Chickenpox

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Dr Nitin Nair
Dermatologist

verified

Chickenpox is a highly contagious viral infection that has a worldwide presence. It is an airborne disease characterised by itchy, red spots all over the body. Chickenpox is generally mild in children; however, in those with impaired immunity and in adults, the disease could be quite severe. Individuals with a history of chickenpox become immune to the virus and do not contract it again in life. However, the virus lies dormant in the nerve tissue of the spinal cord and, in some cases, activates again later in life as shingles, a painful skin condition. Although most people recover fully from chickenpox without needing treatment, some may require medical attention due to severity or perhaps certain complications

Chickenpox used to be a common infection until the mid-1990s. Thereafter, the number of cases declined due to the introduction of the varicella vaccine. Vaccination is the best preventive measure against chickenpox.

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Symptoms

The symptoms of chickenpox typically begin to appear 10 to 21 days after exposure. They usually start with fever, headache, loss of appetite and tiredness. A rash begins to appear on the face, chest and back 1 or 2 days after the initial symptoms and then spreads all over the body. The rash may also show up near the eyelids, inside the mouth and even in the genital area. It begins as raised bumps that turn into fluid-filled blisters. The blisters eventually break open and dry up to form scabs. Most individuals experience symptoms for about 4 to 7 days.

The following symptoms are severe and warrant a visit to the doctor immediately:


  • Fever higher than 102° or lasting for more than 4 days

  • Painful, swollen or pus-filled blisters

  • Severe headache or confusion

  • Unusual sleepiness

  • Itching that persists even after baths and medications

  • Signs of pneumonia (lung infection) – difficulty breathing, cough, etc.

  • Signs of encephalitis (inflammation of the brain): vomiting, severe headache, neck stiffness, sleepiness, etc.

Causes And Risk Factors

Causes

Chickenpox is caused by a type of virus called the varicella-zoster virus. It is a highly contagious virus that spreads by:


  • Inhaling the airborne droplets released when a person with chickenpox sneezes or coughs.

  • Contact with fluids from the blisters of an infected person


The infection can also spread from contact with a person with shingles.

Risk Factors

The following individuals are at a high risk of contracting the infection:

  • Family members (with no history of chickenpox) of an infected person 

  • Children or adults who have never been vaccinated against the varicella-zoster virus.

  • Pregnant women and newborn babies

  • Individuals with low immunity, for example:

    • Those undergoing cancer treatment

    • Those who have had organ transplants

    • Those receiving treatment for severe asthma

    • Those with HIV/AIDS or other chronic medical condition



Prevention

Vaccination is the best preventive measure against chickenpox. Two doses of varicella vaccine are required. Generally, children (below 13 years of age) receive the first and second dose at 12-15 months and 4-6 years of age, respectively. On the other hand, individuals (above 13 years of age) who have not received the vaccine earlier can get the two doses with a gap of 4-8 weeks between the two doses. 

Special instructions for women either planning for pregnancy or who are pregnant:


  • Women who are planning for a pregnancy should wait for at least 28 days after the second dose of the vaccine before trying to conceive.

  • If a pregnant woman who is not immune comes in contact with a person infected with chickenpox, she should contact the doctor or hospital immediately. In such cases, she will be given an injection of varicella-zoster immunoglobulin (VZIG). 


Although the vaccine is very effective at preventing the infection, it is not an absolute preventive measure. Some people may contract the infection even after getting the vaccine; however, they generally experience milder symptoms. They may have a mild fever, and their rash may be limited to red spots or fewer blisters. Chickenpox vaccine can also prevent the development of shingles during adulthood.

Diagnosis

The doctor makes the diagnosis of chickenpox on the basis of one or more of the following:


  • Appearance of a skin rash (most common)

  • Flu-like symptoms

  • Examination of blister-fluids for the presence of the varicella-zoster virus

Treatment

Most people usually experience a mild case of chickenpox and recover completely without any treatment. However, some people may require treatment, which will be determined by: 


  • Severity of the condition

  • Their medical and health history

  • Prognosis of their condition

  • Tolerance to treatment

  • Their opinion/preference


Treatment options that may be recommended by the doctor include:

  • Since chickenpox is a viral infection, antibiotics (antibacterial medicines) are ineffective in treating the infection. However, the doctor may prescribe antibiotics if the skin rash has become infected due to scratching.

  • The doctor may prescribe antiviral medicines to treat chickenpox in the following individuals as they are more susceptible to developing a serious illness from the infection:

    • Pregnant women

    • Those undergoing long-term salicylate or steroid therapy

    • Those with long-term lung or skin disease

    • Those with a weakened immune system

    • Healthy individuals older than 12 years of age




Antiviral medicines are most effective when taken within 24-72 hours of the appearance of rash.

  • For fever and painful symptoms, the doctor may recommend acetaminophen and over-the-counter pain medicines. However, the use of pain medicines that contain aspirin should be avoided in children below 16 years of age as it increases the risk of a serious, life-threatening condition known as Reye’s syndrome.

  • The doctor may prescribe calamine skin lotions that soothe the skin and/or antihistamine medicines to provide relief from itchiness.

Lifestyle / Management

Apart from specific treatments, the following measures may help to control and manage the symptoms of chickenpox:


  • Increase fluid intake to prevent dehydration.

  • Do not let the blisters break open by scratching. Trim the fingernails to minimise the chances of scratching them. Children should preferably wear socks or mittens on their hands to prevent them from scratching the blisters.

