Are "pox parties" safer than vaccines for children?

Question

So-called pox parties have been around in various forms in varying degrees of popularity since the 1980's, and are described on Wikipedia as:

A pox party, or flu party or flu fling, is a social activity where children are deliberately exposed to a virus to promote immunity. Such parties are typically organized by parents on the premise of building the immune systems of their children against diseases such as chickenpox and measles (which can be more dangerous to adults than to children) or flu. Such practices are highly controversial and are discouraged by public health officials.

Is there any immunological advantage to having pox-parties for children, which advantage would not be gained in a safer way by taking the vaccine suggested by the WHO (varicella vaccine)?

Answer 1

Short answer: No, pox parties are NOT safer than vaccines.

This was asked at the Parenting StackExchange. Here is my answer from that:

PROS of VACCINES:

• The vaccine is administered in a doctor's office. Understand that NOTHING is 100% safe (even breathing), so should there be any reactions, you will be with a doctor.
• The patient that gets the vaccine will most likely not suffer from the disease, and the numerous possible side effects (scarring, pneumonia, liver damage, brain damage, death).
• A vaccinated individual contributes to Herd Immunity without going through a contagious stage, thereby offering protection to individuals who are immune-compromised, or may be unable to get the vaccine.
• The rate of SERIOUS complications with a vaccine are about 1 in 1,000,000 (and keep in mind, the majority of these complications are non-permanent treatable reactions such as anaphalaxis if in the presence of a doctor). Other complications appear at about a rate of 1 in 100,000. The complications from the disease itself are about 1 in 10,000 for chicken pox (and depending on the classification, as high as 1 in 50).
• The economic impact is lessened by a vaccine (a good counter argument to the "Big Pharma" lie... In general, a vaccine nets any company much, much LESS than treating someone with the same disease).

CONS of VACCINES:

• None beyond those listed above that have any scientific merit (i.e. the 1 in a million chance of a severe negative reaction). Or the minor issue of the vaccine not totally providing immunity.

PROS of POX-PARTY:

• A very high likelihood that immunity will be gained through exposure (although it should be noted that the level of immunity is the same as for a vaccine...)

CONS of POX-PARTY:

• The much higher possibility of side effects (1 in 10,000 versus 1 in a million) such as brain damage, liver damage, death
• The possibility of spreading the disease to immune-compromised or those who may not know their immunity is somehow compromised.
• Not being in the presence of a doctor during administration
• The economic impact of having to care for a sick child (staying home from work, the child missing school, the cost of additional medicines to deal with symptoms)
• You get sick!

Some good educational sites for you:

The Children's Hospital of Philadelphia.

Stanford (and I) think it's a good idea to eliminate deaths from this preventable disease.

Not sure if this link will work in this format, but here is an interesting video about opting out of vaccines in general (and the consequences): http://www.newsy.com/embed-video/9802/

The whole idea of these parties are based on the false premise that somehow natural immunity is better than a vaccine, or that vaccines are dangerous. Both of these ideas are outright false, and quite often deliberate lies spread by anti-vax pro-disease individuals.

Answer 2

Summary: Chickenpox as a disease results in 2 deaths per 100,000 cases, and about 2,000 per 100,000 cases of complications. Chickenpox vaccine results in ~0.15 deaths per 100,000 cases (most of which turn out to be due to natural varicella, so the true death rate is lower), and about 67.5 per 100,000 cases of complications. Thus, for children, vaccination is safer than pox parties. However, dormant chickenpox virus from both vaccination or natural infection can cause shingles later in life if the immunity fades, and chickenpox re-exposure helps boost immunity. Thus, for adults who have had chickenpox or chickenpox vaccination, pox parties may have some benefit (though they would get a similar benefit from re-vaccination).

Chickenpox is a usually mild infection, and children between 1 and 14 who get it, and who don't have troubles with the immune system, have cancer, or are taking steroids, have an excellent prognosis (source: Medscape)

Otherwise healthy children with varicella have excellent prognoses. In otherwise healthy children aged 1-14 years, the mortality rate is estimated at 2 deaths per 100,000 cases. The case-fatality rate in the general population is 6.7 cases per 100,000 population. Children with immunocompromised states, however, are at risk for severe disease and death. The mortality rate in children who are immunocompromised is much higher than that in otherwise healthy children. Among children with leukemia, the mortality rate of varicella is 7%.

One study suggested that nearly 1:50 varicella cases are associated with complications. Among the most serious complications are varicella pneumonia and encephalitis; both are associated with a high mortality rate. Before universal vaccination, most varicella-related deaths in the United States were from associated encephalitis, pneumonia, secondary bacterial infection, and Reye syndrome. (See Complications.) In addition, significant concerns have been raised about the association of varicella with severe invasive group A streptococcal disease.[15]

The disease can be serious in neonates, depending on the timing of infection in the mother. Varicella during pregnancy can cause various adverse outcomes for mother and infant, depending on the stage of pregnancy. Neonatal varicella mortality rates can reach 30%.

