Steroids and chicken pox not a good mix

Children who have been treated with steroids and are exposed to chicken pox tend to have a more severe case of the virus, according to pediatric oncologists at Brenner Children’s Hospital, part of Wake Forest University Baptist Medical Center.

New research published in the October issue of Pediatrics, says that children who are undergoing steroid treatments for diseases like childhood leukemia are at increased risk of contracting a more severe form of chicken pox, which may result in death.

“Steroids are used to treat leukemia and they suppress the immune system,” said Thomas McLean, a pediatric oncologist at Brenner Children’s Hospital. “When a child is exposed to the varicella virus (the virus that causes chicken pox) around the time they are receiving steroid treatment, they are more likely to contract a more severe case of chicken pox.”

McLean and his colleagues studied 697 patients with acute leukemia over a nine-year period. About 16 percent or 110 patients contracted chicken pox. Of those 110 patients, 54 had severe disease, including two deaths. Of the patients whose chicken pox was diagnosed within three weeks of taking steroids, 70 percent had severe infection whereas only 44 percent of those who had not received steroid therapy within three weeks had severe infection. Although the study was limited to patients with leukemia, the findings may apply to other conditions for which steroids are used, McLean said.

“One of the things we need to remember to ask before we prescribe steroid treatment is whether the child has had a recent exposure to chicken pox,” McLean said. “If so, we recommend waiting until the incubation period has passed before beginning steroid therapy.”

Steroids are a common and highly successful treatment for many childhood cancers, McLean said.

“We just need to make sure we don’t mix the two,” he added. “Steroids and the chicken pox virus don’t go together. They are a bad combination.”

Chicken pox is usually mild, but it can be serious and even life threatening. In 1995, a chickenpox vaccine was developed to help prevent the spread of the virus. Prior to the widespread use of the varicella vaccine, approximately 12,000 people were hospitalized for chicken pox each year in the United States and 100 died as a result of the disease, according to the Centers for Disease Control and Prevention.

“Since the introduction of the vaccine, the incidence of varicella has decreased steadily. We hope one day to eradicate the disease all together,” McLean said. “I strongly encourage any parent whose child has not had chicken pox to get that child vaccinated.”