Viral attacks: Outbreaks make a comeback

By Garren Shipley -- gshipley@nvdaily.com

LURAY -- A contagious virus has been reported in schools in the Northern Shenandoah Valley, prompting local health officials to work to stop the outbreak.

And, no, it's not swine flu.

Some 38 cases of chickenpox have been reported in Page County over the past three weeks, according to Dr. Stephen Haering, director of the Lord Fairfax Health District.

Since the introduction of a chickenpox vaccine in 1995, the county has usually seen only five or six cases for an entire year.

But in the past three weeks, "Luray Elementary has had 18 cases and Stanley Elementary has had 17 cases," said Haering.

The outbreak has prompted calls for Page County students to get a second dose of the vaccine to improve their immunity.

Most children get one dose of chickenpox vaccine as a part of routing immunizations for school.

"The one dose is 70 to 85 percent effective," he said.

That's been made painfully clear in Page County.

"All these kids have been vaccinated once," Haering said. "We're seeing breakthrough disease, which is why we're pushing for a second vaccination."

Chickenpox in an unvaccinated person causes a high fever and rash that becomes blister-like.

"Break-through" chickenpox infections typically have a low or no fever and the rash might not become blister-like, Haering said. "It can easily be mistaken for bed bug bites."

Chickenpox vaccination has been common since 1995, which makes the Page County outbreak something of a mystery.

"My assumption is that there's just a high 'viral load' [or amount of the virus] this year," he said.

Like drugs, some germs are more effective than others. Some need higher concentrations of exposure to cause illness, while some require just a handful of viruses.

"Why there's a high load, I'm not sure," he said.

Vaccines have made the vast majority of childhood viral diseases a thing of the past, according to Jeff Spray, an assistant professor of pharmacy and viral pharmacology expert at Shenandoah University.

Until the second half of the 20th century, a school year was made up of a variety of disease seasons -- winter brought illnesses like chickenpox and measles, while fear of polio often kept children out of swimming pools during the summer.

But starting with smallpox in the 1700s, common viral diseases have rapidly become more uncommon.

Measles, mumps, rubella, chickenpox and now even rotavirus -- responsible for severe diarrhea and vomiting in young children -- have either been relegated to the status of medical oddity or are well on their way to becoming so.

"Most of the common childhood disease are now pretty much covered," Spray said.

While vaccines have the obvious effect of improving immunity for individuals, they also have a significant effect on the community as a whole via what's known as "herd immunity."

Said simply, if the virus runs out of places to live and reproduce, it dies off.

"You're kind of pushing it out of the population" via vaccination, he said. "If you protect most of the people in an area, it's not going to be there, it's not going to be passing around the population."

Vaccines have made even a small outbreak of disease -- like the handful of measles cases reported in Northern Virginia, Washington and Maryland last month -- a novel medical event.

While the chickenpox outbreak is unusual, the higher number of cases might not represent a change in the amount of chickenpox virus circulating in the community -- it could just be a result of a more vigilant population.

With physicians and parents on the lookout for swine flu, people in Page County may simply be reporting illness that would otherwise have slipped under the radar.

While the disease is rarely fatal, it was a miserable experience for elementary school students the world over.

Before the vaccine was introduced in 1995 "there had been 4 million cases a year, and approximately 11,000 hospitalizations per year," Haering said.

There were also roughly 100-150 deaths. About "90 percent of all of that occurred in people under 20," he said.

Dealing with children who have come down with chickenpox is similar to influenza.

Keep sick children away from others, and encourage them cover their cough. Frequent, thorough hand washing will also help keep the germ from spreading.

But the most important step parents can take is getting their children a second dose of vaccine, Haering said.

Free chickenpox clinics

Local health officials are providing a free second dose of chickenpox vaccine to school and pre-school age children in Page County in an effort to stop an outbreak of the disease.

* Immunizations are available Monday through Friday, 8:30 to 11:30 a.m. and 1 to: 3:30 p.m.

* An extend hours chickenpox vaccination clinic will be held May 20 from 1 to 6 p.m.

* No appointment is necessary. Walk-ins welcome during the week and for the extended hours clinic.

* The office is at 75 Court Lane, in Luray. Call the Page County office at 743-6528 for more details

-- Source: Lord Fairfax Health District