Chickenpox

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Diagnosis

History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics

Treatment

Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies

Prognosis

Chickenpox infection is milder in young children, and symptomatic treatment, with a sodium bicarbonate baths or antihistamine medication may ease itching. Paracetamol (acetaminophen) is widely used to reduce fever. Aspirin, or products containing aspirin, must not be given to children with chickenpox (or any fever-causing illness), as this risks causing the serious and potentially fatal Reye's Syndrome.

In adults, the disease can be more severe, though the incidence is much less common. Infection in adults is associated with greater morbidity and mortality due to pneumonia, hepatitis and encephalitis. In particular, up to 10% of pregnant women with chickenpox develop pneumonia, the severity of which increases with onset later in gestation. In England and Wales, 75% of deaths due to chickenpox are in adults. Inflammation of the brain, or encephalitis, can occur in immunocompromised individuals, although the risk is higher with herpes zoster.Necrotizing fasciitis is also a rare complication.

Secondary bacterial infection of skin lesions, manifesting as impetigo, cellulitis, and erysipelas, is the most common complication in healthy children. Disseminated primary varicella infection, usually seen in the immunocompromised or adult populations, may have high morbidity. Ninety percent of cases of varicella pneumonia occur in the adult population. Rarer complications of disseminated chickenpox also include myocarditis, hepatitis, and glomerulonephritis.

Hemorrhagic complications are more common in the immunocompromised or immunosuppressed populations, although healthy children and adults have been affected. Five major clinical syndromes have been described: febrile purpura, malignant chickenpox with purpura, postinfectious purpura, purpura fulminans, and anaphylactoid purpura. These syndromes have variable courses, with febrile purpura being the most benign of the syndromes and having an uncomplicated outcome. In contrast, malignant chickenpox with purpura is a grave clinical condition that has a mortality rate of greater than 70%. The etiology of these hemorrhagic chickenpox syndromes is not known.

Vaccination

Main article: Varicella vaccine

A varicella vaccine has been available since 1995 to inoculate against the disease. Some countries require the varicella vaccination or an exemption before entering elementary school. Protection is not lifelong and further vaccination is necessary five years after the initial immunization.

In the UK, varicella antibodies are measured as part of the routine of prenatal care, and by 2005 all NHS healthcare personnel had determined their immunity and been immunised if they were non-immune and have direct patient contact. Population-based immunization against varicella is not otherwise practiced in the UK, because of lack of evidence of lasting efficacy or public health benefit.

Normal Reactions to vaccine are

• Fever of 101.9 (38.9 C) up to 42 days after Injection
• Soreness, inching at the site of injection within 2 days
• Rash occurring at site of injection anywhere form 8 to 19 days after injection. If this happens you are considered contagious.
• Rash on other parts of body anywhere from 5 to 26 days after injection. If this happens you are considered contagious.

What to do should reaction occur

Control fever and lessen discomfort, take medication containing acetaminophen, (AKA paracetamol) such as

• Panadol,
• Tempra,
• Tylenol.

Additional Reading

• Bernstein, Henry. "Who Discovered Chickenpox?". Pediatrics Questions and Answers. Family Education Network. Retrieved 2005-10-16.
• "Chickenpox (Varicella) Vaccine". Immunization Action Coalition. 2005. Retrieved 2006-06-12.
• U.S. Census Bureau. "Countries Ranked by Popn: 2006". International Data Base. Retrieved 2005-10-16.
• Centers for Disease Control and Prevention (CDC) (2005). "Varicella-related deaths--United States, January 2003-June 2004" (PDF). MMWR Morb Mortal Wkly Rep. 54 (11): 272–4. PMID 15788992.
• Thomas S, Wheeler J, Hall A (2002). "Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study" (PDF). Lancet. 360 (9334): 678–82. PMID 12241874.CS1 maint: Multiple names: authors list (link)
• Jeff Aronson (2000). "When I Use a Word...Chickenpox" (web). BMJ. 321 (7262): 682.

External links

• "Varicella Disease (Chickenpox): Varicella, although a common disease, can be dangerous and even deadly". CDC. May 26, 2005.