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Chickenpox (Varicella Zoster)

Basic Information

Varicella zoster is a human herpesvirus. Varicella manifests as chickenpox while herpes zoster manifests as shingles, which is in effect the reactivation of varicella.

Chickenpox is extremely contagious, spread from person to person by:

  • infected airborne droplets
  • contact with infected lesions

You are at risk for contracting chickenpox from birth to adulthood and the illness is usually more severe and longer lasting in adults than in children. But most persons develop chickenpox during childhood, between the ages of two to ten years. In fact, 90% of cases occur in children under nine years. Most cases appear in the late winter and early spring and tend to erupt in three to four year cycles. The incubation period is between one and three weeks.

You are most contagious two days before symptoms appear and continue to be contagious as long as three weeks after exposure or until the final lesions are completely crusted. Both skin and mucous membranes can be affected.

The first manifestation of chickenpox is the appearance of a rash which is raised (three-to-four-mm red papules). A blister-like (vesicle) stage then occurs, but within a twenty-four hour period the blisters then crust or turn to scabs. New blisters form again every three to four days. Again, scabbing occurs by the sixth day with these new blisters.

Symptoms

First symptoms which often present at least one to two days before the actual rash appears, may include:

  • fatigue
  • abdominal pain
  • backache
  • headache
  • fever
  • chills

These symptoms are likely to be experienced more intensely by those over ten years of age.

After the initial rash erupts, itchy red papules with clear versicles on the surface appear.

At this point, intense itching occurs.

Also fever is at its highest peak during this stage and lessens when versicles resolve.

Ulcerated lesions may appear on the mucous membranes--when found in the mouth the lesions rupture quickly and can cause you pain when swallowing.

Restlessness and anorexia are also symptoms which affect adult patients.

In addition, excoriations may appear as a result of scratching.

Diagnosis/Treatment

Your health care provider will be able to make the diagnosis during the physical examination. Laboratory tests are usually not indicated. The diagnosis is most easily made at the time when the versicles (the clear liquid on the red papules) form.

Other illnesses that mimic chickenpox may need to be ruled out at the time of diagnosis. These include:

  • insect stings, bites
  • secondary syphilis
  • impetigo
  • disseminated herpes simplex virus infection
  • contact dermatitis

While chickenpox is primarily a childhood illness and when acquired in childhood is generally benign, it is much more dangerous for adolescents and adults. Its repercussions can cause serious illness and even death in HIV positive patients with depressed T-cell immunities.

A personal and family health history should be taken at the time of diagnosis. These health histories can be important diagnostic tools for your health care provider should any signs of complications be found at the time of diagnosis. Complications occur more frequently in adolescents and adults but can also affect young children.

Complications from this disease can include:

  • scarring
  • infection of the blisters
  • eye infection
  • Eye's syndrome (from aspirin use during viral infection, especially in patients under 16 years of age) is a serious complication, but unusual.
  • pneumonia (seen in newborns, adults, and immunocompromised patients but is unusual in young children)
  • hepatitis
  • arthritis
  • encephalitis -- relatively rare, occurring in one in one thousand patients and less dangerous than measles encephalitis

There is no magic pill to cure chickenpox as it is a viral infection. Instead, symptomatic relief is the goal.

First of all, if your child develops chickenpox, keep your child away from other children until the blisters are completely healed, because until that point your child remains infectious. Make sure the school nurse is aware of your child's infection. In this way the nurse can notify the parents of children your child has been playmates with, possibly during your child's period of contagion. Do not give your child aspirin because of the association with Eye's syndrome. Use non-aspirin products to reduce fever. Give your child plenty of fluids if fever is present and call your health are provider immediately if your child's temperature reaches 103 degrees.

Your child should get plenty of rest--but that doesn't mean the child needs to lie in bed with nothing to do. Restful activities can be cheerful for a child and help spur recovery. If you are uncertain about what activities are appropriate for your recovering child, contact your health care provider.

It is important to keep your child from itching and scratching the blisters so that scarring or secondary infection does not occur. The child should not be placed in an overheated environment since sweating will make the child want to scratch. Mittens may be recommended for use on the hands of the young child.

Mild soap should be used when bathing. Cool sponge baths and wet compresses can help control itching. Hands should be washed frequently and nails kept clipped. Do not use antiseptics on your blisters unless a secondary infection occurs and then only by direction of your health care provider.

Do not expose your infected child to:

  • persons with AIDS or who are immunocompromised
  • patients undergoing chemotherapy
  • organ transplant recipients

While most children and adults have a benign course of chickenpox, the above patients do not -- serious illness and death may occur. IV acyclovir administered in a hospital setting is indicated for immunocompromised patients who develop chickenpox, as well as for patients with pneumonia.

Most cases resolve spontaneously within ten days and most patients then have a lifetime immunity to the disease.

If you have not had chickenpox, you are at risk for developing it should you have contact with someone with shingles (the reactivation of the chickenpox virus). Your health care provider may recommend oral acyclovir to decrease symptoms and shorten length of the illness -- but only for severe cases in those who are over thirteen years of age and who are not pregnant. Itching can be relieved by antihistamines (can cause drowsiness) or lotions but oral antibiotics are not recommended except in cases of secondary infections, most commonly Streptococcus and Staphylococcus.

PREVENTION

Fortunately, protection from chickenpox is available with the varicella vaccine. The vaccine is recommended by the American Academy of Pediatrics for children from 12 to 18 months. It could be administered at the same time as the MMR (measles, mumps, rubella) vaccine. Children may also be vaccinated at any time from 18 months to 12 years as long as there is no history of chickenpox. (See Childhood Immunizations for vaccination schedule.) Adults may also be vaccinated. (See Adult Immunizations for vaccination schedule.) Protection lasts for six years at least.

Immunocompromised patients should not receive this live vaccine. If you are HIV positive or immunocompromised, do not take the varicella vaccine -- ask your health care provider about possible options.

VZIG (varicella-zoster immunoglobulin) can prevent chickenpox in most individuals if taken soon after exposure. VZIG should be administered to infants with chickenpox as infants are unable to control the virus.

If you or your child has chickenpox or you want to make an appointment for vaccination, please contact your health care provider.