Recently moved to the Netherlands? Not immune to chickenpox? Small kids? Fancying another baby? Then, there’s hardly room for debate. You should do yourself a favor and get the chickenpox vaccination in the Netherlands.
When it comes to this vaccination, the sooner, the better, because it’s not a matter of if, but a matter of when. Like me, you might even catch it before your own kids do – and let’s just say that chickenpox in adults is no walk in the park. On the other hand, whether or not you should vaccinate your kids is a different question. There are pros and cons and this article won’t attempt to tilt the balance. We’d rather leave that to health professionals. But if, whatever your context, you’ve made up your mind and you intend to go ahead with the varicella jab, then read on and you might just save yourself a headache.
Chickenpox Vaccination in the Netherlands: How chickenpox is dealt with in Holland
I caught chickenpox exactly two months into my new life in the Netherlands and exactly 18 weeks into my second pregnancy. Admittedly, not the best timing. Back then, I was blissfully unaware that chickenpox is, in fact, a Dutch rite of passage.
The varicella vaccine is not part of the routine childhood vaccination schedule in the Netherlands. There is no such thing as chickenpox quarantine here. Contagious children return to daycare, school and playgrounds, oozing blisters and all. The universally accepted argument being that they were already contagious for about 48 hours before rash onset. Obviously, exposing contacts to an extra 5-7 days of rash, instead of just the 48h prodrome, can only maximize the number of cases.
It is, essentially, a big chickenpox party. This means that almost all children will have been infected by the time they complete primary school. There are virtually no vulnerable Dutch adults. Good for them! In the meantime, the rest of us are merrily playing Russian roulette. Unsuspecting, way too busy taking in the canals and the windmills and the tulips, to think about something as nasty and improbable as chickenpox in adults. Or chickenpox in pregnancy, if you drew the short straw.
Chickenpox Vaccination in the Netherlands: Chickenpox in Adults? Yes, it’s possible
While sick with chickenpox, I had to spend two nights in the hospital, on intravenous antivirals, in strict isolation. Minutes after I had arrived at the hospital reception desk, they dressed me up from head to toe in single-use scrubs, including surgical hair net and gloves. My eyes were the only part they did not cover.
Not surprisingly, the elevator ride to an upper hospital floor was tragicomic. Everybody else in the elevator looked absolutely horrified, wondering what kind of lethal, end-of-the-world virus they were sharing the elevator with. Despite the state of shock, I felt a nervous smile stretch the already tense muscles of my covered face. I mumbled some awkward reassurance words and mentioned it’s just good old chickenpox. Only to realize they cringed even more and stared at me as if I was nuts. The fact that I had opened my mouth to articulate a few words, even if from behind the surgical mask, was anything but reassuring to them. Of course, given the huge contrast between the way the hospital handled my case and the lax attitude toward chickenpox in day-to-day life, how could have anyone in that elevator believed that it was just chickenpox?
The midwife’s first question, upon admission to hospital, was whether I wanted to terminate the pregnancy. She warned against the risk of the unborn baby getting the congenital varicella syndrome (CVS). It is a dreaded complication that manifests with a wide range of serious birth defects and vision problems. The baby may suffer from intrauterine growth restriction and/or seizures and development disabilities once born. The infection also increases the risk of stillbirth and miscarriage. The risk for congenital varicella syndrome is highest if the mother is infected between pregnancy weeks 13 and 20. All in all, a grim picture. Yet, just a 2% risk, even with my worst case timing, so I was baffled by the midwife’s question.
Fortunately, I had done my homework on the possible complications of chickenpox during pregnancy. It also helped that two friends of mine had been through the same ordeal and had come out just fine. So I was able to shake off the initial shock and carry on throughout the course of the disease and the rest of my pregnancy. Many sleepless nights and several extra-careful ultrasounds later, my chickenpox baby was born. Perfect, with no varicella sequelae. The all-clear from the paediatric team was a huge relief. Still, a chickenpox vaccination before pregnancy would have made my life much easier. Sometimes, learning from mistakes is just not worth it.
Chickenpox Vaccination in the Netherlands: Where to go
If you have your mind set on the varicella vaccine, the go-to place for official information is the RIVM (Rijksinstituut voor Volksgezondheid en Milieu) website. It has a comprehensive section on chickenpox vaccination (waterpokkenvaccinatie), which you can easily translate to English, if necessary.
According to RIVM, the chickenpox vaccination in the Netherlands is only available on prescription from your GP (huisarts), GGD or a private vaccination centrum – and, of course, you have to pay for it. In practice, however, the GP is your best bet. Depending on where exactly you live in the Netherlands, the vaccine might also be available at the GGD travel vaccinations center (reizigersvaccinatiebureau) – but, usually, it is not. For instance, GGD Hart voor Brabant has the varicella vaccine on stock and includes chickenpox vaccination on its custom vaccinations price list (at 74.50 EUR). GGD Amsterdam does not stock the vaccine, nor are they willing to make custom orders or issue prescriptions for the vaccine. Major private travel clinics, such as Thuisvaccinatie or KLM Health Services, don’t offer the vaccine either.
Sure, it sounds like a good idea to have the jab administered in an established vaccination center, by experienced professionals. Unless you live in the right place, though, you will have to knock on your GP’s door. Nothing wrong with that, you’re probably thinking. Well, it depends. Most GPs will cooperate when it comes to adult vaccinations, but many will try to talk parents out of vaccinating their children against chickenpox. Some of them do so out of the conviction that only infection with the wild virus guarantees lifelong immunity. Others, however, are reluctant to step out of their comfort zone with a vaccine that they barely knew existed (true story). Especially when this requires sticking a needle into the arm of a restless toddler.
If you wish to vaccinate your child, but your GP insists that you should instead, go to the GGD Consultatiebureau (another true story), don’t buy into it. The Consultatiebureau doesn’t stock the varicella vaccine. Moreover, according to current regulations, they are not allowed to administer a vaccine for which they cannot guarantee cold chain compliance. In plain English, the Consultatiebureau won’t give the shot if you had to bring it over yourself from the pharmacy. Why this common-sense regulation does not extend to vaccination at the GP office is beyond my comprehension.
According to RIVM, three specific chickenpox vaccines are licensed for use in the Netherlands: Provarivax, Priorix-Tetra and ProQuad. Provarivax is a monovalent vaccine. It contains a live attenuated strain of the varicella-zoster virus. Priorix-Tetra and ProQuad, on the other hand, are combination vaccines, which contain measles, mumps and rubella in addition to varicella. So if MMR immunization status is up-to-date, Provarivax is the logical choice. Assuming all went well with your GP and the vaccine is now available at your local pharmacy, take one final step. A peek in the bag, to make sure that you’re actually getting the right product. Mistakes are not unheard of, considering the lack of overall experience with chickenpox vaccination. You don’t want to end up with the shingles vaccine or, worse, varicella-zoster immunoglobulin (yet another true story).
Do you have any experiences with the Chickenpox Vaccination in the Netherlands? Let us know in the comments!