Chickenpox

Definition

Chickenpox (varicella) was once considered a rite of passage for most children. Before routine chickenpox vaccination, virtually everyone had been infected by the time they reached adulthood, sometimes with serious complications. Today, the number of cases and hospitalizations is down dramatically.

However, when chickenpox does occur, it's highly contagious among people who aren't immune. Most people think of chickenpox as a mild disease — and, for most, it is. Unfortunately, there's no way to know who will develop a severe case.

The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications.

Chickenpox

Chickenpox

Chickenpox consists of an itchy, red rash that breaks out on the face, scalp, chest, back and, to a lesser extent, arms and legs. The spots quickly fill with a clear fluid, rupture and then turn ...

Symptoms

The signs and symptoms of chickenpox are:

• A red, itchy rash, initially resembling insect bites, on your face, scalp, chest and back
• Small, liquid-filled blisters that break open and crust over
• Fever
• Abdominal pain or loss of appetite
• Mild headache
• General feeling of unease and discomfort (malaise) or irritability
• A dry cough
• Headache

The chickenpox rash goes through these three phases:

• Raised pink or red bumps (papules), which break out in different spots over several days
• Fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking
• Crusts and scabs, which cover the broken blisters and take several more days to heal

New bumps continue to appear for several days. As a result, you may have all three stages of the rash — bumps, blisters, and scabbed lesions — at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over.

The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, and lesions may form in the throat, eyes and mucous membranes of the urethra, anus and vagina. New spots continue to appear for several days.

When to see a doctor
If you suspect that you or your child has chickenpox, consult your doctor. He or she usually can easily diagnose chickenpox by examining the rash and by noting the presence of accompanying symptoms. Your doctor can also prescribe medications to lessen the severity of chickenpox and treat complications, if necessary. Be sure to call ahead for an appointment, to avoid waiting and possibly infecting others in a crowded waiting room.

Also, be sure to let your doctor know if any of these complications occur:

• The rash spreads to one or both eyes.
• The rash gets very red, warm or tender, indicating a possible secondary bacterial skin infection.
• The rash is accompanied by dizziness, disorientation, rapid heartbeat, shortness of breath, tremors, loss of muscle coordination, worsening cough, vomiting, stiff neck or a fever higher than 103 F (39.4 C).
• Anyone in the household is immune deficient or younger than 6 months old.

Chickenpox

Chickenpox

Chickenpox consists of an itchy, red rash that breaks out on the face, scalp, chest, back and, to a lesser extent, arms and legs. The spots quickly fill with a clear fluid, rupture and then turn ...

Risk factors

Chickenpox, which is caused by the varicella-zoster virus, is highly contagious, and it can spread quickly. The virus is transmitted by direct contact with the rash or by droplets dispersed into the air by coughing or sneezing.

Your risk of catching chickenpox is higher if you:

• Haven't had chickenpox
• Haven't been vaccinated for chickenpox
• Work in or attend a school or child care facility
• Live with children

People who've been vaccinated against chickenpox are usually immune to the virus. The same is true of anyone who has had chickenpox in the past. People at greatest risk of contracting chickenpox include anyone who hasn't been vaccinated or who has never had the disease.

Complications

Chickenpox is normally a mild disease. But it can be serious and can lead to complications, especially in these high-risk groups:

• Newborns and infants whose mothers never had chickenpox or the vaccine
• Adults
• Pregnant women
• People whose immune systems are impaired by medication, such as chemotherapy, or another disease
• People who are taking steroid medications for another disease or condition, such as children with asthma
• People with the skin condition eczema

A common complication of chickenpox is a bacterial infection of the skin. Chickenpox may also lead to pneumonia or, rarely, an inflammation of the brain (encephalitis), both of which can be very serious.

Chickenpox and shingles
Anyone who had chickenpox is at risk of a latent illness called shingles. After a chickenpox infection, some of the varicella-zoster virus may remain in your nerve cells. Many years later, the virus can reactivate and resurface as shingles — a painful band of short-lived blisters. The virus is more likely to reappear in older adults and people with weakened immune systems.

Shingles can lead to its own complication — a condition in which the pain of shingles persists long after the blisters disappear. This complication, called postherpetic neuralgia, can be severe.

A shingles vaccine is available and is recommended for adults age 60 and older who have had chickenpox in the past.

Chickenpox and pregnancy
Other complications of chickenpox affect pregnant women. Chickenpox early in pregnancy can result in a variety of problems in a newborn, including low birth weight and birth defects, such as limb abnormalities. A greater threat to a baby occurs when the mother develops chickenpox in the week before birth. Then it can cause a serious, life-threatening infection in a newborn.

If you're pregnant and not immune to chickenpox, talk to your doctor about the risks to you and your unborn child.

Preparing for your appointment

Call your family doctor if you or your child has signs and symptoms common to chickenpox. Here's some information to help you get ready for your appointment.

Information to gather in advance

• Pre-appointment restrictions. Ask if there are any restrictions you or your child should follow in the time leading up to the appointment, such as staying isolated from others so as not to spread infection.
• Symptom history. Write down any symptoms you or your child has had, and for how long.
• Recent exposure to possible sources of infection. Try to remember if you or your child has been exposed to someone with signs and symptoms of chickenpox in the last few weeks.
• Key medical information. Include any other health problems and the names of any medications you or your child is taking.
• Questions to ask your doctor. Write down your questions in advance so that you can make the most of your time with your doctor.

The list below suggests questions to raise with your doctor about chickenpox.

