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Chickenpox

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Definition

Chickenpox is a virus that spreads easily to others. It creates a widespread, itchy rash. The infection can also cause serious complications in some people.

Chickenpox
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Causes

Chickenpox is caused by the varicella-zoster virus (VZV). It spreads from person to person via:

  • Airborne droplets of moisture containing the VZV virus
  • Direct contact with fluid from a chickenpox or zoster rash

It is contagious 1-2 days before the rash erupts. It remains contagious until all of the blisters have crusted. This takes 5 days. It is most contagious just after the rash has broken out.

A pregnant mother can transmit the virus to a fetus.

Risk Factors

Chickenpox is more common in children under 3 years old, with peak incidence between 5-9 years old. Other factors that may increase your chance of chickenpox include:

  • Close contact with an infected person, unless you have been vaccinated or have already had chickenpox
  • Conditions or medications that suppress your immune system— cancer , HIV infection, an organ transplant, or high-dose steroid use
  • Pregnancy
  • Time of year—late winter, early spring

Symptoms

Symptoms break out about 10-21 days after contact. They are more severe in adults than they are in children.

Initial symptoms include:

  • Mild headache
  • Moderate fever
  • Cough
  • Sore throat
  • Severe itch
  • Lack of appetite
  • General feeling of discomfort
  • Some children complain of abdominal pain

The rash appears within 1-2 days after the first symptoms. The rash:

  • Begins with small, flat, red spots:
    • Spots become raised and form a round, intensely itchy, fluid-filled blister
    • Blisters develop in clusters, with new clusters forming over 5-6 days
  • Usually develops into patches on the skin above the waist, including the scalp
  • May also appear on the eyelids, in the mouth, upper airway, voice box, or on the genitals
  • Typically crusts over by day six or seven and disappears within three weeks

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Diagnosis is usually based on the rash and your age. Blood and lab tests to identify the virus are rarely needed.

Treatment

Chickenpox is mild in most people. It will naturally run its course. In these cases, treatment focuses on relieving the symptoms.

To Reduce Itching

  • Apply wet compresses to the skin
  • Apply over-the-counter anti-itch creams or lotions
  • Take oatmeal baths
  • Take an oral antihistamine

Note : Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.

Antibiotics

Antibiotics cannot cure infections caused by a virus. They may be given if the rash becomes infected with bacteria.

Antiviral Medication

The course, severity, and duration of the infection may be reduced by antiviral medications.

They are often used in:

  • Adolescents, adults, and individuals with weak immune systems
  • Individuals with chronic skin or lung diseases and those taking aspirin or steroids

Special Needs

Varicella-zoster immune globulin is often given immediately after exposure. It is reserved for newborns and people with weak immune systems.

Prevention

Avoid contact with anyone who has chickenpox. Contact people you may have exposed the virus to. This is very important if you have not been vaccinated against the infection.

Vaccination in Children

The varicella vaccine , or a combination vaccine called MMRV, is recommended for most children. MMRV protects against measles , mumps , rubella , and varicella.

There is a catch-up schedule if your child has missed the routine injections.

Vaccination in Adults

Adults who have never had chickenpox or received the varicella vaccine should be vaccinated.

Vaccination After Exposure

If you or your child has not been vaccinated, but are exposed to chickenpox, a vaccine given right away may help lessen the severity of the infection, or prevent the infection.

If you or your child has not been vaccinated, but are exposed to chickenpox, a vaccine given right away may help lessen the severity of the infection, or prevent the infection.

Revision Information

  • Centers for Disease Control and Prevention

    http://www.cdc.gov

  • Family Doctor—American Academy of Family Physicians

    http://familydoctor.org

  • About Kids Health—The Hospital for Sick Children

    http://www.aboutkidshealth.ca

  • College of Family Physicians of Canada

    http://www.cfpc.ca

  • Chickenpox. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 14, 2014. Accessed August 27, 2014.

  • Gales SA, Sweet A, et al. The safety profile of varicella vaccine: a 10-year review. J Infect Dis. 2008;197(Suppl2):S165-9).

  • Immunization schedules. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/schedules. Updated January 31, 2014. Accessed August 27, 2014.

  • Marin M, Meissner HC, et al. Varicella prevention in the United States: a review of successes and challenges. Pediatrics. 2008;122: e744-51.

  • A New Product (VariZIG) for Postexposure Prophylaxis of Varicalla Available under an Investigational New Drug Application Expanded Access Protocol. MMWR. 2006;55: 209-210.

  • Skull SA, Wang EE. Varicella vaccination: a critical review of the evidence. Arch Dis Child. 2001;85:83-90.

  • Varicella (chickenpox) vaccination. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/vaccines/vpd-vac/varicella/default.htm. Updated April 5, 2012. Accessed August 27, 2014.

  • Vazquez M, LaRussa PS, et al. Effectiveness over time of varicella vaccine. JAMA. 2004;291:851-855.

  • 10/14/2008 DynaMed's Systematic Literature Surveillance. Available at: http://www.ebscohost.com/dynamed: Macartney K, McIntryre P. Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults. Cochrane Database Syst Rev. 2008;(3):CD001833.