Chickenpox

What is chickenpox?

Chickenpox is a highly contagious disease, caused by the Varicella-Zoster Virus (VZV) also known as Human Herpes Virus 3 (HHV-3), one of the 8 herpes viruses known to harm humans. Chicken pox is quite common in children, particularly those under age 12. The infection is characterized by a fever and itchy, red spots. These usually first appear on the chest and stomach, and then spreads all over the body. The red spots transform into small blisters that gradually dry up and form scabs over about a week. Symptoms usually go away without treatment, but as the infection is very infectious, an infected child should stay home and rest until the symptoms go away completely.

How is it spread?

Chickenpox spreads easily. The risk is high from about 2 days before the rash appears.

It spreads from person to person through direct contact with the virus. You can get chickenpox if you just touch a blister, or come in contact with the liquid coming out of a blister or if you touch the spit of a person who has chickenpox. The virus enters the body by the nose or mouth and can make you sick also.

Air can also carry the chicken pox virus and you can easily get affected if you are close to someone with chickenpox who is coughing or sneezing.

A pregnant woman with chickenpox can transmit it on to her baby before birth or after giving birth to a newborn.

The only way to control the spread of the virus from person to person is to prevent infected people from sharing the same room or house, which is utterly impractical.

Chickenpox cannot be spread through indirect contact.

A child with chickenpox should not attend school until all blisters have dried, usually about 1 week. If you\’re confused about whether your child is ready to go back to school, seek your doctor’s help.

As chickenpox is very contagious most children with a sibling who\’s been already infected will get it as well (if they haven\’t already had the disease or the vaccine). The symptoms may occur about 2 weeks after the first child does. To prevent the virus from spreading, make sure your kids wash their hands frequently, especially before eating and after using the bathroom. Keep a child with chickenpox away from unvaccinated siblings as much as possible.

People who haven\’t had chickenpox or the vaccine also can get infected from someone with shingles, but they cannot catch shingles itself because shingles can only develop from a reactivation of VZV in someone who has previously had chickenpox.

Symptoms of chickenpox

A rash that is initially visible on the body and face but later spreads to the scalp and limbs.
The rash may also affect the mucous membranes especially in the mouth and on the genitals.
The rash is often itchy.
It first appears as small red spots which develop into blisters in a couple of hours.
After one or two days, the blisters turn into scabs.
New blisters may develop after three to six days.
The number of blisters vary greatly from person to person.
The infected person may have temperature.
These symptoms are mild in young children.
Chickenpox lasts 7 to 10 days in children and longer in adults.
Adults can feel very sick and take more time to recover than kids. They suffer from more complications unlike children.

Who is at risk of complications?

Pregnant women who have not had chickenpox.
People with weak immunity, particularly those with acute or chronic leukemia or HIV.
Patients taking medicine that suppresses their immune system, like long-term oral corticosteroids.

Complications

In healthy children, chickenpox is not a serious disease. Adults are 25% more likely to develop serious complications. Common complications affecting both children and adults are listed below:

Skin infection: Rarely, an insidious form of Streptococcus can rapidly spread throughout the body and may be fatal.

Pneumonia: This is a relatively rare complication in healthy children. But it is the primary cause of hospitalization for adults (1 in 400 cases) and has a mortality rate between 10%-30%.

Neurological complications: Children most commonly develop an inflammation at the balance center of the brain termed as acute cerebellar ataxia. Symptoms of abnormal eye movements and poor balance are found in about one in 4,000 children approximately one week of the skin manifestations of chickenpox. Symptoms generally continue for a few days, and an absolute recovery is common. Adults more commonly develop a more comprehensive brain inflammation called \”encephalitis\”. The symptoms may include disorientation and seizures. Some studies show a 10% mortality rate and a 15% rate of developing long-term neurological side effects in survivors.

Reye syndrome: This rare childhood complication of chickenpox (and influenza) is most commonly linked with the intake of aspirin. A rapid progress of nausea, vomiting, headache, delirium, and combativeness may lead to coma and is a common type of deterioration. Supportive measures are the only therapy.

Rarely the complications may include Hepatitis, kidney disease, ulcers of the intestinal tract, and inflammation of the testes (orchitis).

Chickenpox and Pregnancy

Even though chicken pox is usually benign the disease acquired during pregnancy may increase the risk of complications both to the mother and the child. A pregnant woman who hasn\’t had chickenpox in the past easily gets it if she comes in contact with an infected person (especially in the first 20 weeks of pregnancy). The fetus may develop birth defects (congenital varicella syndrome, smaller than normal head, eye problems, low birth weight, short limbs and mental retardation) and mother is at risk for more health complications than if she\’d been infected when she wasn\’t pregnant. If she develops chickenpox just before or after the child is born, the newborn is at risk of having serious health complications. But there is no risk to the developing baby if the woman develops shingles during the pregnancy.

