Chickenpox, also known as varicella, is a highly contagious viral infection that causes an itchy rash with small, fluid-filled blisters. Chickenpox is caused by the varicella-zoster virus. People who haven’t had the disease or been vaccinated against it can easily get chickenpox.
Prior to the emergence of chickenpox vaccine, almost all people had been infected by the time they reached adulthood, sometimes with serious complications. However, the number of cases and hospitalizations is intensely down today.
The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications.
Symptoms of Chickenpox
Chickenpox infection appears about 10 to 21 days after exposure to the virus. It usually lasts about five to 10 days. The distinctive rash is the revealing sign of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include:
- Loss of appetite
- Tiredness and a general feeling of being unwell (malaise)
Once the chickenpox rash appears, it goes through three phases:
- Raised pink or red bumps (papules), which break out over several days
- Small 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 more days to heal
New bumps continue to appear for several days and you may have all three stages of the rash including the bumps, blisters and scabbed lesions, at the same time on the second day of the rash. You can spread the virus for up to 48 hours before the rash appears, and you equally remain contagious until all spots crust disappear.
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The rashes can spread to cover the whole body in severe cases 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
Your doctor can diagnose chickenpox by inspecting the rash and by noting the presence of associated symptoms. Also, your doctor can also prescribe medications to reduce the severity of chickenpox and treat complications.
Possible complications of chickenpox include:
- Rash may spread to one or both eyes.
- The rash gets very red, warm or tender, indicating a possible secondary bacterial skin infection.
- The rash comes with dizziness, disorientation, rapid heartbeat, shortness of breath, tremors, loss of muscle coordination, worsening cough, vomiting, stiff neck or a fever higher than 102 F (38.9 C).
- Reye’s syndrome for people who take aspirin during chickenpox
- Inflammation of the brain (encephalitis)
- Toxic shock syndrome
Chickenpox 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 greater 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
Most people who have had chickenpox or have been vaccinated against chickenpox are immune to chickenpox. If you’ve been vaccinated and still get chickenpox, symptoms are often milder, with fewer blisters and mild or no fever.
Who’s at risk?
Those at high risk of having complications from chickenpox include:
- Newborns and infants whose mothers never had chickenpox or the vaccine
- Pregnant women who haven’t had chickenpox
- People whose immune systems are impaired by medication, such as chemotherapy, or another disease, such as cancer or HIV
- Those on drugs that suppress their immune systems
- Those who are taking steroid medications for another disease or condition, such as children with asthma
Chickenpox and pregnancy
Other complications of chickenpox affect pregnant women. Chickenpox early in pregnancy can cause birth weight and birth defects, such as limb abnormalities. A greater threat to a baby is when the mother develops chickenpox in the week before birth or within a couple of days after giving birth. This can lead to a serious, fatal 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.
Chickenpox and shingles
After a chickenpox infection, some of the varicella-zoster virus may still remain in your nerve cells. The virus can reactivate after many years and resurface as shingles, which is a painful band of short-lived blisters. The virus is more likely to reappear in older adults and people with weakened immune systems.
A shingles vaccine (Zostavax) is available and is recommended for adults age 60 and older who have had chickenpox.
The best way to prevent chickenpox is to get the chickenpox (varicella) vaccine. Experts from the Centers for Disease Control and Prevention (CDC) estimate that the vaccine provides complete protection from the virus for nearly 98 percent of people who receive both of the recommended doses.
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 immunization schedule. The vaccine can be combined with the measles, mumps and rubella vaccine, but for some children between the ages of 12 and 23 months, the combination may increase the risk of fever and seizure from the vaccine. Discuss the pros and cons of combining the vaccines with your child’s doctor.
- 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 your immunity.
You don’t need the chickenpox vaccine if you’ve had chickenpox. 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. However, if you’re older than 60, talk to your doctor about the shingles vaccine.
The chickenpox vaccine isn’t approved for:
- Pregnant women
- People with weakened immunity, such as those with HIV or people taking immune-suppressing medications
- People who are allergic to gelatin or the antibiotic neomycin
Consult 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.
Doctors generally diagnose chickenpox based on the revealing rash. To confirm diagnosis of chickenpox, laboratory tests are carried out, including blood tests or a culture of lesion samples.
Chickenpox requires no medical treatment in healthy children. Your doctor may prescribe an antihistamine to relieve itching. In most cases, the disease is allowed to run its course.
If you’re at high risk of complications
For people who have a high risk of complications from chickenpox, doctors sometimes prescribe medications to shorten the period 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 (Privigen). 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 may not be approved or appropriate for all cases. In some instances, your doctor may recommend getting the chickenpox vaccine after exposure to the virus. This can prevent the disease or lessen its severity.
Don’t give anyone with chickenpox any medicine containing aspirin because this combination has been associated with a condition called Reye’s syndrome.