Chickenpox (Varicella)

Chickenpox (Varicella)

What is chickenpox?

A viral infection that is characterised by the appearance of itchy, red fluid-filled blisters (with a skin rash) on the body, chickenpox is also known as varicella (VARR-i-SEL-uh). Chickenpox mainly affects young children due to their underdeveloped immune systems, but can occur in adults too (especially those have weak immune systems). An infection is caused by the varicella-zoster virus (VZV) and was once so rife among children that it was considered ‘a childhood rite of passage’.

A vaccine for the infection was introduced during the mid-1990s, which has significantly reduced cases of chickenpox across the globe. Before a vaccination had been developed, a chickenpox infection could develop serious medical complications. With a vaccination available, the number of infections and necessary hospitalisations have declined significantly. Although rare, it is possible for an infection to occur in a single person more than once in their lifetime.

Blisters can occur throughout the body and within a few days of developing, begin to pop (break open) and leak, and then crust, forming a scab. Once this happens, the blisters typically begin to heal, but can leave deep and visible scars if not effectively treated. Chickenpox experienced in childhood is generally a lot milder than when an infection occurs in adulthood.

A rash typically begins on the stomach (abdominal area), back and face. In severe cases, the rash and blisters can spread all over the body, including the mouth, nose, eyes, and sometimes the genitals too. Along with blisters and rash, symptoms of fatigue or tiredness, and a fever can also occur. An infection can produce anywhere between 250 and 500 very itchy, and inflamed blisters on the body.

Illustration of the varicella-zoster virus (chickenpox)

Is chickenpox contagious?

A chickenpox infection is highly contagious, and is easily spread from person-to-person. An infection is easily spread through:

  • Coughing
  • Sneezing
  • Saliva
  • Direct contact with leaking blisters

Those most vulnerable are individuals who have never had an infection or who haven’t been vaccinated against the virus.

Symptoms typically appear between 10 and 21 days following contact with someone (touching or breathing in virus particles from blisters or tiny airborne droplets of infected moisture) who has the virus. Recovery can be as long as 2 weeks.

Once infected with the virus, a person can become contagious within a day or two before any signs of rash, bumps and blisters appear. A person will remain contagious until blisters have crusted and formed scabs. This typically occurs within 5 to 7 days following infection.

What happens to the body?

Varicella zoster virus or Chickenpox (Close-up image of a fresh blister on the skin)

Signs and symptoms of chickenpox

At the beginning stages of an infection (1 to 2 days following exposure) a person may begin to feel unwell (malaise) and feverish, develop a headache, as well as experience a loss of appetite.
The inflamed rash and fluid-filled blisters then typically follow these symptoms. The rash and blisters occur in three phases on the body:

  • Red or pink-looking bumps (papules), often first noted on the stomach, chest, back or face areas, which then spread throughout the body.
  • The bumps fill up with fluid, forming blisters (vesicles), that begin to break open and leak.
  • The blisters develop a crust and scab (begin to heal).

Not every blister on the body will form at the same time following exposure to the virus, but these will follow the same phase pattern. New blisters will develop throughout the infectious period (time when the virus is prone to spreading). This is why a person remains contagious for several weeks, until all bumps have scabbed over and begun to heal.

All symptoms are typically mild for young children. Those who have been vaccinated (including children and adults) can also still get an infection, but symptoms will be milder and produce fewer blisters on the body. A severe case of chickenpox can result in rash and blisters spreading throughout the body. In some instances, small lesions may even form on the throat, around the eyes and in the mucus membranes of the urethra, vagina or anus.

If you suspect a case of chickenpox, it is best to get in contact with your doctor as soon as possible and notify them of your suspicion before arriving for a consultation.

If you note that a rash appears to have spread to one or both eyes, is very red, tender or warm, or is accompanied by symptoms of disorientation, dizziness, shortness of breath, a rapid heartbeat, a cough (which worsens), poor muscle coordination, a stiff neck, a very high fever or vomiting, it is best to see a medical professional as soon as possible. Any of the aforementioned symptoms could indicate another possible medical condition or complication which may require prompt medical intervention.

Other serious warning signs for immediate medical attention include:

  • Confusion
  • Difficulty walking or waking up
  • Other breathing difficulties
  • Severe abdominal pain
  • A haemorrhagic rash (signs of bruising or bleeding along with a rash)

Are there risk factors and complications?

Who is at greater risk of getting a chickenpox infection?

Any person who has not been exposed to the chickenpox virus is vulnerable to contracting it. Risk increases in the following ways:

  • A person is exposed to an infected individual who is contagious
  • A person is younger than 12 years of age (children under the age of 2 are at most risk with 90% of cases occurring in young children)
  • A person is an adult who lives with children
  • A person spends time in childcare facilities or schools
  • A person has not been vaccinated against the virus
  • A person has a weakened or impaired immune system (child or adult) due to use of medications or the effects of an existing illness or medical condition.