If a pregnant woman has experienced chickenpox prior to the pregnancy, the baby will be safe from developing infection for the first few months of life, since the mother\’s immunity gets passed on to the baby through the placenta and breast milk.

Those at risk of acquiring severe disease or serious complications, especially newborns whose mothers had chickenpox during delivery, patients with leukemia or HIV, and kids receiving drugs to suppress the immune system — may be given varicella zoster immune globulin after exposure to chickenpox to limit its severity.

When to seek Medical Advice

Although most cases of chickenpox get recovered without any severe complications, sometimes medical attention is needed. Consult the doctor if any of the following conditions develop:

Fever higher than 103degree F
A rash involving an eye
Continued dehydration, vomiting, or decreased fluid intake
Uncertainty of diagnosis or what medication to give
Blisters leak a thick, yellow or green fluid.
Areas around a blister become red, increasingly painful, or swollen, or have red streaking extending from the site.

Exams and Tests

A doctor usually grounds the diagnosis of chickenpox on the clinical history and physical findings. However, laboratory exams can be helpful. Your doctor can test blister fluid if there is any chance of secondary skin infection by Staphylococcus or Streptococcus. If the blisters get infected by bacteria, such a bacterial culture can guide to determine which antibiotics may be helpful.

Chickenpox Treatment

Self-Care at Home

Most cases of chickenpox can be managed only by staying at home. Chickenpox rash may be felt extremely itchy. Several treatments can be followed at home to help a child feel better.

Cool compresses applied to blisters may give relief. You may also use calamine lotion. Lotions containing diphenhydramin (Benadryl) should be avoided. Erratic absorption through open skin lesions may occur and be associated with toxicity owing to elevated blood levels.

You can offer cool-water baths every three to four hours, mixing baking soda to the water to soothe itching. You may also have an an Aveeno oatmeal bath to soothe itching blisters.

Trimming fingernails can protect your child from catching infection from scratching the blisters. If you have a small infant suffering from chickenpox, cover the child\’s hands with mittens in order to minimize scratching.

Diphenhydramine (Benadryl), loratadine (Claritin), or citirizine (Zyrtec) can be taken orally also to relieve itching. These medicines are available over the counter.

Treat fever with acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil, Motrin, Excedrin, Nuprin, and Pamprin are common brand names). Read the label before consuming any medication because some medicines contain many different agents that may react. If the medicine is for a child, make sure it contains no aspirin because aspirin has been associated with Reye syndrom.

Occasionally a child may develop blisters in the mouth, making eating or drinking painful. But a person should be encouraged to take fluids in order to prevent dehydration. To reduce pain, provide cold fluids such as ice pops, milk shakes, and smoothies and soft bland foods. Avoid any spicy, hot, or acidic (for instance, orange juice) food.

Keep children at home until all blisters have crusted. A child with chickenpox is extremely contagious until the last crop of blisters has cured totally. So prevent your child from going school or daycare.

If you take your child to a doctor\’s office, seek an appointment and let the staff know that you think your child has chickenpox. They may provide you a special waiting or treatment room to avoid exposing other children.

Medical Treatment

If you have fever, your doctor may recommend acetaminophen or ibuprofen.
If you appear dehydrated and are unable to drink fluids, you may be recommended IV fluids either in an emergency room or as a hospitalized patient.
Secondary bacterial skin infections may be treated with antibiotics.
For people who have severe infections, an antiviral agent called acyclovir (Zovirax) has been useful to shorten the duration and severity of symptoms if given right after the beginning of the rash. Acyclovir may be given orally or by IV to help people at risk for severe infection.
Neonatal VZV infection may be treated with VZIG (varicella zoster immune globulin). It is a form of highly concentrated anti-VZV gamma globulin. But the availability of VZIG is rapidly declining since the only product manufacturer has ceased production. Now an alternative product, VariZIG, is available on a research protocol.

Prevention

Varivax, a two-dose vaccine for chickenpox, is highly recommended for healthy children, adolescents, and adults to combat chicken pox virus. You can arrange an immunization schedule for your child consulting with your doctor.

If your child is fully immunized, the vaccine has been found to be 95% effective in preventing childhood cases of chickenpox. A small percentage of newly immunized people will develop a mild rash. Keep it in mind that pregnant women and infants younger than 1 year of age should not be vaccinated.