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Chicken pox question.

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Old 21st Mar 2004, 13:07
  #21 (permalink)  
 
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SRB,

Thanks for sharing your knowledge in such an eloquent manner.

Am sure that the better informed people are the easier it gets to make a well balanced decision on this issue.

When people undertake a variety of activities in their life they make an assessment of the risk involved.

In your professional opinion what is the greater danger that someone exposes themselves to when embarking upon airtravel.

The inherent risk of that mode of transport or getting in contact with chickenpox? Let alone getting infected by it or the even smaller chance of getting complications of it.

You write a very emotive posting and of course nobody wishes any of these conditions on anyone else, but it does nothing to help people making informed choices.

Do any of these people worry about travelling even though the risks of a DVT/PE is many many times greater than if they were not pregnant? No. Or use the pill in order to prevent to get pregnant. Anyone stopped the pill before they embark upon long haul travel?

If this about throwing around some impressive but meaningless figures you should tell everyone that they are 60 times more likely to have a DVT/PE than when using a contraceptive method like condoms. But condoms have a failure rate 5 times greater than the pill, failure means pregnancy means higher risk of DVT/PE and getting a baby with complications if I travel if there was a kid with chickenpox. How about infected kids without the typical lesions yet? Therefore stick them all in 10 day quarantaine?

And of course if you are worried about any of these conditions/risks you need to know that they are all magnitudes smaller than crossing the road.

Or living in your house. Or doing any DIY.

Would I advice any of my patient's to travel with a kid with chickenpox? No. Would I make a big deal of it if I found one amongst the passengers after we had taken off? No.

Do I think that most people should worry about these things? No.

There are better things to do with your time and energy!

Bon vols

FD
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Old 21st Mar 2004, 13:43
  #22 (permalink)  
 
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I also had adult chicken pox at age 21 and it was hell on earth.

The other thing is shingles I caught the CP off a collegues child who i was baby sitting for. Went to doctor and was signed off after spots were active for about a day. Unfortunatly while at work due to the joys of open planned offices one of the more elderly gents got shingles (which his doctor presumed was from me). He was off work for nearly 3 weeks and was in seriously painful way for much of this time.

I whole heartly agree with my grannys policy of throwing kids together at nursery with other kids who have these childhood lurgys. But it should be with everyones knowledge. Mind you in these days of suing each other for farting in the area of someone else I doudt nursery schools are allowed to even consider this to be allowed.

MJ
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Old 21st Mar 2004, 14:06
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chicken pox question

I felt I had to add my bit to this topic......

18 months ago I caught chicken pox whilst working as cabin crew.
The outcome was, that as a child I had never had it and thus as an adult it was severe and very nasty I can assure you. I had 5 weeks off work, was not allowed to return to work until some of the scarring had disappeared so as not to frighten pax. Not only did I suffer the discomfort of suffering from chicken pox, but the 5 week sick leave affected my chances at promotion...and not to mention the permanent scars I am left with. And when I was suffering I had to be very careful around my parents as it could have triggered another onset of 'Shingles' in my mother .

So I would say that anyone who knowingly takes a child with chicken pox onboard an aircraft and thinks they have done well to keep it hidden is VERY IRRESPONSIBLE. Remember the knock on effect it has all round - not how you feel discriminated against from the airline.

PLEASE PLEASE PLEASE DONT DO IT - I would not anyone to suffer as I did.

PS: I Forgot to mention I was 36yrs old at the time!!! So it is not just a childhood disease
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Old 21st Mar 2004, 15:32
  #24 (permalink)  
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Flyhardmo

You’ve provoked a very good debate and I tried to choose my words carefully so it didn’t appear as if I was having a personal dig at you, that’s why I referred to the, ““. . .selfish view described by Flyhardmo (who, to be fair to him, was acting on medical "advice") ” . It was more your doctor’s approach I found “disappointing” so I’m sorry you felt a bit put out. Chicken pox, incidentally, is spread by droplet infection so they are the ones who leave the germs on the door handles, hence the advice not to travel until all of the lesions have crusted over. People may not have complained because they probably did not notice the condition your child was in, and if they did they were probably not aware of the more serious complications of the disease. Most people aren’t, that’s why we get advice from “experts”.