Risk-reducing factors include:

  • Exposure to the chickenpox virus through a previous infection
  • Exposure to the chickenpox virus through vaccination
  • Immunity passed from mother to her new-born baby (which lasts approximately 3 months after birth)

What possible complications can occur?

Although the majority of chickenpox cases develop mild symptoms, an infection can be severe, sometimes resulting in warning signs that will require prompt medical assistance.

If a person experiences a rash or blisters that spread to one or both eyes, is warm and tender at the site of a rash (this could indicate a bacterial infection, as well as chickenpox) or experiences shortness of breath or dizziness, medical attention must be sought out as soon as possible for prompt treatment.

At high risk for complications are:

  • Infants (young children under the age of 2), especially those whose mothers have never been vaccinated against the virus or had chickenpox themselves.
  • Pregnant women who have never had chickenpox (and are at risk of giving birth to a new-born with a small head size, growth problems, intellectual disabilities and eye issues).
  • Individuals with weakened or impaired immune systems (especially those who suffer infections of the skin, have arthritis, cancer - or are being treated with chemotherapy, HIV or transient synovitis – an acute hip pain, or who have had an organ transplant).
  • Adults (An adult can get chickenpox for a second time as the VZV virus can remain in the nerve cells for years and become active again. This can also lead to another infection, known as shingles.)
  • Seniors or elderly people
  • Individuals who are taking steroid medications for a medical condition, such as asthma, or who are taking medication that suppress the immune system.

When severe, complications of chickenpox can include:

  • Bacterial infections (affecting the skin, bones, joints, soft bodily tissues or bloodstream)
  • Pneumonia
  • Dehydration
  • Encephalitis (inflammation of the brain) or cerebellar ataxia
  • Bleeding problems and blood stream infections (sepsis)
  • Toxic shock syndrome
  • Reye’s syndrome

Many severe infection cases will require hospitalisation, and in extreme instances can result in death. It is important to have all cases of suspected chickenpox infections diagnosed and treated by a medical professional, and the utmost care taken to ensure that transmission and spreading is hindered while infected.

How is chickenpox diagnosed?

Any rash, especially if it is accompanied by cold or flu symptoms, including a fever, should be assessed by a medical doctor. These are often signs of any number of viral and sometimes bacterial infections. Many infections are contagious and will require careful treatment.

A doctor will assess the overall symptoms being experienced and conduct a physical exam, assessing the nature of rash and blisters on the body. Your doctor may ask you a series of questions which can include:

  • When did you first begin to feel unwell?
  • What symptoms or changes to your body have you noticed?
  • Do you know of anyone with chickenpox you may have recently been exposed to?
  • Have you, or has your child, been vaccinated against chickenpox?
  • If yes, how many doses of the vaccine have been administered?
  • Are you, or your child, currently taking any medications or supplements (over-the-counter or prescribed)?
  • Is your child attending a child care facility or school?
  • Are you pregnant?
  • Are you a new mom and breast-feeding?

Confirmation of chickenpox can be done with the assistance of blood tests or a culture of lesion samples.

Those who are potential high-risk cases, especially, will need to be diagnosed by a doctor as soon as any suspicion arises, so as to avoid any potential complications.

How is chickenpox treated?

In most instances a mild chickenpox infection will require homecare. A doctor will likely advise way to best manage the infection symptoms while the virus works through the body’s system. A doctor will also insist on keeping away from public places, work or school while an infection is contagious.

Treatment recommendations will take into account a person’s age, overall health condition, how long ago exposure to the virus took place, the symptoms being experienced, as well as whether you fall into a high-risk category.

  • A generally healthy child experiencing itching and fever will be required to stay home. A doctor will prescribe or recommend non-aspirin based medications to help reduce fever. It is vitally important that children with a viral infection are never given aspirin as it places them at high risk of developing Reye’s Syndrome, which is a condition that severely affects the liver and brain, and can result in death.
  • Teenagers and adults experience more severe symptoms and are thus at higher risk for possible complications. In this case, as well as if there are signs of a weak immune system, or a woman is pregnant, a doctor may prescribe antihistamine medications to help protect against the virus and topical ointments to help alleviate itching.
  • If high-risk, antiviral medications may be prescribed to reduce or prevent possible complications as a result of the viral infection. The medications are not prescribed as a ‘cure’ for chickenpox, but more so to alleviate any potential complication risks, reduce chickenpox symptoms and assist the body with healing.

