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Can chickenpox cause injury and/or death?
The Institute of Medicine (IOM) has acknowledged that there is individual susceptibility to vaccine reactions for genetic, biological and environmental reasons, but that vaccine providers cannot accurately predict prior to a vaccine’s administration who will suffer complications, injury or death from vaccination. However, a person who has previously had a serious reaction to a vaccination or is acutely or chronically ill should become informed about all potential risks associated with vaccination and discuss any concerns with a trusted health care professional before receiving a chickenpox vaccine or any other vaccine.
According to the CDC, possible side effects from the varicella (chickenpox) vaccine include:
- Pain, swelling, and redness at the injection site
- Seizures, often associated with fever
- Full body rash
- Severe allergic reaction
During the pre-licensing clinical trial of Merck’s Varivax (Varicella Virus Vaccine, Live) vaccine, reported adverse events included: injection site pain, redness, itching, swelling, rash, induration, bruising, and stiffness; fever; chickenpox-like rash at injection site; generalized chickenpox rash; upper respiratory infection; cough; irritability; nervousness; fatigue; sleep disturbances; loss of appetite; diarrhea; vomiting; inflammation of the ear; contact rash; diaper rash; other rash; heat rash; malaise; teething; headache; abdominal pain; muscle pain; chills; eye complaints; lymphadenopathy; nausea; lower respiratory infection; joint pain; stiff neck; dermatitis; itching; eczema; dry skin; constipation; allergic reaction; canker/cold sore; pneumonitis; and febrile seizures.
Serious complications reported by Merck since FDA licensure of Varivax have included:
- Guillain-Barre Syndrome
- Transverse Myelitis
- Bell’s Palsy
- Non-febrile seizures
- Aseptic meningitis
- Anaphylaxis, including anaphylactic shock
- Peripheral edema
- Facial edema
- Angioneurotic edema
- Necrotizing retinitis in immunocompromised individuals
- Idiopathic thrombocytopenic purpura (ITP)
- Aplastic anemia
- Vaccine strain chickenpox infection
- Henoch-Schönlein purpura
- Erythema multiforme
- Secondary bacterial infections of skin and soft tissue including cellulitis and impetigo
- Stevens-Johnson Syndrome
Meningitis or encephalitis caused by the vaccine-strain chickenpox virus have been reported in healthy individuals previously vaccinated with Varivax vaccine months to years after vaccination. Reported cases were commonly associated with a shingles rash.
In the comprehensive report evaluating scientific evidence, Adverse Effects of Vaccines: Evidence and Causality, published in 2012 by the Institute of Medicine (IOM), 15 reported vaccine adverse events following the varicella (chickenpox) virus vaccine were evaluated by a physician committee. These adverse events included disseminated vaccine strain virus with and without other organ involvement, vaccine strain viral reactivation (vaccine strain shingles) with and without other organ involvement, varicella encephalopathy, varicella seizures, acute disseminated encephalomyelitis, anaphylaxis, Guillain-Barre Syndrome, stroke, cerebellar ataxia, small fiber neuropathy, onset or exacerbation of arthropathy, transverse myelitis and thrombocytopenia.
The IOM committee concluded that in 5 out of 15 varicella (chickenpox) virus vaccine-related adverse events, the scientific evidence convincingly supported a causal relationship between the vaccine and the adverse event. These five adverse events included disseminated vaccine strain virus without organ involvement, disseminated vaccine strain virus with organ involvement, vaccine strain viral reactivation (vaccine strain shingles) without organ involvement, vaccine strain viral reactivation with organ involvement, and anaphylaxis. In the remaining 10 reported vaccine adverse events, the IOM committee concluded that there was inadequate evidence to support or reject a causal relationship between the chickenpox virus vaccine and the reported adverse event, primarily because there was either an absence of methodologically sound published studies or too few quality studies to make a determination.
In the past three decades, published studies have linked the chickenpox vaccine to serious adverse events in both children and adults. These adverse events include aplastic anemia, ocular complications, streptococcal toxic shock syndrome, skin rashes, thrombocytopenic purpura, stroke, pneumonia, Stevens - Johnson syndrome, and central nervous system disorders including meningitis, and encephalitis.
Adolescents between the ages of 11 and 17 are also at a higher risk of developing immune thrombocytopenic purpura (ITP) following chickenpox vaccination.
In 2013, the vaccine strain chickenpox virus was found to be responsible for the death of a 15-month-old vaccinated child. The young girl developed a chickenpox-like rash 20 days after receiving the chickenpox vaccine. She developed severe respiratory complications despite 2 months of anti-viral medications, and eventually died from sepsis and multi-organ failure.
Case studies have also found that severe complications can occur in persons with previously undiagnosed HIV infections who developed vaccine strain chickenpox after vaccination. While the live virus chickenpox vaccine is contraindicated in persons with a history of solid organ transplant, when administered, serious complications may occur.
Persons with a history of chickenpox vaccination may still be at risk for developing severe chickenpox infection, with complications which may include transverse myelitis, pneumonia, and meningitis. Children previously vaccinated with the chickenpox vaccine can also develop vaccine-strain shingles infections which may result in serious complications.
In November 2014, the National Vaccine Information Center published a special report The Emerging Risks of Live Virus and Virus Vectored Vaccines: Vaccine Strain Virus Infection, Shedding and Transmission. This report reviewed the medical literature for evidence that live virus vaccine strain infection, shedding, and potential for transmission occurs, including chickenpox vaccine strain infection and shedding.
