Chickenpox

Chickenpox is an infection caused by the varicella-zoster virus (VZV). When a person comes in contact with an infected person, this virus enters the body through the nose and mouth. The infection spreads easily from one person to another, and it shows up as an itchy and blistery rash. The disease spreads from one day before the appearance of the rash until the blisters have crusted over. A person almost always develops a lifelong immunity to chickenpox infection; in other words, once a person is infected with chickenpox he/she would not get chickenpox again.

Chickenpox mostly occurs in children under 10 years of age but it can affect people of any age and occurs worldwide. Although chickenpox is more associated with children, adults who lack immunity can also contract this disease. It usually affects young adults in tropical countries. Chickenpox occurs more during the weather transition from winter to summer, especially after the rainy season. Chickenpox is an extremely contagious disease with a secondary high rate over 90%. Crowded areas are most vulnerable. Schools, urban slum areas and colleges have chances of the disease transmission.

Anyone who has not been vaccinated against chickenpox or has not contracted it can get the disease. The illness caused in chickenpox lasts for about 5-7 days. There is an appearance of a rash which is typical of chickenpox. This rash undergoes 3 changes:

• First, there is an appearance of pink or red bumps called papules that are raised; they break out over several days.
• Then, Fluid-filled small blisters known as vesicles are formed form the raised bumps over about one day before breaking and leaking.
• Lastly, crusts and scabs cover the broken blisters and take time to heal.

New bumps develop for many days. Therefore, one may have all the three stages of rash, the bumps, blisters, and scabbed lesions, at the same time on the second day of the rash. The virus can spread in up to 48 hours once infected before the rash appears. The infection is contagious until all the spots crust over.

The rash may first show up on the chest, back, and face, subsequently spreading to the rest of the body including the genital area, eyelids, or inside the mouth. All the blisters become scabs usually within one week.

Some typical symptoms may appear one to two days before the rash, which may include the following:

• Headache
• Fever
• Loss of appetite
• Fatigue

Chickenpox can still occur in people who have been vaccinated. Symptoms seen in vaccinated people are much milder. They have mild or no fever and fewer blisters or red spots. However, few vaccinated people acquiring chickenpox will occasionally have an illness as serious as those who are unvaccinated.

Make sure to call your doctor if:

• your chickenpox looks infected (draining pus, scabs become bigger).
• you get any new chickenpox after the sixth day.
• your child’s condition gets worse.

Causes

Chickenpox is caused by a virus known as the Varicella Zoster virus (VZV). Some people may get the infection due to close contact with the infected person or through coughing or sneezing similar to flu or cold. The virus is also spread by direct contact with the fluid in the blisters and by handling contaminated surfaces and items and then by touching the face.

Children can contract chickenpox after being in contact with someone who has another viral rash called shingles (Herpes Zoster). People who never had chickenpox previously can be infected from a person with shingles but would only develop chickenpox and not shingles. If anyone has had chickenpox in their lifetime, they can develop shingles. The VZV can remain active in the body for several years after a person has had chickenpox. When the virus becomes active again, shingles (Herpes Zoster) occurs.

Risk Factors

Since chickenpox is a highly contagious disease, it can spread quickly. The virus is spread through direct contact with the droplets dispersed into the air by coughing or sneezing. Following are the factors that can increase your risk of getting chickenpox:

• If you have not had chickenpox.
• If you are not vaccinated against chickenpox.
• If you attend or work in a school or in a child-care facility.
• Adults.
• Mothers of infants and newborn babies who have never had chickenpox or its vaccine.
• Pregnant women who have not had chickenpox.
• Individuals with a weak immune system due to medications, such as chemotherapy, or a disease, such as HIV or cancer.
• People taking steroid injections for another disease or conditions, such as children with asthma.
• People who are on medicines that suppress their immune systems.

A database of the National Health Insurance (NHIR) in the year 2000 was analysed for the seasonal variation of chickenpox. The results suggested that temperature and season are significantly linked to the occurrence of chickenpox.

People who are vaccinated with two doses of varicella are 3.3-fold less likely to have an occurrence of varicella compared to those vaccinated with a single dose of varicella, through the first 10 years after immunisation.

The vaccination for prevention of chickenpox comprises of 2 dozes for children who are or below 12 months of age.

Vaccination regimen

• Varicella is a highly infectious yet a common disease that infects almost every person in the absence of vaccination. Approximately 4 million cases occurred every year in the United States before the availability of varicella vaccine, which resulted in 10000 hospitalisations and 100 deaths.
• The controlled clinical trials before the licensure have demonstrated the varicella vaccine to be 70-90% effective in avoiding varicella and more than 95% effective in avoiding severe varicella.
• Children from the age of 12 months to 12 years should receive two doses of 0.5 mL of varicella vaccine in the form of subcutaneous injection, separated by at least three months. If the second dose is unintentionally administered between 28 days and three months after the first dose, the second dose does not have to be repeated.
• All children should receive the first dose of varicella-comprising vaccine routinely at 12 to 15 months of age. The second dose of the vaccine is recommended routinely when children are aged 4 to 6 years (before a child enters the first grade or kindergarten) but can be given at an earlier age. Adults, adolescents, and children should get two doses of the chickenpox vaccine to prevent the disease.

You or your child does not have to undergo any medical tests to get diagnosed with chickenpox. If you notice the key symptoms of mild fever followed by a prickly rash, blisters, and scabs, you can be sure that it is chickenpox. Rashes seen in chickenpox are quite different from the other rashes; however, it can be confusing sometimes if you have other skin conditions, such as scabies or insect bites. If you are still unsure about what is causing the symptoms in you or your child, consult your doctor.

