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|Subject: Chickenpox Thu Jan 20, 2011 1:02 pm|| |
Filed under: Infectious Diseases
Chickenpox (varicella) was once considered a rite of passage for most
children. Before routine chickenpox vaccination, virtually everyone had
been infected by the time they reached adulthood, sometimes with serious
complications. Today, the number of cases and hospitalizations is down
However, when chickenpox does occur, it's highly contagious among people
who aren't immune. Most people think of chickenpox as a mild disease —
and, for most, it is. Unfortunately, there's no way to know who will
develop a severe case.
The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications.
The signs and symptoms of chickenpox are:
* A red, itchy rash, initially resembling insect bites, on your face, scalp, chest and back
* Small, liquid-filled blisters that break open and crust over
* Abdominal pain or loss of appetite
* Mild headache
* General feeling of unease and discomfort (malaise) or irritability
* A dry cough
The chickenpox rash goes through these three phases:
* Raised pink or red bumps (papules), which break out in different spots over several days
* Fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking
* Crusts and scabs, which cover the broken blisters and take several more days to heal
New bumps continue to appear for several days. As a result, you may have
all three stages of the rash — bumps, blisters, and scabbed lesions —
at the same time on the second day of the rash. Once infected, you can
spread the virus for up to 48 hours before the rash appears, and you
remain contagious until all spots crust over.
The disease is generally mild in healthy children. In severe cases, the
rash can spread to cover the entire body, and lesions may form in the
throat, eyes and mucous membranes of the urethra, anus and vagina. New
spots continue to appear for several days.
When to see a doctor
If you suspect that you or your child has chickenpox, consult your
doctor. He or she usually can easily diagnose chickenpox by examining
the rash and by noting the presence of accompanying symptoms. Your
doctor can also prescribe medications to lessen the severity of
chickenpox and treat complications, if necessary. Be sure to call ahead
for an appointment, to avoid waiting and possibly infecting others in a
crowded waiting room.
Also, be sure to let your doctor know if any of these complications occur:
* The rash spreads to one or both eyes.
* The rash gets very red, warm or tender, indicating a possible secondary bacterial skin infection.
* The rash is accompanied by 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
* Anyone in the household is immune deficient or younger than 6 months old.
Chickenpox, which is caused by the varicella-zoster virus, is highly
contagious, and it can spread quickly. The virus is transmitted by
direct contact with the rash or by droplets dispersed into the air by
coughing or sneezing.
Your risk of catching chickenpox is higher if you:
* Haven't had chickenpox
* Haven't been vaccinated for chickenpox
* Work in or attend a school or child care facility
* Live with children
People who've been vaccinated against chickenpox are usually immune to
the virus. The same is true of anyone who has had chickenpox in the
past. People at greatest risk of contracting chickenpox include anyone
who hasn't been vaccinated or who has never had the disease.
Chickenpox is normally a mild disease. But it can be serious and can
lead to complications, especially in these high-risk groups:
* Newborns and infants whose mothers never had chickenpox or the vaccine
* Pregnant women
* People whose immune systems are impaired by medication, such as chemotherapy, or another disease
* People who are taking steroid medications for another disease or condition, such as children with asthma
* People with the skin condition eczema
A common complication of chickenpox is a bacterial infection of the
skin. Chickenpox may also lead to pneumonia or, rarely, an inflammation
of the brain (encephalitis), both of which can be very serious.
Chickenpox and shingles
Anyone who had chickenpox is at risk of a latent illness called
shingles. After a chickenpox infection, some of the varicella-zoster
virus may remain in your nerve cells. Many years later, the virus can
reactivate and resurface as shingles — a painful band of short-lived
blisters. The virus is more likely to reappear in older adults and
people with weakened immune systems.
Shingles can lead to its own complication — a condition in which the
pain of shingles persists long after the blisters disappear. This
complication, called postherpetic neuralgia, can be severe.
A shingles vaccine is available and is recommended for adults age 60 and older who have had chickenpox in the past.
Chickenpox and pregnancy
Other complications of chickenpox affect pregnant women. Chickenpox
early in pregnancy can result in a variety of problems in a newborn,
including low birth weight and birth defects, such as limb
abnormalities. A greater threat to a baby occurs when the mother
develops chickenpox in the week before birth. Then it can cause a
serious, life-threatening infection in a newborn.
If you're pregnant and not immune to chickenpox, talk to your doctor about the risks to you and your unborn child.
Preparing for your appointment
Call your family doctor if you or your child has signs and symptoms
common to chickenpox. Here's some information to help you get ready for
Information to gather in advance
* Pre-appointment restrictions. Ask if there are any restrictions
you or your child should follow in the time leading up to the
appointment, such as staying isolated from others so as not to spread
* Symptom history. Write down any symptoms you or your child has had, and for how long.
* Recent exposure to possible sources of infection. Try to remember
if you or your child has been exposed to someone with signs and symptoms
of chickenpox in the last few weeks.
* Key medical information. Include any other health problems and the names of any medications you or your child is taking.
* Questions to ask your doctor. Write down your questions in advance
so that you can make the most of your time with your doctor.
The list below suggests questions to raise with your doctor about chickenpox.
* What is the most likely cause of these signs and symptoms?
* Are there any other possible causes?
* What treatment approach do you recommend?
* How soon do you expect symptoms to improve?
* Are there any home remedies or self-care steps that could help relieve symptoms?
