Chickenpox

Chickenpox is a viral infection caused by the varicella-zoster virus (VZV), which is in the herpesvirus family. These viruses infect many tissues during primary infection and then become dormant; they can reactivate later to cause disease. In the case of VZV, reactivation disease is called shingles or herpes zoster and typically occurs when there is a weakened immune system. Before chickenpox vaccine became routine in the U.S., chickenpox was a common childhood disease. Today, it still occurs in populations that are not routinely vaccinated. Varicella-zoster virus is often categorized with the other common so-called "viral exanthems" (viral rashes) such as measles(rubeola), German measles (rubella), fifth disease (parvovirus B19), mumps virus, and roseola (human herpesvirus 6), but these viruses are unrelated except for their tendency to cause rashes. In unimmunized populations, most people contract chickenpox by age 15, the majority between ages 5 and 9, but all ages can contract it. Chickenpox is usually more severe in adults and very young infants than children. Winter and spring are the most common times of the year for chickenpox to occur.

 Chickenpox Fact

  • Chickenpox is caused by the varicella-zoster virus, which also causes shingles.
  • Chickenpox is highly contagious and spreads by closeness and contact with someone with chickenpox.
  • Fever, malaise, and a very itchy rash (red spots, fluid-filled tiny blisters, and crusted lesions) are all symptoms and signs of chickenpox.
  • Treatment for chickenpox is basically supportive.
  • Although usually self-limited, chickenpox can also cause more serious complications, including pneumonia, encephalitis, and secondary skin infections.
  • The chickenpox vaccine has resulted in a decrease in chickenpox incidence by 90% in the United States.

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Varicella-zoster virus (VZV) causes the chickenpox infection. Most cases occur through contact with an infected person. The virus is contagious to those around you for one to two days before your blisters appear. VZV remains contagious until all blisters have crusted over. The virus can spread through:

  • saliva
  • coughing
  • sneezing
  • contact with fluid from the blisters

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

Most people who have had chickenpox or have been vaccinated against chickenpox are immune to chickenpox. If you've been vaccinated and still get chickenpox, symptoms are often milder, with fewer blisters and mild or no fever. A few people can get chickenpox more than once, but this is rare.

Chickenpox infection appears 10 to 21 days after exposure to the virus and usually lasts about five to 10 days. The rash is the telltale indication of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include:

  • Fever
  • Loss of appetite
  • Headache
  • Tiredness and a general feeling of being unwell (malaise)

Once the chickenpox rash appears, it goes through three phases:

  • Raised pink or red bumps (papules), which break out over several days
  • Small 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.

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.

Chickenpox generally resolves within a week or two without treatment. There is no cure, but a vaccine can prevent it.

A doctor may prescribe medication or advise on how to reduce symptoms of itchiness and discomfort, and also on how to prevent the infection from spreading to other people.

Pain or fever: Tylenol (acetaminophen), which is available to purchase online, may help with symptoms of high temperature and pain. It is important to follow the instructions provided by the manufacturer. Aspirin containing products should NOT be used for chickenpox as this can lead to complications. Acetaminophen (Tylenol) can be used at any time during pregnancy.

Avoiding dehydration: It is important to drink plenty of fluids, preferably water, to prevent dehydration. Some doctors recommend sugar-free popsicles or Pedialyte for children who are not drinking enough.

Mouth soreness: Sugar-free popsicles help ease symptoms of soreness if there are spots in the mouth. Salty or spicy foods should be avoided. If chewing is painful, soup might be a good option, but it should not be too hot.

Itchiness: ltchiness can become severe, but it is important to minimize scratching to reduce the risk of scarring.

The following may help prevent scratching:

  • keeping fingernails clean and as short as possible
  • placing mittens or even socks over a child's hands when they go to sleep, so that any attempt at scratching during the night does not cut the skin
  • applying calamine lotion or having an oatmeal bath to reduce itching
  • wearing loose clothing

Antiviral medication may be prescribed during pregnancy, for adults who get an early diagnosis, in newborns, and for those with a weakened immune system. Acyclovir is one example.

This works best if it is given within 24 hours of developing symptoms. Acyclovir reduces the severity of symptoms but does not cure the disease.

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 98 percent of people who receive both of the recommended doses. 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. The vaccine can be combined with the measles, mumps and rubella vaccine, but for some children between the ages of 12 and 23 months, the combination may increase the risk of fever and seizure from the vaccine. Discuss the pros and cons of combining the vaccines with your child's doctor.
  • 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 chickenpox 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. However, if you're older than 60, talk to your doctor about the shingles vaccine.

The chickenpox vaccine isn't approved for

  • Pregnant women
  • People with weakened immunity, such as those with HIV or people taking 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.

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