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Direct Link To This Post Topic: Chickenpox killed our son (squeemish pic included)
    Posted: Sep 01 2009 at 5:30am

Chickenpox killed our son: How a little boy died just three weeks after the first spots appeared

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By Jo Waters
Last updated at 9:13 AM on 01st September 2009

An itchy rash. A bit of a temperature. For most children, chickenpox is easy to shrug off. But this tragic story will terrify any parent.

Ricardo Alves-Nunes spotted the tell-tale signs of chickenpox on his five-year-old son Fabio's face as he got him ready for school. 'Fabio was full of beans, just like he was on any other day, so I wasn't too worried about the three red spots on his cheeks,' says Ricardo, 37.

'Like most parents, we thought it was a good idea for him to have chickenpox young and get it over with. We both knew it could be a lot more serious for an adult. We kept him off school and waited for more spots to appear.


Healthy: Fabio Alves-Nunes before he was struck with chickenpox

'My wife, Anna, phoned the GP to check if she needed to bring him in, but the receptionist told her it wasn't necessary. I'm from Madeira originally and Anna is Polish, and we've always had high regard for the NHS and trusted their advice.'

Little did the family know that Fabio would be among the one-in-100 chickenpox patients who suffer complications from the virus - and that three weeks later he would be dead. Around 95 per cent of children catch chickenpox before the age of 16, and for most it's a mild illness leading to itching, blisters and sometimes a high temperature. It's caused by the varicella-zoster virus and is highly contagious, usually lasting a week to ten days.

In an estimated one per cent of cases, though, serious complications can develop such as pneumonia, meningitis, encephalitis ( inflammation of the brain), inflammation of the heart and toxic shock, a type of blood poisoning - all usually down to impaired immunity.

Experts have calculated that complications may result in 6,700 children's hospital admissions a year in the UK. Indeed, there were 28 deaths from chickenpox in England and Wales in 2007, the latest figure available, including nine children.

Fabio's spots first appeared on February 7, 2008, but over the next few days Ricardo, a chef at a boarding school, and Anna, 36, from Redhill, Surrey, began to feel increasingly uneasy, despite being told a visit to the GP was unnecessary.

'Fabio had suffered from severe eczema outbreaks since he was a baby - he'd even seen the GP two weeks earlier because his skin had become so sore. The chickenpox spots just made it worse,' says Anna.

'As he scratched the blisters, they turned into sores and began to weep pus. He was extremely distressed, which was heartbreaking to see.'

By February 13, nearly a week after the first spots had appeared, Fabio was getting worse. Usually by this stage, the spots have begun to scab over and the worst is past.

'The doctor simply prescribed antibiotics and said I should carry on giving him Nurofen. I blame myself now that I didn't challenge the doctor'


Anna was so worried she phoned her GP surgery for a home visit. 'He had a high temperature and could barely open his eyes because they were so swollen,' recalls Anna tearfully. 'But the receptionist told me a home visit wasn't necessary and that I should give him a cool bath and some Calpol. At no point did she consult a doctor.

'I was upset, but didn't argue. All three of our children - Patrick, 12, Fabio and Olivia, who is now three - had been treated for severe eczema by the NHS and received good care. We had no reason to doubt them.'

But over the next 24 hours Fabio's condition worsened. Anna called the surgery again late in the afternoon. When she was referred to an outofhours service, she begged her brother, Jacek, to drive her to A&E at East Surrey Hospital a few minutes away.

'By this stage both Ricardo, who was home from work, and I knew Fabio needed urgent attention. The only time he stirred was when we touched him and that was because the pain woke him.

'I took a photograph of him before we left for hospital and thought I would be showing it to him when he'd got better to give him some idea of how ill he'd been. At the hospital, Fabio was so weak he had to be taken upstairs in a wheelchair.

'When I showed the doctor his open wounds I felt sure he would be admitted - if nothing else, I thought there must be a danger they could become badly infected. But the doctor simply prescribed antibiotics and said I should carry on giving him Nurofen. I blame myself now that I didn't challenge the doctor.