This report found that healthy children and adults can transmit vaccine strain chickenpox infection to other healthy children and adults but immune compromised persons were found to be at a special risk for contracting vaccine strain chickenpox infections and suffering complications. Published case studies in the medical literature have reported on vaccine strain chickenpox infections in solid organ transplant recipients, newborn infants, and individuals with cancer.
The Varivax chickenpox vaccine package insert states: “Post-marketing experience suggests that transmission of vaccine virus may occur rarely between healthy vaccinees who develop a varicella-like rash and healthy susceptible contacts. Transmission of vaccine virus from a mother who did not develop a varicella-like rash to her newborn infant has been reported. Due to the concern for transmission of vaccine virus, vaccine recipients should attempt to avoid whenever possible close association with susceptible high-risk individuals for up to six weeks following vaccination with VARIVAX.” High risk individuals include the immunocompromised; pregnant women who have never had varicella infection and their newborn infants; and premature babies born before 28 weeks gestation.
According to the CDC, possible side effects from the measles, mumps, rubella, and varicella (MMRV) vaccine include:
- Pain, swelling, redness, and rash at the injection site
- Swelling of the glands in the neck or cheeks
- Seizures, often associated with fever
- Full body rash
- Low platelet count which may result in unusual bruising or bleeding
- Severe allergic reaction
The CDC also reports that there is a higher risk of seizures following the MMRV vaccine when compared with separate injections of MMR and varicella vaccines. This risk is significantly greater when the MMRV vaccine is administered as the first dose of the series.
Adverse events reported during the pre-licensure clinical trials of Merck’s ProQuad (MMRV) vaccine included: measles-like rash; chicken-pox rash; fever; injection site pain, tenderness, redness, swelling, ecchymosis, hemorrhage and rash; irritability; rash; viral exanthema; upper respiratory infection; diarrhea; vomiting; nasopharyngitis; eczema; and febrile seizure.
Serious complications reported by Merck in the ProQuad (MMRV) package insert during vaccine post-marketing surveillance have included:
- atypical measles;
- vaccine strain varicella;
- varicella-like rash;
- herpes zoster;
- herpes simplex;
- pneumonia and respiratory infection;
- skin infection;
- subacute sclerosing panencephalitis;
- aseptic meningitis;
- aplastic anemia (anemia due to the bone marrow’s inability to produce platelets, red and white blood cells);
- lymphadenitis (inflammation of the lymph nodes);
- anaphylaxis including related symptoms of peripheral, angioneurotic and facial edema;
- ocular palsies;
- necrotizing retinitis (inflammation of the eye);
- nerve deafness;
- optic and retrobulbar neuritis (inflammation of the optic nerve);
- Bell’s palsy (sudden but temporary weakness of one half of the face);
- cerebrovascular accident (stroke);
- acute disseminated encephalomyelitis;
- measles inclusion body encephalitis;
- transverse myelitis;
- Guillain-Barre syndrome;
- syncope (fainting);
- febrile seizure;
- afebrile seizures or convulsions;
- polyneuropathy (dysfunction of numerous peripheral nerves of the body);
- Stevens-Johnson syndrome;
- Henoch-Schönlein purpura;
- acute hemorrhagic edema of infancy;
- erythema multiforme;
A 2014 published study on the MMRV vaccine use in Canada found that the risk of febrile seizures following MMRV vaccination was double that of children receiving separate doses of MMR and varicella vaccines. Additionally, a 2015 meta-analysis found a two-fold increase in febrile seizures between 5 and 12 days following MMRV vaccination in children between the ages of 10 and 24 months.
MMRV vaccine contains albumin, a human blood derivative, and as a result, a theoretical risk of contamination with Creutzfeldt-Jakob disease (CJD) exists. Merck states that no cases of transmission of CJD or other viral diseases have been identified and virus pools, cells, bovine serum, and human albumin used in vaccine manufacturing are all tested to assure the final product is free of potentially harmful agents.
As of August 31, 2023, there have been more than 103,594 reports of varicella vaccine (Varicella, MMRV) reactions, hospitalizations, injuries and deaths following varicella vaccinations made to the federal Vaccine Adverse Events Reporting System (VAERS). This includes 239 related deaths, 3,802 hospitalizations, and 843 related disabilities. However, the number of vaccine-related injuries and deaths reported to VAERS may not reflect the true number of serious health problems that occur after chickenpox vaccination.
Even though the National Childhood Vaccine Injury Act of 1986 legally required pediatricians and other vaccine providers to report serious health problems following vaccination to federal health agencies (VAERS), many doctors and other medical workers giving vaccines to children and adults fail to report vaccine-related health problem to VAERS. There is evidence that only between 1 and 10 percent of serious health problems which occur after use of prescription drugs or vaccines in the U.S. are ever reported to federal health officials, who are responsible for regulating the safety of drugs and vaccines and issue national vaccine policy recommendations.
As of September 1, 2023, there have been 193 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following chickenpox vaccination (Varicella, MMRV), including 12 deaths and 181 serious injuries. Of that number, the U.S. Court of Claims administering the VICP has compensated 100 children and adults, who have filed for varicella vaccine injury.
IMPORTANT NOTE: NVIC encourages you to become fully informed about Chickenpox and the Chickenpox vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.