Flyin’ Dutch

I tried not to be “emotive” in my posting but laid out the facts and figures as I read and understand them. If this is, to quote you, “. . .throwing around some impressive but meaningless figures”, and it “. . . does nothing to help people making informed choices”, then so be it. I won’t argue with much of what you say about the overall risk assessment of travelling and making informed choices, but I didn’t join this debate to discuss risk assessment, I joined to discuss chicken pox and travel. I felt a professional duty to impart some better sourced information about chicken pox and travel in order to assist others to make those “more informed choices”. If I’ve failed then that’s unfortunate but I don’t regret trying.

I agree with you that, in the overall scheme of things, the actual numbers who will be affected by this are small compared with some of the issues you mentioned, but the aviation industry has always endeavoured to reduce risk wherever it can, even if this seems obsessional to some. So, as I write, the rules still dictate that you will get a life jacket under your seat, you won’t be allowed to use your mobile phone for most of the time you’re on board, those with infectious chicken pox can’t travel, and if you get offloaded for any of these reasons your bags will be offloaded with you regardless of the delay it causes.

All I can reiterate to those not qualified in aviation medicine is that the rules in many countries state that people suffering from infectious diseases should not be permitted to travel. Chicken pox is classed as an infectious disease 4 days before the rash develops until all of the lesions have scabbed over. If the staff checking you in, or those on the aircraft, suspect you have chicken pox then they are obliged by law to forbid you from travelling or to offload you. Your insurance should cover it.

I personally have no really strong feelings about this and am only the messenger, so please don’t shoot me.
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Old 21st Mar 2004, 16:10
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Let's just get some facts correct:

1. Shingles are not the result of a primary infection with chickenpxo but a reactivation of the virus which lies dormant in the dorsal ganglia after you have had an infection with chickenpox. Once you have had chickenpox you will carry the virus. Nothing you can do about it.

So MJ you colleague did not get his shingles off you! And DD you could not have triggered another outbreak of shingles of your mother.

2. Although chickenpox is classed as an innocent childhood disease it can happen at all age ranges and in common with other childhood diseases contracted at a more mature age a much more debilitating course. Mononucleosis infectiosa (kissing disease) is another one.

3. Although rare people can have chickenpox more than once.

FD
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Old 21st Mar 2004, 16:32
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Excuse my earlier rant which deflected the thread, luckily now the drugs are starting to wear off.
However there seems to be a very serious problem if doctors are suggesting to passengers to blatantly ignore the rules, especially if the doctor is not a aviation specialist. I have total sympathy with people in this situation, whether trying to get home or if it is the start of their hard earned holiday. I would be desperate to hear someone saying just to go home. However a doctor has a professional responsibilty to do the right thing. My responsibilty as a Captain is the safety and well-being of EVERY person on board the aircraft. What if I took this attitude of everything being alright. Would passengers be happy if I just had a little look below MDA, or accepted a loadsheet 500 kgs overweight. Of course the chances of anything bad happening are small, but what if? Would you like to be responsible?
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Old 21st Mar 2004, 16:34
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How can you avoid getting shingles again then?

From what the chap went through I will do my upmost to stop reactivating my chicken poxs again!!
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Old 21st Mar 2004, 16:43
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In one short answer: You can't!

Most people accept that shingles usually occurs if people are a bit worn out either physically, emotionally or a combination of both.

Sometimes there seems to be no particular reason.

Obviously if you have a problem with your immune system you are more prone to having an outbreak.

Most of the time it is a major nuisance for the sufferer but the mainstain of treatment would be symptom (read pain) control.

Unless you fall in a few defined categories you would not be treated with antivirals (in the UK that is)

Main exception on this rule is if it affects the face and more in particular the nose as this indicates that the eye is at risk of being involved, with potentially dire consequences.

As shingles happens mostly on parts of the body covered by clothing the chance of infecting others (and causing chickenpox NOT shingles) is thought to be very small.

FD
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Old 21st Mar 2004, 22:57
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Only just noticed this lunatic thread!

FD, my friend, I'd like to give you some support. The opinions being expressed in this thread are a clear indication of the way in which risk perception in society has gone completely out of proportion. The words 'storm' and 'teacup' come to mind.