• What is the most likely cause of these signs and symptoms?
• Are there any other possible causes?
• What treatment approach do you recommend?
• How soon do you expect symptoms to improve?
• Are there any home remedies or self-care steps that could help relieve symptoms?
• Am I or is my child contagious? For how long?
• What steps should be taken to reduce the risk of infecting others?

Don't hesitate to ask more questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor may ask:

• What signs and symptoms have you noticed, and when did they first appear?
• Has anyone else you know had signs and symptoms common to chickenpox within the last few weeks?
• Are you and your child current with recommended vaccinations for your age group?
• Are you or is your child currently being treated or have you recently been treated for any other medical conditions?
• What medications are you or your child currently taking, including prescription and over-the-counter drugs as well as vitamins and supplements?
• Is your child in school or child care?
• Are you pregnant or breast-feeding?

What you can do in the meantime
While you wait for your appointment, you may be able to reduce fever with ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others). Avoid aspirin — in people with chickenpox, it increases the risk of Reye's syndrome.

Rest as much as possible, and avoid contact with others until you've seen the doctor. Chickenpox is highly contagious until skin lesions have fully crusted.

Diagnosis
Doctors generally diagnose chickenpox based on the telltale rash.

If there's any doubt about the diagnosis, chickenpox can be confirmed with laboratory tests, including blood tests or a culture of lesion samples.

Treatments and drugs

In otherwise healthy children, chickenpox typically requires no medical treatment. Your doctor may prescribe an antihistamine to relieve itching. But for the most part, the disease is allowed to run its course.

For people who have a high risk of complications from chickenpox, doctors sometimes prescribe medications to shorten the duration of the infection and to help reduce the risk of complications.

If you or your child falls into a high-risk group, your doctor may suggest an antiviral drug such as acyclovir (Zovirax) or another drug called immune globulin intravenous (IGIV). These medications may lessen the severity of the disease when given within 24 hours after the rash first appears. Other antiviral drugs, such as valacyclovir (Valtrex) and famciclovir (Famvir), also may lessen the severity of the disease, but have been approved for use only in adults. In some cases, your doctor may recommend getting the chickenpox vaccine after exposure to the virus. This can prevent the disease or lessen its severity.

If complications do develop, your doctor will determine the appropriate treatment. Treatment for skin infections and pneumonia may be with antibiotics. Treatment for encephalitis is usually with antiviral drugs. Hospitalization may be necessary.

Don't give anyone with chickenpox — child or adult — any medicine containing aspirin because this combination has been associated with a condition called Reye's syndrome.

Lifestyle and home remedies

To help ease the symptoms of an uncomplicated case of chickenpox, follow these self-care measures:

Don't scratch
Scratching can cause scarring, slow down the healing process and increase the risk that the sores will become infected. If your child can't seem to stop scratching:

• Put gloves on his or her hands, especially at night.
• Trim his or her fingernails

Relieve the itch and other symptoms
The chickenpox rash can be very itchy, and broken vesicles sometimes sting. These discomforts, along with fever, headache and fatigue, can make anyone miserable. For relief, try:

• A cool bath with added baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for the tub, not the stove
• Calamine lotion dabbed on the spots
• A soft, bland diet if chickenpox sores develop in the mouth
• Antihistamines such as diphenhydramine (Benadryl, others ) or hydroxyzine (Atarax, others) for itching. Check with your doctor to make sure your child can safely take antihistamines.
• A soft, bland diet if chickenpox sores develop in the mouth
• Acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) for a mild fever

Don't give aspirin to anyone with chickenpox because it can lead to a serious condition called Reye's syndrome. And don't try to treat a high fever without consulting your doctor.

Prevention

The chickenpox (varicella) vaccine is the best way to prevent chickenpox. Experts from the Centers for Disease Control and Prevention (CDC) estimate that the vaccine provides complete protection from the virus for nearly 90 percent of young children who receive it. When the vaccine doesn't provide complete protection, it significantly lessens the severity of the disease.

The chickenpox vaccine (Varivax) is recommended for:

• Young children. In the United States, children receive two doses of the varicella vaccine — the first between ages 12 and 15 months and the second between ages 4 and 6 years — as part of the routine childhood immunization schedule.

• Unvaccinated older children. Children ages 7 to 12 years who haven't been vaccinated should receive two catch-up doses of the varicella vaccine, given at least three months apart. Children age 13 or older who haven't been vaccinated should also receive two catch-up doses of the vaccine, given at least four weeks apart.
• Unvaccinated adults who've never had chickenpox but are at high risk of exposure. This includes health care workers, teachers, child care employees, international travelers, military personnel, adults who live with young children and all women of childbearing age. Adults who've never had chickenpox or been vaccinated usually receive two doses of the vaccine, four to eight weeks apart. If you don't remember whether you've had chickenpox or the vaccine, a blood test can determine your immunity.

If you've had chickenpox, you don't need the vaccine. A case of the chickenpox usually makes a person immune to the virus for life. It's possible to get chickenpox more than once, but this isn't common.

The vaccine isn't approved for:

• Pregnant women
• People with weakened immunity, such as those with HIV or people on immune-suppressing medications
• People who are allergic to gelatin or the antibiotic neomycin

Talk to your doctor if you're unsure about your need for the vaccine. If you're planning on becoming pregnant, consult with your doctor to make sure you're up to date on your vaccinations before conceiving a child.

Is it safe and effective?
Parents typically wonder whether vaccines are safe. Since the chickenpox vaccine became available, studies have consistently found it safe and effective. Side effects are generally mild and include redness, soreness, swelling and, rarely, small bumps at the site of the shot.