Treatment recommendations and homecare

Colloidal oatmeal for treatment

For the most part, homecare treatment recommendations will be made by your doctor to best ensure relief from symptoms, and prevent any further infections. Unless a case of chickenpox is complex, the following self-care measures can be easily implemented at home:

  • Avoid scratching: Although blisters and rash can be quite itchy and broken blisters which leak can also sting, scratching such a tender area can lead to sores becoming infected, as well as scarring once healed. Scratching also slows down the healing process. It is a good idea to trim down fingernails or wear gloves to try and reduce the possibility of causing scarring damage to the itching rash and blistered areas of the body. It is also a good idea to wash hands often to reduce bacteria build-up, which can aggravate an infection when in contact with the inflamed areas of the body. It can sometimes help to provide children with distraction in order to deter them from scratching as a means of alleviating itch.
  • A cool or lukewarm bath: Soothing ingredients you can put into a cool or lukewarm bath include just a handful of baking soda, colloidal oatmeal (a finely ground oatmeal) or uncooked oatmeal (this can be ground down to a powder). A 20 to 30-minute soaking in cool or lukewarm water as often as is needed can help to alleviate itching and keep you clear, reducing any chance for bacteria to worsen the infection. A doctor may recommend a mild soap (if any at all) to use that is made for sensitive skin. It is best to blot or pat the skin dry instead of rubbing which will aggravate blisters, rash and sores.
  • Little two year old girl at home sick with chickenpox, cream applied by her mother to the rash.Calamine, antihistamine and oatmeal lotions: Those that contain antihistamines should only be recommended by your doctor and used sparingly (too much lotion can be damaging to the already very sensitive skin). Typically, any antihistamine treatment that is prescribed to alleviate itching may be recommended orally (taken in pill form by mouth), especially at night before bed, and not as a lotion. Calamine (camphor, menthol and phenol) and oatmeal lotions can be used to dry out and soothe blistered areas of the body. Dab on itching and stinging blisters and sores to help soothe inflammation.
  • Cool compresses: A soft, absorbent cloth can be wet with cool water and applied directly to the skin to help alleviate itching and stinging. Oatmeal can also be made into a paste (ground oatmeal mixed with warm water) and applied to itching areas of the body using a soft paper towel to relieve discomfort. It is best to apply the paste directly on the towel and place on an infected area of the body, and then hold it there for between 10 and 15 minutes. A soft cloth can then be used to gently wash the area clean, and then pat dry with a clean towel.
  • A bland diet: Although it doesn’t sound very appealing, if blisters and rash develop around the mouth, a soft and bland diet can help to alleviate aggravation to sensitive and tender areas.
  • General hygiene practices: Wear loose-fitting clothing – cotton is soft and won’t cause any aggravated inflammation or discomfort. Use a mild laundry detergent to clean linens and clothing (clothes and bedsheets should be washed daily). It is also a good idea to be mindful of getting hot (doing activity that increases body temperature and leads to sweating) as this can aggravate itching. It sometimes helps to stay out of sunlight until the infection has cleared.

What is the long-term outlook for chickenpox?

In less complex instances, chickenpox infections typically clear themselves and work through the system. Within a few weeks, normal activities can resume. Once an infection clears, most become immune to the VZV virus (when it becomes dormant in the body).

It is rare, but a person can experience a second round of chickenpox in adulthood when their immune system temporarily weakens (due to illness or advanced aging). The VZV virus can either reactivate as chickenpox or more commonly as shingles (also triggered by varicella-zoster).

Can chickenpox be prevented?

Female doctor giving an injection (vaccination)

The best and most effective means of prevention is the chickenpox vaccine (varicella vaccine). To date it has prevented up to 90% of infections in children who have had the vaccine. Those who haven’t received the vaccine are not immune to the virus causing chickenpox and can get an infection at any stage. The vaccine is given in two shots, one around 12 to 15 months and another between the ages of 4 and 6. Catch-up doses of the vaccine are available for older children and adults who have not received a vaccine during early childhood.

The vaccine is recommended for all young children at least 12 months of age, who are in good health, as well as anyone who is generally healthy but hasn’t had or isn’t sure if they’ve had the vaccine during early childhood. Women who are planning to get pregnant should also ensure that they are either immune or receive the vaccine beforehand, this can be done through a simple blood test.

If a woman becomes pregnant and contracts the virus, the combination can be dangerous and lead to terrible complications during the gestation period. A doctor can best advise a woman about the most appropriate time to receive a vaccination before getting pregnant so as to prevent potential complications. If a woman is pregnant and contracts chickenpox, she may be given a shot of antibodies (immunoglobulin) or an antiviral medication to alleviate symptoms.

Those with a weak immune system should be well aware of anyone around them who may be infected with chickenpox, especially if they have not received a vaccination against the virus. If you find that you are exposed to the virus, talk to your doctor. You may be able to receive the vaccine and either prevent yourself from falling ill or only experience milder symptoms of an infection.

What is the chickenpox (varicella) vaccine?

