Chickenpox

1 What is Chickenpox?

Chickenpox (varicella) is a highly contagious viral infection that causes an itchy, blister like rash with mild to sometimes serious complications.

All people are susceptible to get infected by chickenpox.

It is highly contagious in person with no previous history of the disease or who have not been vaccinated.

Getting vaccinated is the safest way to stay away from the disease and its complications.

Vaccination has led to a dramatic decrease in number of cases and associated hospitalizations.

2 Symptoms

The major symptom of chickenpox is rash which is raised pink or red bumps (papules).

The early signs and symptoms of chickenpox which may appear one to two days before the rash includes:

  • Fever
  • Loss of appetite
  • Headache
  • Tiredness
  • Malaise

Stages of chickenpox rash

  • Stage 1: Appearance of the papules which appear for several days.
  • Stage 2: Formation of fluid filled blisters (vesicles) from the papules, which breaks and leaks in about one day.
  • Stage 3: Formation of crusts and scabs from the vesicles, covering the broken blister which takes several days to heal.

The infection usually lasts for about 5-10 days with new spots to appear for several days. All three stages of the rash – bumps, blisters and scabbed lesions may be seen on the second day of the rash. After infection, transmission of virus can occur up to 48 hours before the rash appears until all the crusts and scabs heal.

The disease is generally mild in healthy children however in severe cases, the rash can spread to cover the entire body including throat, eyes mucous membranes of the urethra, anus and vagina.

When suspected of chickenpox, make an appointment mentioning the disease, for consultation with doctor and to avoid possible transmission to others. Chickenpox can be diagnosed by examination of the rash and other associated symptoms and medications are prescribed to reduce and treat complications, if necessary.

Inform the doctor if any of these complications occur:

  • Rash spreads to one or both eyes
  • Rash becomes very red, warm or tender, indication a possible secondary bacterial skin infection
  • 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)
  • If anyone in the household is immune deficient or younger than 6 months old
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3 Making a Diagnosis

Generally, doctors diagnose chickenpox based on the telltale rash. It can be confirmed with laboratory tests which includes blood tests or a culture of lesion samples.

Consult a doctor if you have any symptom that might be an indicative of chickenpox.

How to prepare yourself for the visit

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

  • List out all the symptoms
  • Write down your key medical information.
  • Write down the names of all your medications, vitamins or supplements.
  • Recent exposure to possible sources of infection
  • Make a list of the questions to ask your doctor.

Some typical question can be:

  • What might be responsible for my condition?
  • Do I need to take medicine? Can any over-the-counter medicines treat my condition?
  • How can I prevent it in the future?
  • Am I contagious?

What your doctor wants to know

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

  • Have you had a chickenpox vaccine? If yes, what is the dose?
  • What medications are you currently taking including prescription and over-the-counter drugs, vitamins and supplements?
  • Is your infected child in school or child care?
  • Are you pregnant or breast-feeding?
  • How long have you been experiencing the symptoms?
  • Are you or is your child being treated or have you recently been treated for other medical conditions?
  • Have any over-the-counter products been successful in treating your symptoms?

It is advisable to take over the counter drugs like ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol) to reduce the associated fever and pain. However, it is contraindicated to take aspirin while recovering as it is linked to Reye's syndrome, a rare but potentially life-threatening condition.

4 Treatment

Chickenpox requires no medical treatment in healthy children other than antihistamine to relieve itching.

But if the patient is at high risk of complication, doctors may prescribe medications within 24 hours after the rash first appears, including antiviral drug such as acyclovir (Zovirax) or another drug called immune globulin intravenous (IGIV) which shorten the duration of the infection and reduce the risk of complications.

Other antiviral drugs include valacyclovir (Valtrex) and famciclovir (Famvir), which have been approved for use only in adults.

Chickenpox vaccine is also recommended in some cases after exposure to the virus.

Any medication containing aspirin must not be taken during chickenpox infection as this combination has been associated with a condition called Reye's syndrome. In case of further complications, such as skin infections and pneumonia (treated with antibiotics), encephalitis (treated with antiviral drugs), hospitalization may be necessary.

5 Prevention

Chickenpox vaccine (Varivax) is the main preventive measure used for Chickenpox.

The chickenpox vaccine is recommended preventive measure for young children which according to Centers for Disease Control and Prevention (CDC) estimated to provide complete protection from the virus for nearly 90 percent of the children or significantly reduce the severity of the disease.

Chickenpox vaccine has been found to be safe and effective with mild side effects such as redness, soreness, swelling and rarely small bumps at the site of the shot. Consult with doctor to remain informed about vaccination of a child.

Children vaccination schedule in the United States is as follows:

  • First Vaccination: It is given between ages 12 and 15 months
  • Second Vaccination: It is given between ages 4 and 6 years

Chickenpox vaccine is often combined with the measles, mumps and rubella vaccine. However, it may increase the risk of fever and seizure if given in combination.

  • Unvaccinated children of ages 7 to 12 years who haven't been vaccinated previously are given two catch-up doses of the varicella vaccine, given at least three months apart.
  • Unvaccinated children of ages 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 includes health care workers, teachers, child care employees, international travelers, military personnel, adults who live with young children and all women of childbearing age. Such personnel usually receive two doses of the vaccine, four to eight weeks apart.

Previous history of chickenpox or previous history of vaccination can be tested with a blood test to determine your immunity. Vaccinated person have rare chances of developing the conditions again as your body is already immunized against the disease. However, if you're older than 60, it is often advisable to talk to your doctor about the shingles vaccine.

Consult your doctor if you are planning to be pregnant to make sure if you can get vaccinated or not.

The chickenpox vaccine is contraindicated to following recipients:

  • Pregnant women
  • People with weakened immunity such HIV patients or patients administering immune-suppressing medications
  • People who are allergic to gelatin or the antibiotic neomycin

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with Chickenpox.

Avoid scratching as it causes scarring, delayed healing and increase risk of infection. If unavoidable, trim fingernails and put on gloves, especially at night.

To relieve from itching, use a cool bath with added baking soda, uncooked oatmeal or colloidal oatmeal or apply Calamine lotion on the spots or antihistamines such as diphenhydramine as prescribed by doctor.

If chickenpox sores has developed in the mouth, eat a plain and soft diet.

7 Risks and Complications

There are several risks and complications associated with Chickenpox.

Chickenpox is highly contagious which is transmitted by direct contact with the rash or by droplets dispersed into the air by coughing or sneezing.

Higher risks of infection for person with:

  • No history of chickenpox infection
  • Unvaccinated person
  • Both of above case and live with children

Complications include:

High risks of complications seen in following:

  • Newborns and infants whose mothers never had chickenpox or the vaccine
  • Adults Pregnant women with no history of chickenpox
  • People with impaired immune system due to chemotherapy, or disease, such as cancer or HIV
  • People who are taking steroid medications for a condition, such as children with asthma
  • People taking drugs that suppress their immune systems

Chickenpox and pregnancy

Variety of problems such as low birth weight and birth defects, such as limb abnormalities or a serious, life-threatening infection occurs in a newborn when mother have chickenpox early in pregnancy or in the week before birth respectively.

Chickenpox and shingles

Infection with chickenpox increase the risk of another disease called shingles which appears as a painful band of short-live blisters, especially in older adults and people with weakened immune systems. Some of the varicella-zoster virus which may remain in nerve cells after chickenpox infection can reactivate as shingles. The complication of shingles is post-therapeutic neuralgia in which the pain of shingles persists long after the blisters disappear.

A shingles vaccine (Zostavax) is recommended for adults age 60 and older who have had chickenpox.

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