Chickenpox (patient information)
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Chickenpox |
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Chickenpox On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-in-Chief: Alexandra M. Palmer
Overview
Chickenpox is a viral infection in which a person develops extremely itchy blisters all over the body. It used to be one of the classic childhood diseases. However, it has become much less common since the introduction of the chickenpox vaccine.
What are the symptoms of Chickenpox ?
Most children with chickenpox have the following symptoms before the rash appears:
The chickenpox rash occurs about 10 to 21 days after coming into contact with someone who had the disease. The average child develops 250 to 500 small, itchy, fluid-filled blisters over red spots on the skin.
The blisters are usually first seen on the face, middle of the body, or scalp.
After a day or two, the blisters become cloudy and then scab. Meanwhile, new blisters form in groups. They often appear in the mouth, in the vagina, and on the eyelids.
Children with skin problems, such as eczema, may get thousands of blisters.
Most pox will not leave scars unless they become infected with bacteria from scratching.
Some children who have had the vaccine will still develop a mild case of chickenpox. They usually recover much more quickly and have only a few pox (fewer than 30). These cases are often harder to diagnose. However, these children can still spread chickenpox to others.
What causes Chickenpox?
In a typical scenario, a young child is covered in pox and out of school for a week. The first half of the week the child feels miserable from intense itching; the second half from boredom. Since the introduction of the chickenpox vaccine, classic chickenpox is much less common. Chickenpox is extremely contagious, and can be spread by direct contact, droplet transmission, and airborne transmission. Even those with mild illness after the vaccine may be contagious. When someone becomes infected, the pox usually appear 10 to 21 days later. People become contagious 1 to 2 days before breaking out with pox. They remain contagious while uncrusted blisters are present. Once you catch chickenpox, the virus usually remains in your body for your lifetime, kept in check by the immune system. About 1 in 10 adults will experience shingles when the virus re-emerges during a period of stress. Most cases of chickenpox occur in children younger than ten. The disease is usually mild, although serious complications sometimes occur. Adults and older children usually get sicker than younger children do. Children under one year of age whose mothers have had chickenpox are not very likely to catch it. If they do, they often have mild cases because they retain partial immunity from their mothers' blood. Children under one year of age whose mothers have not had chickenpox, or whose inborn immunity has already waned, can get severe chickenpox. The pox are worse in children who have other skin problems, such as eczema or a recent sunburn. Complications are more common in those who are immunocompromised from an illness or medicines like chemotherapy. Some of the worst cases of chickenpox have been seen in children who have taken steroids during the incubation period, before they have any symptoms.
Who is at highest risk?
Since chickenpox is contagious, anyone in close proximity to someone with the disease is at risk.
Diagnosis
Chickenpox is usually diagnosed from the classic rash and the child's medical history. Blood tests, and tests of the pox blisters themselves, can confirm the diagnosis if there is any question.
When to seek urgent medical care?
Call your health care provider if you think that your child has chickenpox or if your child is over 12 months of age and has not been vaccinated against chickenpox.
Treatment options
In most cases, it is enough to keep children comfortable while their own bodies fight the illness. Oatmeal baths in lukewarm water provide a crusty, comforting coating on the skin. An oral antihistamine can help to ease the itching, as can topical lotions. Lotions containing antihistamines are not proven more effective. Trim the fingernails short to reduce secondary infections and scarring. Safe antiviral medicines have been developed. To be effective, they usually must be started within the first 24 hours of the rash. For most otherwise healthy children, the benefits of these medicines may not outweigh the costs. Adults and teens, at risk for more severe symptoms, may benefit if the case is seen early in its course In addition, for those with skin conditions (such as eczema or recent sunburn), lung conditions (such as asthma), or those who have recently taken steroids, the antiviral medicines may be very important. The same is also true for adolescents and children who must take aspirin on an ongoing basis. Some doctors also give antiviral medicines to people in the same household who subsequently come down with chickenpox. Because of their increased exposure, they would normally experience a more severe case of chickenpox.
DO NOT USE ASPIRIN for someone who may have chickenpox. Use of aspirin has been associated with Reyes Syndrome. Ibuprofen has been associated with more severe secondary infections. Acetaminophen may be used.
Where to find medical care for Chickenpox?
Directions to Hospitals Treating Chickenpox
What to expect (Outlook/Prognosis)?
The outcome is generally excellent in uncomplicated cases. Encephalitis, pneumonia, and other invasive bacterial infections are serious, but rare, complications of chickenpox.
Possible complications
Rarely, serious bacteria infections such as encephalitis have occurred. Other complications may include:
- Reye's syndrome
- Myocarditis
- Pneumonia
- Transient arthritis
- Cerebellar ataxia may appear during the recovery phase or later. This involves a very unsteady walk.
Women who get chickenpox during pregnancy can pass the infection to the developing baby. Newborns are at risk for severe infection.
Prevention
Because chickenpox is airborne and very contagious before the rash appears, it is difficult to avoid. It is possible to catch chickenpox from someone on a different aisle in the supermarket, who doesn’t even know they have chickenpox! A chickenpox vaccine is part of the routine immunization schedule. It is about 100% effective against moderate or severe illness, and 85-90% effective against mild chickenpox. Parents often express concern that the immunity from the vaccine might not last. The chickenpox vaccine, though, is the only routine vaccine that does not require a booster. However, a higher dose of the vaccine given later in life may reduce the incidence of herpes zoster (shingles). Reimmunization with the high dose is currently being considered by vaccination experts. Talk to your doctor if you think your child might be at high risk for complications and might have been exposed. Immediate preventive measures may be important. Vaccine given early after exposure may still reduce the severity of the disease.