'The next three days were a nightmare. Fabio barely ate or drank and his skin was so raw and weeping that I had to change his pyjamas four times a day,' says Anna. 'Every morning his sheets were stained with blood.'

'But we trusted what the doctors had told us, so I never thought to take him back to hospital - of course, I see that was a mistake now.'

On February 17, Fabio began to lose consciousness. Ricardo says: 'I carried him downstairs and his head rolled back - I thought he was dying. I called 999, but they sent just one paramedic.' 


Blistering: Fabio pictured just four days apart as his spots scabbed over. Shown the open wounds, doctors simply prescribed him antibiotics

Although back-up was called, the crew were happy to leave Fabio at home and it was only on Ricardo's insistence that he was eventually taken to East Surrey Hospital.

'We spent three-and-a-half hours in A&E. When a doctor eventually came, I could see the shock and panic in his eyes. They couldn't even take any blood samples, as Fabio was so dehydrated,' says Ricardo.

'He was eventually admitted and I stayed with him while Anna looked after the other children at home. Fabio woke me several times that night asking for sips of water.

'When the nurses put bandages on, they used the type used on burns victims. No one gave us any indication that his life was in danger; we just thought: "Thank God he's finally getting treatment; he'll be OK now." '

But on February 18, Fabio's condition deteriorated and he was transferred by ambulance to the Evelina Children's Hospital in London.

'When we arrived, doctors warned us that he was very sick and might not survive,' Ricardo says. 'We were totally shocked. How could a skin infection have made him so ill that he was fighting for his life? Still, no one really explained what was wrong or what treatment they were going to give.'

It was only after Fabio's death that a post-mortem revealed he had developed toxic shock, a type of blood poisoning caused by the bacteria Staphylococcus aureus. A rare complication of chickenpox, the bacteria produces a poison which enters the bloodstream through a wound and can cause organ failure.

Fabio was given fluids and antibiotics and spent the next ten days on a respirator, which took over his breathing function and supported his organ function. He appeared to stabilise.

Anna's brother was now looking after the other children, who also had chickenpox (although less severely) so both Ricardo and Anna were able to stay with Fabio at the hospital.

'When we arrived, doctors warned us that he might not survive. How could a skin infection have made him so ill that he was fighting for his life?'


We talked to him and played CDs of his favourite songs and stories. He loved the Crazy Frog song and Winnie the Pooh; when we played them, he would squeeze our hands and move his head - he really wanted to live.'

Sadly, it was too late; Fabio died on March 1 of multiple organ failure. A priest came and said prayers at his bedside and they sat and sobbed together. 'The hardest thing was telling Patrick,' says Ricardo. 'Olivia was too young to understand, but Patrick cried a lot and asked to come and sit with his brother Fabio.'

Friends, family and teachers from Fabio's school crowded out the chapel near the family's home for his funeral.

Seventeen months on and the couple remain devastated. Anna and Ricardo blame themselves - but feel staff at the GP surgery and East Surrey Hospital failed them.

Anna, who has been treated for depression, says: 'Our family is shattered. I feel mistakes have been made and my son paid the price with his life. I want those responsible held to account.'

The family complained to the hospital after Fabio's death and had a meeting with officials, but it took until June this year to get a formal apology or explanation of the events that led to Fabio's death.

Such deaths are rare, but Ricardo and Anna feel the risks of complications should be highlighted to patients and doctors.

Skin diseases like eczema are not believed to put patients at higher risk of chickenpox complications, says Adam Finn, professor of paediatrics at Bristol University, with a special interest in chickenpox. Those thought most at risk are pregnant women, people with suppressed immunity or babies under four weeks old.

'Unfortunately, it is not easy to predict which of the thousands of children who get chickenpox every year will develop severe complications. I took part in a research study which proved exactly that.'

He says there are no specific symptoms which would alert parents to the fact that their child was developing complications, but if your child is not showing signs of improvement you should seek medical advice.

But as around 700,000 children get chickenpox every year, many experts - including Professor Finn - believe vaccination against the virus is the most effective way of preventing deaths.

