mean age of 28 years
were analyzed for antibodies against measles, mumps, rubella,
poliomyelitis, and varicella. The study showed that the pregnant women
had detectable levels of antibodies against measles virus in 79%,
against mumps virus in 96%, against rubella virus in 87%, against
polioviruses types 1-3 in 62-64%, and against varicella-zoster virus
(VZV) in 97% of the cases. The seroprevalences of the antibodies in the
newborns were not significantly different from those of their mothers.
When antibody titers of mothers and newborns were compared,
significantly higher titers to VZV could be detected in the cord blood
sera of newborns. It is suggested that the prevalence of antibodies
against measles and poliomyelitis is insufficient to protect the
newborns efficiently. An immunity gap of 13% against rubella in mothers
results in a potential risk for a congenital rubella syndrome in
newborns. Despite the high seroprevalence of rubella and chickenpox,
there is considerable potential for infections during pregnancy and
neonatal period.


Pediatr Infect Dis J. 2004 Apr;23(4):361-3.  Related Articles, Links


Transplacentally acquired immunoglobulin G antibodies against measles,
mumps, rubella and varicella-zoster virus in preterm and full term newborns.

Leineweber B, Grote V, Schaad UB, Heininger U.

Division of Pediatric Infectious Diseases, University Children's
Hospital Basel, CH-4005 Basel, Switzerland.

IgG antibody values against measles, mumps, rubella and varicella-zoster
virus in 71 full term and 101 preterm infants and their 152 mothers and
the decay of maternally acquired antibodies during infancy were studied.
Both magnitude of transplacental antibody passage and cord blood
antibody values correlated with gestational age. After 6 months preterm
infants born before 32 weeks of gestation had lost maternal antibodies.

J Perinat Med. 2002;30(4):345-8.  Related Articles, Links


Placental boost to varicella-zoster antibodies in the newborn.

Sauerbrei A, Wutzler P.

Institute for Antiviral Chemotherapy, Friedrich-Schiller University,
Jena, Germany. Andreas.Sauerbrei@med.uni-jena.de

IgG antibodies to varicella-zoster (VZV) were analyzed in cord and the
corresponding maternal blood samples using the indirect fluorescence
antibody test and the fluorescent antibody to membrane antigen test. The
investigations revealed protective antibody levels in 96.7% of both
newborns and mothers. In the cord blood samples, significantly higher
titers were detected being indicative of an active placental transfer of
VZV-specific IgG

Also, here is a quote from a case report in the Lancet of an infant who
did contract VZV as a neonate:

"It is generally accepted that passively acquired maternal
antibody protects neonates from varicella even in low-birthweight
infants1,2 with neonatal titres of VZV IgG antibody
usually matching maternal levels.3"

So while I would agree that neonates are not "immune" to VZV by virtue
of maternal immunity, there certainly seems to be general agreement that
they have significant protection because of transfer of maternal
antibodies. Do you know of evidence that this is incorrect?

--
David Rind
drind@caregroup.harvard.edu