Varicella vaccine in vial with syringe and medicines

The vaccine was developed from a live, but weakened varicella-zoster virus (VZV) so as to make so as to make an infection with chickenpox less virulent or destructive on the body. Generally, the vaccine is incapable of causing an infection, but it can still stimulate a response in the immune system (this affords protection from falling ill from the virus). As little as 2% of vaccinated children may develop a mild case of chickenpox, with just a handful of blisters.

A vaccine is deemed necessary by medical professionals even for those who do not fall into high-risk categories (such as infants, adults and those with impaired immune systems) as there is no way to predict who will fall into a small percentage of people who’ll experience complications of a severe or life-threatening nature. The other main reason for the vaccine is the contagious nature of the virus.

Most will agree that anyone who has had chickenpox (whether they’ve been vaccinated against it or not) should not require a vaccine. Typically, once you’ve had an infection, you are immune. The vaccine is generally available as a combination for protection against other conditions, namely measles, German measles (rubella), mumps and chickenpox (varicella). This vaccine is known as MMRV.

What side-effects can be expected with getting a vaccine?

The chickenpox (varicella) vaccine, like any other medication is not without associated side-effects. Any that are to be expected, are relatively mild though. Once you receive the vaccine you may experience temporary inflammation (redness) and swelling at the injection site, and a little pain. Some may even develop a little bit of a mild rash or low-grade fever. All side effects typically clear in a short period of time and aren’t to be too alarmed about.

A very small percentage of people may experience more severe side effects (such as seizures, Pneumonia, balance problems or a brain infection) or even an allergic reaction (anaphylaxis). If you are concerned about any associated side-effects, see your medical professional as soon as possible to be on the safe side.

It can happen that a vaccine is administered when a person is moderately or more seriously ill with another condition. Generally, a medical professional will not administer a vaccine shot unless a person is generally healthy as this can bring about health complications and severe side-effects.

Individuals who will not likely be recommended to receive a vaccination include:

  • Women who are pregnant
  • Those who have a known allergy to gelatin (gelatine) or neomycin (an antibiotic)
  • Those who have been diagnosed with and are being treated for an immune system condition, such as HIV/AIDS
  • Those who are being treated with high doses of steroids, radiation or chemotherapy
  • Those who have received a blood transfusion or other blood products within 5 months

When should an adult be vaccinated against chickenpox?

If you’ve never had chickenpox or been vaccinated, your doctor can advise whether or not you can receive a vaccination, following a quick consultation. If it is determined that it is safe for you, you are likely to receive 2 doses, at 4 weeks apart. Thereafter the likelihood of falling ill after being exposed to someone with the virus is dramatically reduced (the vaccine is estimated to be between 70% to 90% effective).

If you do happen to be exposed to someone with chickenpox and fall ill, symptoms will be significantly milder than if you hadn’t received a vaccine.

Can you get chickenpox during pregnancy?

It is possible to contract chickenpox during pregnancy, and it isn’t something to be taken lightly. If you are pregnant and fall ill with the virus, both you and your developing baby are exposed to serious health concerns, such as varicella pneumonia.

Complications affecting a developing baby depends largely on the timing of infection. If infection occurs:

  • During the first 20 weeks of pregnancy: A baby is at risk of serious birth defects (congenital varicella syndrome) which include scarring of the skin, underdeveloped limbs (arms and legs), eye inflammation, and impaired brain development. Risk is especially high between weeks 8 and 20.
  • At least 48 hours before birth (delivery of the baby): A baby may be born with neonatal varicella, which is a potentially life-threatening infection. A baby may be treated with antiviral medications once born, as will a mother who delivers with a chickenpox infection.

A woman who is not immune and intends falling pregnant should consult her doctor. If she is exposed to the virus during pregnancy, a doctor will recommend an injection of antibodies or antiviral medication so as to provide the best means of reducing the severity of falling ill. There is no absolute certainty that an immune globulin shot won’t have any side-effects on a developing baby either. The best means of protection is to have a vaccination at least 3 months before falling pregnant to ensure immunity. Blood tests can confirm immunity, and also determine whether you’ve had a vaccine (if you are unsure whether you have or have not been vaccinated).

Are you more vulnerable to shingles when you’ve had chickenpox?

Shingles - illustration showing a viral infection with skin blisters and sores.The varicella-zoster virus (VZV) can also lead to falling ill with a condition known as shingles (herpes zoster). Visible symptoms of this condition include a rather painful skin rash (sometimes with blisters), known as postherpetic neuralgia, which typically develops in a strip / band along a small area on one side of the body or even the facial area. The rash and blisters can be painful and typically last even after marks and inflammation clear.

It is common for the chickenpox virus to remain in a person’s nerve cells following an infection, becoming dormant, and reactivating again at some stage during a person’s lifetime. When this happens, it can resurface as a shingles infection. This typically happens to older adults or those who have weakened or impaired immune systems.

 

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