  • People with mouth blisters should eat foods that are soft, cold and bland to avoid the blisters from breaking open. Avoid eating citrus or salty foods.

  • A cool bath with baking soda or uncooked oatmeal can provide relief from the itchiness.

  • Keep a cool and moist cloth or rag over the rash for comfort.

  • Get enough rest.


An infected person becomes contagious 1 to 2 days prior to the appearance of the rash until all the blisters on the body turn into scabs. Therefore, people who have chickenpox should take the following measures to prevent the spread of the disease:

  • Wash hands frequently.

  • Cover the face while sneezing or coughing.

  • Keep away from school, work and public places. One should resume school or work only after consultation with the doctor.

  • Avoid contact with individuals with low immunity.

Prognosis And Complications

Prognosis

The symptoms of chickenpox infection in healthy children are usually mild. It takes about 2-4 weeks for the skin to return to normal after a chickenpox infection; however, the area of rash may have some remnant scars. Blisters that have been scratched, however, result in noticeable scars. 

When the varicella-zoster virus enters the body and causes chickenpox, the body produces a substance called antibodies that fights off the virus and is retained by the body for life. Therefore, most individuals who contract chickenpox in their childhood become immune to the virus in adult life. However, the virus lies dormant in the nerve tissue and may sometimes become active again during adulthood and cause shingles – small, painful bumps in the skin that subside on their own in about 1-2 weeks. About one in three adults develops shingles later in life.

Complications

Complications occur in about 1 per cent of the total cases. In addition, certain people (e.g., those with low immunity or babies) have a high risk of developing serious complications due to the infection. Complications may include:


  • Dehydration

  • Liver problems

  • Bacterial infections of the blood, skin and soft tissues

  • Impaired blood clotting

  • Cerebellar ataxia (impaired muscle coordination)

  • Pneumonia

  • Encephalitis

  • Transverse myelitis (inflammation in the spinal cord)

  • Reye syndrome

  • Death (rare)


Depending on when the pregnant woman is infected with chickenpox during pregnancy, the following complications can occur in the baby:

  • Exposure in the first 20 weeks of pregnancy can cause the baby to have congenital problems such as neurological abnormalities, eye defects, small limbs, scarring of the skin.

  • Exposure between 20 and 36 weeks of pregnancy can lead to the baby having shingles during the initial years of life.

  • Exposure during the month prior to childbirth: Chickenpox in the newborn.

  • Within a week of childbirth: Life-threatening severe disease in the newborn.

References


  1. Familydoctor.org. Chickenpox [Internet] [Updated Nov 13, 2018]. Available at: https://familydoctor.org/condition/chickenpox/. Accessed on Feb 11, 2020.

  2. StatPearls. Varicella zoster [Internet] [Updated Aug 11, 2020]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK448191/. Accessed on Feb 11, 2020.

  3. HealthyWA. Chickenpox (varicella) [Internet]. Available at: https://healthywa.wa.gov.au/Articles/A_E/Chickenpox-varicella. Accessed on Feb 11, 2020.

  4. Johns Hopkins Medicine. Chickenpox [Internet]. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/chickenpox. Accessed on Feb 11, 2020.

  5. BetterHealth Channel. Chickenpox [Internet] [Updated Apr, 2019]. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chickenpox#:~:text=Chickenpox%20(varicella)%20is%20a%20highly,calamine%20lotion%20and%20lukewarm%20baths. Accessed on Feb 11, 2020.

  6. Centers for Disease Control and Prevention. Signs and symptoms [Internet] [Updated Dec 31, 2018]. Available at: https://www.cdc.gov/chickenpox/about/symptoms.html. Accessed on Feb 11, 2020.

  7. Cleveland Clinic. Chickenpox [Internet] [Updated Aug 10, 2018]. Available at: https://my.clevelandclinic.org/health/diseases/4017-chickenpox. Accessed on Feb 11, 2020.

  8. Centers for Disease Control and Prevention. Prevention and treatment [Internet] [Updated Dec 31, 2018]. Available at: https://www.cdc.gov/chickenpox/about/prevention-treatment.html. Accessed on Feb 11, 2020.

  9. Guidelines for vaccination in normal adults in India. Indian J Nephrol. 2016;26(Suppl 1):S7-S14.

  10. Australian Government Department of Health. Chickenpox (varicella) [Internet] [Updated May 27, 2020]. Available at: https://www.health.gov.au/health-topics/chickenpox-varicella. Accessed on Feb 11, 2020.

  11. Johns Hopkins Medicine. Antibiotics [Internet]. Available at: https://www.hopkinsmedicine.org/health/wellness-and-prevention/antibiotics. Accessed on Feb 11, 2020.

  12. NCBI. Human herpesvirus: biology, therapy and immunoprophylaxis [Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK47401/. Accessed on Mar 3, 2021.

  13. Harvard Health Publishing - Harvard Medical School. Chickenpox (varicella) [Internet] [Updated Mar 2019]. Available at: https://www.health.harvard.edu/a_to_z/chickenpox-varicella-a-to-z. Accessed on Feb 11, 2020.

  14. Centers for Disease Control and Prevention. Chickenpox (varicella) [Internet] [Updated on Dec 31, 2018]. Available at: https://www.cdc.gov/chickenpox/hcp/index.html. Accessed on Mar 3, 2021.

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