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Definition
Chickenpox is a highly contagious viral infection. It produces a widespread itchy rash. Chickenpox can cause serious complications, especially when contracted by adults, newborns, or people with suppressed immune systems.
Chickenpox
2008 Nucleus Medical Art, Inc.
Causes
Chickenpox is caused by the varicella zoster virus (VZV). It spreads from person to person via:
- Airborne droplets of moisture containing the VZV virus
- Direct contact with fluid from a chickenpox rash
Chickenpox is contagious 1-2 days before the rash erupts. However, it is most contagious just after the rash has broken out and remains contagious until all of the blisters have crusted.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
- Close contact with an infected person (unless you've been vaccinated or have already had chickenpox)
- Age: less than three years old with peak incidence between 5-9 years old
- Immune deficient state (eg, leukemia , organ transplantation)
- Time of year (late winter, early spring)
Symptoms
Adults have more severe symptoms than children. Symptoms usually break out 10-21 days after contact.
Initial symptoms include mild headache, moderate fever, and a general feeling of malaise.Within 1-2 days after the initial symptoms, a rash develops. The rash consists of small, flat, red spots. The spots become raised and form a round, itchy, fluid-filled blister. The blisters develop in clusters, with new clusters forming over 5-6 days.The rash usually develops on the skin above the waist, including the scalp. The rash may also appear on the eyelids, in the mouth, upper airway, voice box, or on the genitals. The rash typically crusts over by day six or seven and disappears within three weeks. DiagnosisThe doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis is usually made on the basis of age and the rash. Blood and laboratory tests to identify the VZV virus are rarely necessary. TreatmentIn most people, chickenpox is mild and will naturally run its course. In these cases, treatment focuses on relieving the symptoms. To Reduce ItchingWet compresses on the skinNonprescription anti-itch creams or lotionsOatmeal bathsOral antihistaminesNote: Aspirin should not be given to children, adolescents, and young adults with chickenpox because of the increased risk of Reye's syndrome .
AntibioticsSince a virus causes chickenpox, antibiotics are not curative. They may be prescribed, however, if the rash becomes infected with bacteria. Antiviral Medication There are several antiviral drugs (acyclovir, valacyclovir, famciclovir) which may shorten the course and reduce the severity of infection. They are often used in: Adolescents, adults, and individuals with compromised immune systemsThese drugs are also used in individuals with chronic skin or lung diseases and those taking aspirin or steroids. Special NeedsVaricella-zoster immune globulin is often given immediately after exposure to VZV to newborns and people with compromised immune systems. PreventionIf you have not had chickenpox and have never been vaccinated, avoid contact with anyone who has the condition. The varicella vaccine is recommended for virtually all children 12-18 months of age. The second dose is administered between age 4-6 years. For those who have not been vaccinated, the Centers for Disease Control and Prevention (CDC ) recommend the following schedule: Up to age 13 years2 doses, with an interval of 3 months between the first and second dose (minimum age of 12 months for the first dose) 13 years and above2 doses, with a minimum interval of 4 weeks between the first and second dose * It is recommended that the following people not be vaccinated:
Those with a history of severe allergic reaction to vaccinesAnyone who is immunosuppressed, or receiving immunosuppressive drugs or therapiesPregnant women RESOURCES: American Academy of Family Physicianshttp://www.aafp.org American Academy of Pediatricshttp://www.aap.org National Immunization ProgramCenters for Disease Control and Preventionhttp://www.cdc.gov/vaccines/ References: Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ . The Merck Manual of Medical Information. 17th ed. Simon and Schuster, Inc; 2000. National Centers for Infectious Diseases website. Available at: http://www.cdc.gov/ncidod . Skull SA, Wang EE. Varicella vaccination: a critical review of the evidence. Arch Dis Child. 2001;85:83-90. Vazquez M, LaRussa PS, Gershon AA, et al. Effectiveness over time of varicella vaccine. JAMA. 2004;291:851-855. *Updated Who Should Get Vaccinated and When section on 1/31/2008 according to the following study, as cited by DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 yearsUnited States, 2008. MMWR. 2008;57;Q1-Q4. Centers for Disease Control and Prevention, MMWR website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm . Updated January 10, 2008. Accessed January 28, 2008.
Last reviewed February 2008 by David Horn, MD, FACPPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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