Chickenpox

Chicken pox (varicella) is a very contagious viral disease. Once a common childhood illness, its incidence has been dramatically reduced by routine childhood immunization. Before the chickenpox vaccine became available, approximately 4 million U.S. children had chickenpox each year; it caused about 100 deaths annually.

Chicken pox may be severe, especially in infants, adults and people with impaired immune systems.

The illness is usually spread by breathing in droplets that are coughed, sneezed, or exhaled by an infected person. After exposure, it can take 10 to 21 days before symptoms appear. A person usually develops the symptoms 14 to 16 days after being exposed and can spread the disease to others before he or she even has any symptoms of chickenpox. The contagious period begins about one to two days before the rash appears and continues until new sores stop appearing. Once all the sores have turned to scabs, the contagious period is over.

Symptoms

The early symptoms of chickenpox may include cold symptoms, fever, abdominal pain, headache and a general feeling of illness. These can come with the rash or a day or two before it. The fever may be higher the first few days after the rash appears.

The rash appears as small, itchy, red bumps and spots on the face, scalp, shoulders, chest and back. It is also normal for it to appear inside the mouth, on the eyelids and in the genital area. Some people may have just a few bumps, while others are covered with them.

The early bumps are usually flat, red marks that enlarge to form clear blisters surrounded by a red ring. The blisters quickly dissolve and become dry crusts or scabs, which fall off within two weeks. New sores continue to appear for the first four to five days, so all stages of the rash may be present at the same time.

Complications of Chickenpox

Chicken pox may leave permanent scars, especially in teenagers and young adults. Temporary marks may remain for six months to a year before fading.

Chicken pox can cause viral pneumonia or encephalitis, and the lesions can become infected, a condition called cellulitis. Cellulitis is a serious bacterial infection of the skin, which becomes red, tender, swollen and unusually warm.  The varicella virus can infect the lungs, causing fever, cough and shortness of breath. Encephalitis, an infection of the brain, is a very rare complication of chickenpox. Still, it's wise to be alert to its symptoms: fever, mental confusion, forgetfulness, tiredness and a stiff neck. Take the person to the doctor's office or emergency room at once if you notice any of the symptoms associated with these three conditions.

It is rare for a person to have more than one case of chickenpox in a lifetime. Although a case of chickenpox brings immunity to the virus, the virus may lay dormant in the body and later be reactivated in some adults, causing a different rash. This often painful rash, called shingles (or herpes zoster), is more common in people older than age 60.

For those over the age of 60, a vaccine, Zostavax, was licensed by the FDA in 2006 to prevent shingles. Shingles is a disease caused by the varicella-zoster virus, the same virus that causes chickenpox. After an attack of chickenpox, the virus lies dormant in certain nerve tissue. As people age, it is possible for the virus to reappear in the form of shingles, which is estimated to affect 2 in every 10 people in their lifetime. Shingles is characterized by clusters of blisters, which develop on one side of the body and can cause severe pain that may last for weeks, months or years after the virus reappears. Studies showed that the vaccine reduced the occurrence of shingles in those over the age of 60 between 50 and 64 percent. 

Self-Care for Chickenpox

• Give plenty of cold fluids.

• To reduce fever, give acetaminophen (Tylenol or Tempra). Do not use aspirin or aspirin-containing products.

• To relieve discomfort from mouth ulcers, prepare a soft, bland diet. Avoid salty foods and citrus fruits and juices.

• For painful or itchy pox in the genital area, apply a petroleum-based ointment or an over-the-counter local anesthetic.

• If a sore seems to be infected, wash with antibacterial soap and apply antibacterial ointment.

• Call your doctor if fever is higher than 101 F for more than 4 days.

• Children don't have to stay in bed but should be kept cool and quiet.

• Children may return to school or day care when they have no fever and all sores are crusted over.

Scratching the scabs off chickenpox sores can lead to more itching, infection and scarring. These steps will help reduce the urge to scratch:

• Take cool baths every 3 to 4 hours.

• Add an oatmeal bath product, such as Aveeno (follow directions), or baking soda (about a half cup) to tub water to reduce itchiness.

• Give acetaminophen or another non-aspirin pain reliever if symptoms are very bothersome.

• Keep fingernails trimmed short and wash hands often to prevent infection.

• Wear clean cotton gloves (or socks on the hands) to bed to reduce the danger of scratching while asleep.

• Apply calamine lotion or hydrocortisone products to itchy areas. Caladryl is helpful too, but on rare occasions people can develop an allergy to it.

• If you have been exposed to chickenpox and are immunocompromised, pregnant or have had a bone marrow transplant, see your doctor.

Reye's Syndrome

Children and teenagers should not take aspirin or aspirin-containing products because aspirin may be linked to Reye's syndrome, a dangerous condition of the liver and brain. Reye's syndrome sometimes develops as a complication of viral illnesses such as influenza and chickenpox. Although it is uncommon, it is seen more often in children who have been treated with aspirin.

Preventive Care for Chickenpox

If you've been exposed to chickenpox, call your doctor. Medication called immune globulin antibodies or immunization may prevent the disease.

• Avoid contact with others during the contagious period (until all sores have turned to scabs). That means anyone with chickenpox should not be at work, school or day care while contagious. If other people may have been exposed to the disease, be sure to tell them to watch out for spots about two weeks from the date of exposure.

• It's nearly impossible to prevent the spread of chickenpox among unvaccinated people within a household. Most times, siblings of a person with chickenpox will get the disease.

• If you need to take the person to the doctor's office, call ahead and tell the staff that you suspect chickenpox, so arrangements can be made to avoid spreading the disease to other clinic patients.

In most cases, people with chickenpox don't need to go to the clinic. The condition can be successfully handled at home with calls to the doctor's office for advice. Your doctor may recommend medication that can shorten the length of the disease or result in fewer sores if taken within the first few days of the onset of the rash.

Chickenpox Immunization

The varicella vaccine for chickenpox has been approved for general use in the United States since 1995. It is recommended for children over one year who have not had chickenpox.

Initial varicella immunizations are normally given between 12-18 months although it can be given to anyone at any age.  In 2006 the Advisory Committee for Immunization Practices (ACIP) recommended a second dose of varicella (chickenpox) vaccine for children four to six years of age.  In addition they recommended a second dose for any adult previously immunized against chickenpox.

If you haven't had chickenpox or been vaccinated, you should consider vaccination if you are in any of these groups:

• You work in a hospital, day care or other setting that puts you at risk for the illness.

• You are a parent of young children.

• You live with or are in contact with people who have a weakened immune system.

• You are a woman of childbearing age, but NOT pregnant.

• You travel internationally.

You should not get the vaccine if you are pregnant or if your immune system has been affected by disease or medication.