This is under consideration by the Government's Joint Committee on Vaccinations - although some doctors speculate that adding another vaccine to the schedule might further damage the uptake of the MMR vaccine, a potentially important risk as measles cases are rising.

But this is all too late for Fabio's family.

'A coroner's inquest found that Fabio died of natural causes, but how can it be "natural" for a child to die like Fabio did?' says Ricardo. 'For some reason, I wasn't allowed to give evidence at the inquest. I had a letter prepared about his eczema - but this wasn't discussed. It was as if they were saying it wasn't relevant.'

'A coroner's inquest found that Fabio died of natural causes, but how can it be "natural" for a child to die like Fabio did?'


Now an independent investigation team, led by paediatric doctors and nurses from nearby Darent Valley Hospital, has published a damning 26-page report on what went wrong with Fabio's care at East Surrey Hospital.

The report reveals a catalogue of 'missed opportunities' to treat the boy's condition earlier and more aggressively, poor communication between doctors and a culture where nurses said they felt unable to challenge medical opinion.

Names of staff are blacked out, but the report clearly states the care provided by three doctors at the hospital 'fell below the standard expected from a paediatric unit in a District General Hospital'.

Dr Gareth Tudor-Williams, reader in paediatric infectious diseases at Imperial College, London, says: 'It is easy to be wise after the event, but if a five-year-old child with chickenpox, a history of severe eczema and a heart rate of 164 presented to hospital, I would say unequivocally that he should be admitted and given acyclovir (an anti-viral treatment for chickenpox) intravenously.

'Alarm bells should be ringing.' Gail Wannell, chief executive of Surrey and Sussex NHS Healthcare NHS Trust, says: 'Fabio's death was tragic and we offer our deepest sympathies to his family and friends.

'At the inquest, the coroner reviewed all the care Fabio had received and concluded there was no evidence that the outcome for Fabio would have been different had he been admitted sooner.'

But Ricardo and Anna are not satisfied with the response.

'People say we should sue the hospital, but money would not give me the answers I need, and until I get those I won't have any peace,' says Ricardo.

The couple are now making a complaint to the Parliamentary and Health Service Ombudsman in a bid to get the answers to the questions they feel have not been dealt with by the Trust, and may also launch legal action.

'We have to find out what went wrong for Fabio, to stop it happening to another child.'


Edited by jacy_babi - Sep 02 2009 at 3:12am
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dynamite23 View Drop Down
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Direct Link To This Post Posted: Sep 01 2009 at 5:34am
Shocked the last pic. OMGCry
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Direct Link To This Post Posted: Sep 01 2009 at 5:38am
Cry Poor kid.....Cry May he RIP.Unhappy

The doctors/paramedics/nurses have been negligent but for real chickenpox is so common and harmless usually that I can understand their reactions........

Makes me even more scared to send my son to kindergardenConfused

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Direct Link To This Post Posted: Sep 01 2009 at 5:43am
oh yh i heard about this!!!!... this seems rare....
u r meant to have chicken pox at a v young age to builld up ur immune if u dnt get it  and just keep having vaccination jabs every 5 yrs also u will die from it at an older age if u do contract it (shingles)
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Direct Link To This Post Posted: Sep 01 2009 at 7:13am
Wow !
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Direct Link To This Post Posted: Sep 01 2009 at 7:19am
OMG! Cry
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Direct Link To This Post Posted: Sep 01 2009 at 7:20am
wow, that sound slike someone miss something, because Pox is not that bad by itself.  SOunds like there was something else wrong with the very sad indeed
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Direct Link To This Post Posted: Sep 01 2009 at 7:27am
This is just heartbreaking..........that poor little boy!!Cry 
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Direct Link To This Post Posted: Sep 01 2009 at 7:37am
wow. thats horribleCry
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Direct Link To This Post Posted: Sep 01 2009 at 7:43am
Oh my! Any childhood infection has the potential to be dangerous. I'm not blaming the parents, but doctors aren't always right. We have HAVE to be advocates for our kids and ourselves. If it doesn't feel right to you as a parent-- get a second opinion. You have your baby everyday-- you know how they are when it's not that serious. That poor baby.
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