And as for this:

Do they offer immunizations to Varicella in the UK? I would certainly reccommend getting one for my child or anyone who has not had chickenpox
I would not recommend this. A non-immune adult, especially a healthcare professional, is another story, but a child is quite probably better off with chickenpox, which tends to be a mild illness in children. At least they know they will then have lifelong immunity, something they cannot be sure of with the vaccine.

QDM
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Old 22nd Mar 2004, 04:45
  #30 (permalink)  

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There is much interesting reading here, and for what it is worth to help foster an understading of the situation,

IMHO there are lots more very nasty and much higher risk lurgies to a wider population than chicken pox on aircraft, and very few will be picked out during a check in. Some folks will not even know they have diseases that are transmissible to other parties. Modes of transmission of a disease agent are important in discussing the infective possibilities. Some diseases require carriers, the length of time the agent can remain dormant or active is also important as is the specific immunogical status of a population. (eg the early American indian and Australian aborigine populations had little exposure to the normal childhood diseases the european populations brought with them and thus utter destruction of large family groups occured.)

Saying that, in most cases a healthy body will fight off infection with the valour most would attribute to heros. It happens every day without you knowing it. Some really nasty critters live within your own system, and whilst under effective control, folks remain happily assymptomatic. (no symptoms)

Folks at risk, will usually have been advised as dicussed earlier. Most people will not want to deliberately put any one else at risk. Every parent wants the best life for their child, and thus does not want them every to get sick. Its a miserable experience nursing a crook kid. Due to the way an immune system functions, disease exposure and re-exposure build immune systems, and fortify them, building a "log of disease ID's" that it usually retains to some extent for life. (synthetic and "innert" vaccines aside) which is where I totally agree with QDM.

(Please dont take this as a justification to turn up to work with the flu commin on! Sniffles and snuffles are produced from an ever changing array of influenza and rhino type virus's). Im not real fussed on catching anything just like the next person.

I also am immunised with a flu virus every year. As a health professional, if I catch something and the infective period is assymptomatic, then I am putting my patients at risk. Sick or traumatised persons are much more susceptable to infection than a healthy person. As an adult who caught whooping cough a couple of years ago (not pleasant!!!!!!!!!) was misdiagnosed twice, and sent back to study. I was crook so I went home. Ironically, right through the infectious period. It wasnt definitively diagnosed until the third week as in the opinion of one chap, sure sounds like whooping cough commin on, but adults dont get whooping cough!

I contracted it from some kids whose parents thought it would be quite alright to knowingly send their infective, and presymptomatic and symptomatic children to a health care training unit (normally no patients are anywhere near this facility) It put quite a number of health care professionals off road and on antibiotics over a period of weeks, where no other source of pertussus bacteria was found.

My opinion of these parents wasnt high, but they made an informed decision to send their children for training even though the children were quarrantined! This is a totally different scenario to the above where an informed decision to travel was made after consultation.
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Old 22nd Mar 2004, 09:30
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FD take the argument about risk management.

Probably about 90 % of the passengers will be immune, having had the disease earlier in their life. Of the 10% remaining, most of them will be fit and well, and will probably go on to catch the disease later in life anyway. In fact, some may be glad to catch the disease, and gain immunity, at a time when they are fit and well (enough to travel anyway). So the risk to public health is fairly slim. (And as you point out, there is no evidence to suggest the risk to public health is greater without restrictions.)

However, from a risk management point of view, isn't the "cost" to the parent, of not travelling, in this case, fairly low, as they are likely to be covered by insurance.

Interesting debate, I may re-evaluate where I stand....up until now I used to sign the forms and recommend patients with varicella do not travel.

I declare a personal interest, my honeymoon was recently cancelled as my wife got the spots one day before our departure. (It all turned out ok in the end).

Last edited by gingernut; 22nd Mar 2004 at 09:55.
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Old 22nd Mar 2004, 12:22
  #32 (permalink)  
 
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To be honest I have learnt alot about chickenpox from this thread, and if and when I have kids the little buggas are getting sent round pronto to play with any kid which comes down with it.

But getting my pilots hat on it isn't really the job of the medics to say if the child is allowed to fly. They are there to say yes/no the patent has a condition.

Its up to the airline and in the last case the Captain to decide if they will accept the pax. There are a whole heap of regulations out there with immigration and public health which doctors don't have access to for every country. If the pax turns up in a country with a bug and the locals spot it ( even if there is valid western data to suggest it isn't a problem) it could still mean a lengthy grounding of the plane and huge fines. The airlines also have a duty of care to the other pax. And by excepting a pax with something which there is even a remote chance of passing it on to anyone else they would be breaking this duty of care. And I would imagine the lawyers would have a field day in court.

