When I started nursing school I found out that I'm not immune to varicella and I got 2 vaccines. After that my titer level was still low. I got a prescription for another vaccine, but after 3rd vaccine the abs level didn't go up as well. At my last physical, the doctor said that I shouldn't get another vaccine because my body is not responding to the vaccine. She said that she believes that even the level is very low I have "some" protection.
Now that I'm almost done with the nursing school, we decided with my husband to have another child. It seemed like perfect time, I nursing school I have only one patient a week, my older son will go to pre-k next year.
We already are trying to get pregnant and here where the problem starts... My pediatric rotation is coming up in 6 weeks and yesterday my the pediatric professor stopped by. I went to talk with her about my low varicella titer and her answer was: "You should be very very careful! If you are pregnant this could turn out very tragic." She scared me so bad...
I'm trying to rationalize the whole situation. Most of children with varicella are not hospitalized, and pregnant or not my clinical instructor wouldn't give me a patient with varicella because I'm not immune to it. I think I have a higher risk when I go to playground with my son, or when I'm in the subway. I live in New York City where most of the people are from different countries and probably are not vaccinated. I think that my risk is greater outside the hospital where I don't know who is sitting next to me. In hospital at least you know the patient's history.
I would never make a decision that would harm my unborn baby. I really need some input, please. Encouragement, discouragement...
Aug 29, '12
Talk to your doctor, get the facts. Make your decision base on those facts. I am not sure that what your instructor told you is correct -- but I am not an expert in immunology and don't want to give you false information.
I work in a children's hospital -- and have a lot of pregnant staff members and students. We require everyone (staff and students) get varicella vaccine. But once they have it, we have no special policies or restrictions based on how strong their titers are. We don't even know their titers. All they show us is their proof of vaccination.
Talk to your doctor and/or to a specialist in immunology if you are still concerned after talking with your regular doctor). As you say, you say ... playgrounds, daycare, the supermarket ... there are lots of places you could be exposed to lots of bugs. Find out what your particular level of risk is and make your decision accordingly.
Aug 29, '12
I haven't seen a child with chickenpox be hospitalized. In a pedi office you would be more likely to come in contact with chicken pox. Have actually seen a couple of adults hospitalized with it but they go in a negative pressure room so you would know. And I think you are correct, you are more apt to come in contact with it out in public. My daughter had chicken pox as a child and only AFTER 120+ other kids in her preschool got it. HAHA pretty easy diagnosis that time.
Aug 29, '12
Thank you so much for replies! This means a lot to me, I'm so scared and depressed.
Even my lab result are mixed. In spring the titer was done in one lab and it came out 129 out of minimum 165, which seemed pretty close. And 6 months later the blood was sent to a different lab and the result was 0.3 out of 1.0. Clearly they use different scales but the results seem out of proportion, or the antibody level is going down. I had a clinical instructor who was saying" Don't be afraid of the patients in isolation, because you know what they have and how to protect yourself. You should be afraid of strangers who cough next to you." My pediatric rotation will be for 6 clinical days and I'll get a patient each day. The common sense is telling me that the bigger risk for me would be outside the hospital. But the professor put it out in a harsh way. I don't even know if she meant to be careful in general or especially for pediatric rotation.
By the way,I remember when I was a child some children that had chicken pox played around me but I never got it.
Aug 30, '12
It's definitely scare to be pregnant and work around a sick population- whether that population is adults or children. I work as a PICU nurse and throughout the course of this pregnancy I have been exposed to patients with HIV, PCP pneumonia, CMV and pertussis (and other bacteria but these were the more serious ones that come to mind) before they were diagnosed. Unfortunately there is no way of knowing what exactly disease a patient might have when they first come to the unit. But that's why you follow standard precautions always and use common sense around a patient that may be communicable.
I have to say, though, that it's highly unlikely that you'll be exposed to varicella during your clinical rotations. I'd hasten to guess that the risk is higher you'll encounter an adult patient with shingles than a child hospitalized with chicken pox. Just follow standard precautions and isolation precautions when necessary. Of course, avoid contact with patients who do have diseases that are known to cause harm during pregnancy, such as CMV- but those will be rare cases as well.
Good luck with your future pregnancy!
Aug 30, '12
We cannot offer medical advice as per the TOS....your best bet would be to check with your PCP or your OBGyn for the most accurate information for your situation.
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You almost done with school. Getting pregnant during school is the risky part. What if you have to go on bed rest and have to drop out of school? Personally I would wait until I graduated.
Sep 2, '12
I work in a kids hospital and all the infectious patients (such as with chicken pox) are in our infectious ward. So if you have an infectious ward, I would avoid that. I would also avoid emergency as new cases of chicken pox can come through there. Otherwise, being on a general ward, based on our stats, there is a very rare chance of chicken pox being a problem. We probably have one case a year of a sibling of a patient being diagnosed on the general ward, or a patient having exposure to chicken pox on a general ward.
Sep 3, '12
The US doesn't tend to have "infectious wards". Chicken pox is rare these days with most children being vaccinated against it... in 5 years of working inpatient peds, I saw active varicella infection once. The child presented with mental status changes and was found to have CSF VZV and, ultimately, full blown AIDS with a CD4 count of 5. She was on airborne precautions and, per hospital policy, non-immune staff were not allowed to care for her. The odds of you coming into contact with chicken pox are small... as you said, most children with chicken pox are not hospitalized (if they were, it would be because of other problems... i.e. a child who is s/p stem cell transplant loses their immunity and, if exposed, could get very, very sick if they develop it. They would be hospitalized but any responsible hospital would not allow a non-immune student to care for this child.)
Oct 26, '13
Most hospitals are pretty diligent about isolating people with varicella as it is airborne. Where I work anyone who has chicken pox or varicella, or has been exposed, are placed in airborne precautions with a hepa-filter. That being said there are very few kids with chicken pox coming in to the hospital. I don't think your chances of coming into contact with varicella on a peds ward is any higher than if you go to the mall.
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