* Am I or is my child contagious? For how long?
* What steps should be taken to reduce the risk of infecting others?
Don't hesitate to ask more questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor may ask:
* What signs and symptoms have you noticed, and when did they first appear?
* Has anyone else you know had signs and symptoms common to chickenpox within the last few weeks?
* Are you and your child current with recommended vaccinations for your age group?
* Are you or is your child currently being treated or have you recently been treated for any other medical conditions?
* What medications are you or your child currently taking, including
prescription and over-the-counter drugs as well as vitamins and
* Is your child in school or child care?
* Are you pregnant or breast-feeding?
What you can do in the meantime
While you wait for your appointment, you may be able to reduce fever
with ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol,
others). Avoid aspirin — in people with chickenpox, it increases the
risk of Reye's syndrome.
Rest as much as possible, and avoid contact with others until you've
seen the doctor. Chickenpox is highly contagious until skin lesions have
Doctors generally diagnose chickenpox based on the telltale rash.
If there's any doubt about the diagnosis, chickenpox can be confirmed
with laboratory tests, including blood tests or a culture of lesion
Treatments and drugs
In otherwise healthy children, chickenpox typically requires no medical
treatment. Your doctor may prescribe an antihistamine to relieve
itching. But for the most part, the disease is allowed to run its
For people who have a high risk of complications from chickenpox,
doctors sometimes prescribe medications to shorten the duration of the
infection and to help reduce the risk of complications.
If you or your child falls into a high-risk group, your doctor may
suggest an antiviral drug such as acyclovir (Zovirax) or another drug
called immune globulin intravenous (IGIV). These medications may lessen
the severity of the disease when given within 24 hours after the rash
first appears. Other antiviral drugs, such as valacyclovir (Valtrex) and
famciclovir (Famvir), also may lessen the severity of the disease, but
have been approved for use only in adults. In some cases, your doctor
may recommend getting the chickenpox vaccine after exposure to the
virus. This can prevent the disease or lessen its severity.
If complications do develop, your doctor will determine the appropriate
treatment. Treatment for skin infections and pneumonia may be with
antibiotics. Treatment for encephalitis is usually with antiviral drugs.
Hospitalization may be necessary.
Don't give anyone with chickenpox — child or adult — any medicine
containing aspirin because this combination has been associated with a
condition called Reye's syndrome.
Lifestyle and home remedies
To help ease the symptoms of an uncomplicated case of chickenpox, follow these self-care measures:
Scratching can cause scarring, slow down the healing process and
increase the risk that the sores will become infected. If your child
can't seem to stop scratching:
* Put gloves on his or her hands, especially at night.
* Trim his or her fingernails
Relieve the itch and other symptoms
The chickenpox rash can be very itchy, and broken vesicles sometimes
sting. These discomforts, along with fever, headache and fatigue, can
make anyone miserable. For relief, try:
* A cool bath with added baking soda, uncooked oatmeal or colloidal
oatmeal — a finely ground oatmeal that is made for the tub, not the
* Calamine lotion dabbed on the spots
* A soft, bland diet if chickenpox sores develop in the mouth
* Antihistamines such as diphenhydramine (Benadryl, others ) or
hydroxyzine (Atarax, others) for itching. Check with your doctor to make
sure your child can safely take antihistamines.
* A soft, bland diet if chickenpox sores develop in the mouth
* Acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) for a mild fever
Don't give aspirin to anyone with chickenpox because it can lead to a
serious condition called Reye's syndrome. And don't try to treat a high
fever without consulting your doctor.
The chickenpox (varicella) vaccine is the best way to prevent
chickenpox. Experts from the Centers for Disease Control and Prevention
(CDC) estimate that the vaccine provides complete protection from the
virus for nearly 90 percent of young children who receive it. When the
vaccine doesn't provide complete protection, it significantly lessens
the severity of the disease.
The chickenpox vaccine (Varivax) is recommended for:
* Young children. In the United States, children receive two doses
of the varicella vaccine — the first between ages 12 and 15 months and
the second between ages 4 and 6 years — as part of the routine childhood
* Unvaccinated older children. Children ages 7 to 12 years who
haven't been vaccinated should receive two catch-up doses of the
varicella vaccine, given at least three months apart. Children age 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. This includes health care workers, teachers, child
care employees, international travelers, military personnel, adults who
live with young children and all women of childbearing age. Adults
who've never had chickenpox or been vaccinated usually receive two doses
of the vaccine, four to eight weeks apart. If you don't remember
whether you've had chickenpox or the vaccine, a blood test can determine
If you've had chickenpox, you don't need the vaccine. A case of the
chickenpox usually makes a person immune to the virus for life. It's
possible to get chickenpox more than once, but this isn't common.
The vaccine isn't approved for:
* Pregnant women
* People with weakened immunity, such as those with HIV or people on immune-suppressing medications
* People who are allergic to gelatin or the antibiotic neomycin
Talk to your doctor if you're unsure about your need for the vaccine. If
you're planning on becoming pregnant, consult with your doctor to make
sure you're up to date on your vaccinations before conceiving a child.
Is it safe and effective?
Parents typically wonder whether vaccines are safe. Since the chickenpox
vaccine became available, studies have consistently found it safe and
effective. Side effects are generally mild and include redness,
soreness, swelling and, rarely, small bumps at the site of the shot.