I havn't read the full pax contract but i think there is a section which states that it is the duty of the pax to inform the airline of any medical condition which is likely to cause problems in flight or is infectious. If you don't tell the airline it is possible that if anything happens they could come after you for any lost revenue and fines imposed due to your action (not a lawyer and don't know if it has ever happened) this could be into 7 figures for a 747. I have heard of divers being billed for a diversion after getting a bend mid flight.

MJ
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Old 23rd Mar 2004, 04:17
  #33 (permalink)  
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Infections in general on aircraft:

Despite my previous quasi-vitriolic condemnation of people that willfully infect others, I did have a situation in latter years when at an away base and a "nobody to replace you...cost thousands...pax stranded..." type of call from crewing made me decide to carry on with a streaming cold. After all, I had got it from a F/O that had received a similar call.

I felt OK, it's just that I looked like a ball of snot with stripy shoulders.

The point is, that I took extreme measures to protect my crew from infection. Every cough/sneeze was into a damp paper towel, and anti-bacterial wipes were used on the power-levers etc. etc.. I had read somewhere, that infections usually associated with airborne viruses, are very often conveyed in a similar manner to bacterium; a contagious transmission if you like. The anti-bug product is seemingly strong enough to at least break down the fluid carrier, if not the virus itself. Anyway, we seemed to break the infection chain.

This care has produced good results many, many times in the confines of our home, but while I take care as a PAX, I'm afraid my fellow travelers do not. The last flight, people were coughing, mouths wide open, not giving a.........care. I doubt that one of these people would have punched my wife on the nose, yet the throbbing ache of full blown flu for a week and a half, is probably much worse, and this is what she got. I just do not know what the answer is for this kind of selfishness.

Has there been any studies on the effectivity of paper masks v viral infections. I had always assumed that as a virus is so small nothing would filter it out, but the carrier fluid is another matter. Any comments?
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Old 26th Mar 2004, 18:13
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BRL,

Having just skimmed through this post (it's been a loooong day) it occurs to me that amid all the ranting and raving no-one's answered your question. (Apologies if someone did and I missed it.) According to our copy of the Children's Health Bible, the infectious phase of the condition runs through the incubation period (11 - 14 days prior to the appearance of the spots) to 72 hours after said appearance. This is fresh in the memory as our 11 month old has just had the chickenpox ..... luckily prior to our recent holiday!
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Old 27th Mar 2004, 21:47
  #35 (permalink)  

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I'm with Flyin' Dutch on this one. I strongly suspect that we've gone over the top with our attempts to avoid infection, so that now people's immunity is reduced because they so rarely come into contact with diseases.

Years ago I spent several years working as a market research interviewer. I came into contact with the public at large - in their homes, at work, in the street. I often interviewed sick people: "I don't mind taking part, but I' ve got flu". I was out in all weathers, often soaked, working long hours. And I virtually NEVER even caught a cold! I don't think I had a day off work, in eight years.

Now, meeting far fewer people, I pick up considerably more colds and viruses. I think I should try and get out more.

When I was a kid, we all caught every infectious disease going, got over them, and no further problems. There was no fuss, and no-one died.

So I do rather wonder if the world's gone mad. Personally I'll be happy to sit next to someone's sick kid next time I fly.
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Old 27th Mar 2004, 21:53
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So I do rather wonder if the world's gone mad. Personally I'll be happy to sit next to someone's sick kid next time I fly.
I agree. People don't understand risk these days and the Daily Mail, combined with basic innumeracy, is a major factor.

QDM
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Old 27th Mar 2004, 22:52
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At odds with my earlier posts I tend to agree. Our obsession with cleanliness especially with young children completely wipes out our immune system. Chickenpox is a difficult one. Proving whether somebody is infectious must be difficult. You are taking the word of the individual of when the spots came out. The bottom line is that the airlines have rules, and I would think the doctor involved is taking a huge risk advising a family to ignore them. Even recently I have been told by a doctor that he cannot sign a fit to fly cetificate for my wife to fly at 29 weeks pregnant, because the BMA advise them of liability problems.
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