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Deborah Bershel, MD
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Chickenpox {Varicella}   ( see also Shingles)
BASIC INFORMATION

DESCRIPTION

A very contagious, but usually mild disease caused by herpes zoster virus. It can affect all ages, but most common in children.

FREQUENT SIGNS AND SYMPTOMS
The following are usually mild in children, severe in adults:
• Fever.
• Abdominal pain or general ill feeling that lasts 1-2 days.
• Skin eruptions that appear almost anywhere on the body, including the scalp, penis, and inside the mouth,
   nose, throat or vagina. They may be scattered over large areas, and they occur least on the arms and legs.
   Blisters collapse within 24 hours and form scabs. New crops of blisters erupt every 3 to 4 days.
• Adults have additional symptoms that resemble influenza and percentage-wise are more likely to have complications but most hospitalizations and deaths (rare) occur in children

CAUSES
• Infection with the herpes zoster virus. It is spread from person to person by airborne droplets or contact with skin eruption
  on an infected person. Incubation after exposure is 7 to 21 days.
• A newborn is protected for several months from chickenpox if the mother had the disease prior to or during  pregnancy.
  The immunity diminishes in 4 to 12 months.

POSSIBLE COMPLICATIONS
• Secondary bacterial infection of
   chickenpox blisters
• Pneumonia
• Viral eye infection
• Encephalitis (rare)
• Reye's syndrome (a very rare liver complication) - avoid taking aspirin if you think you have    chicken pox
• Arthritis (transient)
• Myocarditis
• Scarring, if blisters become
   infected (rare)

Occasionally a secondary bacterial infection will occur such as pneumonia and this can lead to hospitalization.

Shingles can occur months of decades after getting chicken pox. It is due to a reappearance of the virus along the path of a nerve root where the virus had been dormant. Stress  (who doesn’t have stress though!), physical trauma or underlying immune weakness can bring out a shingles attack.


PREVENTIVE MEASURES

Children-
A live attenuated (weakened) vaccine are available and recommended by the  Advisory Committee on Immunization Practices (part of the Centers for Disease Control). The first dose is recommended for children after 12 months of age and a second dose is recommended after 4 years. Typically schools will require only one dose. I will leave it up to the parents as to whether they desire their child to get a second dose.

Adults-
The ACIP also recommends the chicken pox vaccine for all adults born after 1980 who have not had evidence for chicken pox or shingles. Any woman thinking of becoming pregnant and has not been immunized (or had the disease) should get the vaccine or have her immunity checked.

There is also a shingles vaccine for those over 60. I’m not a big fan of this vaccine as I think that if you know the signs of shingles you can take antiviral agents EARLY  and do just as well in preventing shingles.

EXPECTED OUTCOME
• Spontaneous recovery. Children usually recover in 7 to 10 days. Adults take longer and are more likely to develop complications.
• After recovery, a person has lifelong immunity against recurrence of chickenpox.

Treatment for Chickenpox

General Measures
•  Diagnosis is usually determined by the appearance of skin eruptions and laboratory tests are not necessary.
•  Treatment is directed toward relieving symptoms.
•  Use cool-water soaks or cool-water compresses to reduce itching
.
•  Keep the patient as quiet and cool as possible. Heat and sweat trigger itching.
•  Keep nails short to discourage scratching, which can lead to secondary infection.

Medication
•  The following non-prescription medicines may decrease itching:
    Topical anesthetics and topical antihistamines, which provide quick, short-term relief. Preparations containing
    lidocaine and pramoxine are least likely to cause allergic skin reactions. Lotions that contain phenol, menthol and camphor
    (such as calamine lotion). Follow package instructions.
•  If you must reduce a fever, use ibuprofen. Never use aspirin as it may contribute to the development of Reye's syndrome
   (a form of encephalitis) when given to children during a viral illness.
•  Acyclovir (brand name Zovirax), an antiviral medication may be prescribed’

Activity
•  Bed rest is not necessary. Allow quiet activity in a cool environment. A child may play outdoors in the
   shade during nice weather.
•  Keep an ill child away from others, away from school, for 5 days after the blisters first appear.
•  No special diet is necessary.

Notify Our Office If
•  You or your child have symptoms of chickpox.
•  Lethargy, headache or sensitivity to bright light develop.
•  Fever rises over 101°F (38.3°C).
•  Chickenpox lesions contain pus or otherwise appear infected.
•  A cough occurs during a chickenpox infection as it could suggest pneumonia.

Last screened and modified by Deb Bershel, MD 1/2010
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