If you have been in contact with anyone who has chickenpox symptoms, if you have chickenpox symptoms and you have a weak immunity, if you are pregnant, or if your baby is less than four weeks old, contact your doctor urgently. If the chickenpox remains untreated in such instances, it may cause serious complications. If there is any suspicion about the diagnosis of chickenpox, laboratory tests including a culture of lesion samples or a blood test can be done to confirm chickenpox.

Chickenpox usually requires no medical treatment when it occurs in children who are otherwise healthy. The treatment is mostly supportive aimed at relieving symptoms and preventing infections. Your doctor may prescribe anti-allergic medicines (antihistamines) to reduce the itching. Antihistamines taken orally can reduce itchy rashes and blisters, especially during sleep. If over the counter antihistamines are used, label directions should be followed.

Chickenpox can cause complications at times, and if you have one of them, the doctor may give you medications to shorten the duration of the infection and medications that can help reduce the complications.

• For children with a high risk of complications, doctors may suggest.
• Antiviral drugs – acyclovir.
• Intravenous immunoglobulins.

These medications can decrease the severity of the disease if given within 24 hours after the first rash appears. Some other antivirals, such as famciclovir and valaciclovir, may also be given to decrease the severity of the disease, but it may not be appropriate in all cases of chickenpox.

• In some instances of chickenpox, once you are exposed to the virus, the doctor may recommend you to get the chickenpox vaccine to help lessen the severity or to prevent the disease
• If at all you develop any complications, your doctor will decide on the suitable treatment. If you develop complications, such as pneumonia and skin infections, antibiotics may be given to you. If you develop encephalitis, antiviral drugs may be given to you. Hospitalisation may be necessary.

A person infected with chickenpox can spread the infection from two days before the spots appear until the spots have crusted over, which is usually five days after the first time they appeared.

Self-care

Here are some self-care tips that you can follow to maintain your health condition during chickenpox:

• Take cool baths: Cool baths for 10 minutes are helpful for reducing itching. Baths do not spread chickenpox. You can also add soda 2 Oz (56.699 grams) per tub. (Caution: avoid getting chilled)
• Try Benadryl: You may give oral Benadryl if itching becomes worse or if it interferes with sleep. You may also apply Benadryl cream to areas where there is excessive itching.
• Use calamine lotion: You can apply calamine lotion to areas where it is very itchy. Alternatively, you can massage those areas with ice cubes for 10 minutes. (Caution: Avoid areas where you have applied Benadryl cream because it can cause skin inflammation after it gets absorbed and then causes side effects)
• Do not scratch: Wash your hands frequently with an antibacterial soap and trim your fingernails to prevent skin infections such as impetigo. Refrain from scratching or picking the crusts of the lesions.
• Bring down the fever: Take paracetamol (acetaminophen) when the temperature goes above 39oC. Never use aspirin during chickenpox as it can cause a serious health problem called Reyes syndrome. Do not use painkillers like ibuprofen during chickenpox because it may increase your risk of acquiring a streptococcus infection.
• Opt for soft diets: If you have throat ulcers or a painful mouth, follow a diet with soft foods. Give fluids by a cup rather than in a bottle because the bottle nipples can cause more pain. (Read more - Mouth ulcer treatment)
• Use antacids for mouth pain: Use one teaspoon of a liquid antacid four times per day as a mouthwash after meals for severe mouth ulcers in children over 4 years old. Put a few drops of the liquid antacid after meals in the front of the mouth for younger children.
• Try petroleum jelly to ease painful urination: Use petroleum jelly for females with painful ulcers in the vulva area. Use a numbing ointment four times a day for severe pain. This also works in males who have a painful pox on the tip of their penis.

Your child may continue with school or daycare when all the sores have crusted over, usually on the day 6 or day 7 of the rash.

Lifestyle management

Following are some of the do’s and don'ts for chickenpox patients:

Do’s

• Drink plenty of fluids to avoid dehydration. If your child does not drink enough fluids, try ice lollies.
• When in pain and discomfort, take a paracetamol.
• Put socks on your child’s hands at night so that he doesn’t scratch.
• Cut your child’s nails.
• Use cooling gels or creams from your pharmacy store.
• If you want to use an antihistamine medicine to help reduce the itching, speak to your pharmacist about it.
• Pat the skin dry and do not rub your skin after your bath, bathe in cool water.
• Wear loose clothes.
• If you are travelling, check with your airlines beforehand, as many airlines would not permit you to fly with chickenpox.

Don'ts

• Do not be around pregnant women, people with weakened immune systems, and newborns, as it can be unsafe for them.

Prognosis

Most children with chickenpox recover completely without any complications. However, sometimes the infection can become serious especially in pregnant women, adolescents, adults, and people with weak immune systems and in babies. Make sure that all members of your family are up to date on their chickenpox vaccine. It is the best way to protect not only your family from chickenpox but also your community.

Complications

Complications of chickenpox do not occur commonly in healthy people who get chickenpox. People who have a serious case of chickenpox and are at a higher risk of developing complications are as follows:

• Adolescents
• Pregnant women
• Infants
• Adults
• People with weakened immune systems because of illness or medications; for example, those:
  • who have had transplants.
  • with HIV/AIDS or cancer.
  • who are on chemotherapy, immunosuppressive medications, or long-term use of steroids.

Serious complications that arise due to chickenpox include the following:

• Infection or inflammation of the brain (encephalitis, cerebellar ataxia).
• Bleeding problems.
• Dehydration.
• Bacterial infections of the skin and soft tissues in children including Group A streptococcal infections.
• Bloodstream infections (sepsis).
• Pneumonia.

Some people with serious complications of chickenpox become extremely ill and need to get hospitalised. It can even cause death. Chickenpox may lead to death in some unvaccinated but healthy people. Several healthy adults who died from chickenpox acquired the disease from their unvaccinated children.