There have been deaths following chickenpox vaccination, though the rate of death is 10-fold smaller than for chickenpox itself (0.15 in 100,000 vaccinations), and whenever an autopsy has been performed, it was found that the cause of death was from wild-type chickenpox virus, rather than from the vaccine, and that the patient had undiagnosed cancer or other complications (source: Wise RP, Salive ME, Braun MM, et al. (2000). "Postlicensure safety surveillance for varicella vaccine". JAMA 284 (10): 1271–9.; make sure to read the reports in Box 1)

[The US Vaccine Adverse Event Reporting System (VAERS)] received 6574 case reports of adverse events in recipients of varicella vaccine, a rate of 67.5 reports per 100,000 doses sold. Approximately 4% of reports described serious adverse events, including 14 deaths. The most frequently reported adverse events were rashes, possible vaccine failures, and injection site reactions. Misinterpretation of varicella serology after vaccination appeared to account for 17% of reports of possible vaccine failures. Among 251 patients with herpes zoster, 14 had the vaccine strain of varicella zoster virus (VZV), while 12 had the wild-type virus. None of 30 anaphylaxis cases was fatal. An immunodeficient patient with pneumonia had the vaccine strain of VZV in a lung biopsy. Pregnant women occasionally received varicella vaccine through confusion with varicella zoster immunoglobulin. Although the role of varicella vaccine remained unproven in most serious adverse event reports, there were a few positive rechallenge reports and consistency of many cases with syndromes recognized as complications of natural varicella.

Both chickenpox and the chickenpox vaccine can lead to shingles, a neurological disease that occurs when dormant virus re-emerges as immunity fades. To reduce the risk of shingles, immune people need to be re-exposed to the virus or be re-vaccinated in their 50s. Re-exposure used to happen automatically before vaccination, however, since vaccination has lead to a ~80% decrease in the number of varicella cases, natural re-exposure has become more difficult (see medscape reference below). Thus, there has been an increase in the incidence of shingles. Pox parties can be one way of getting re-exposed to varicella.

Before varicella vaccine use became widespread, 4 million cases of chickenpox were reported annually. National seroprevalence data for 1988-1994 indicated that 95.5% of adults aged 20-29 years, 98.9% of adults aged 30-39 years, and more than 99.6% of adults older than 40 years were immune to varicella.[4] The disease was responsible for 11,000 hospitalizations each year and approximately 50-100 deaths.

The adoption of universal vaccination against varicella in 1995 reduced the incidence of varicella, as well as the associated morbidity and mortality rates.[5, 6, 7, 8] By 2000, vaccination coverage among children 19-35 months in 3 communities in Texas, California, and Pennsylvania had reached 74-84%, and reported total varicella cases had declined 71-84%. Most of the decline occurred among children aged 12 months to 4 years; however, incidence declined in all age groups, including infants and adults.[9]

Currently, fewer than 10 deaths occur per year, most of them in unimmunized people. Although vaccination coverage has exceeded 80% over the past few years, outbreaks of breakthrough varicella still occur in schools and daycare centers.[10, 11, 12]

Answer 3

Also reposting my answer from the parenting.se version of the question:

Some people believe that obtaining the virus naturally provides better levels of immunization than you would get from the vaccine, as evidenced by the requirement for a second "booster" shot if you opt for the vaccine, or the possibility of still catching the disease even after receiving the vaccine (it is worth noting that infection after immunization is nearly always mild). Although I have not been able to find conclusive evidence, there are researchers who believe that natural exposure provides higher levels of antibodies. There is also concern that the vaccine may not provide life-long immunity, which, if true, would result in more adults catching active chicken pox infections, opening them to generally more serious and dangerous symptoms.

In past years, a fairly common reason cited for chicken-pox parties is because people are concerned with the possible link between autism and immunization vaccines. This concern was due to a study which has since been thoroughly discredited, and retracted.

However, the possible benefit of deliberate exposure is speculative, whereas the risks are concrete.

Deliberate exposure carries the risk of serious, or even life-threatening, complications. These complications are much more likely in high-risk patients (pregnant women, immune-compromised, infants), but can effect even health children rarely. Possible complications include encephalitis, pneumonia, and bacterial infection (including flesh-eating bacteria).

These are admittedly rare scenarios. However, there is one additional advantage of the vaccine over "natural" immunization: immunization from exposure to the active virus makes the individual susceptible to shingles. The vaccine may not, although I found conflicting information on this.

I updated the part above to indicate conflicting data on whether you can get shingles after receiving the vaccine. This site is a good reference for the risks of each option, but it mentions that the vaccine can still expose the person to shingles (although cases may be less frequent).

I found an article on mothering.com, which has since been removed, that includes a fair amount of research and citations in favor of deliberate exposure over vaccines. However, most of what I saw in there was still what I would call speculative: the vaccine may not be as effective as claimed due to corresponding removal of reporting requirements; "there are too many questions about the adverse effects and efficacy"; "allegedly, [the wild version of the virus] produces much higher levels of antibodies than the vaccine"; questions about the the possible short-term nature of the immunity.

The strongest argument I saw in that article was that, if the reports suggesting that the immunity provided by the vaccine is measured in decades or less are accurate, it might result in more cases of adult chicken pox, and symptoms are generally much more severe in adults than in children. However, the evidence supporting that argument is peppered with terms like "unknown," "theorized," and "might."