Chickenpox

Chicken Pox An Overview ~ Possible symptoms ~ Treatment for chickenpox ~ Complications Of Chickenpox ~ About the Vaccine ~ What are the risks from chickenpox vaccine? ~ Benefits of vaccinating child against chickenpox ~  Who should NOT receive the vaccine? ~ Helpful tips ~ Conclusion
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Chickenpox (varicella zoster)

Chickenpox (varicella) is a disease affecting most children before their 10th birthday. Until recently it could not be prevented, only treated. Today, parents can have their children immunized against chickenpox. Vaccinations are an important part of your child's total health care. The chickenpox vaccine can protect your child against a severe case of chickenpox and prevent the discomfort and possible serious complications the disease can cause. Chickenpox is one of the most common childhood diseases. It is usually mild and not life-threatening to healthy children. Chickenpox can occur at any time of the year. Peak times are in the winter and early spring, especially in moderate climates

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Possible symptoms
1. Begins with feeling unwell and maybe a slight temperature. 
2. Red spots appear and become small fluid-filled blisters which develop every day for 3-4 days, usually starting on the trunk and then spreading to the face, arms and legs. 
3. The blisters eventually dry into scabs, which drop off. 
4. Intense itchiness.
5. Headache and fever.
6. . coughing 
7. fussiness 
8. loss of appetite 

Chickenpox can easily be spread in any of the following ways: 

• By direct contact with an infected person, usually through fluid from broken blisters
• Through the air when an infected person coughs or sneezes
• Through direct contact with lesions (sores) from a person with shingles

A person with chickenpox is contagious from 1 to 2 days before the rash starts and for up to 5 days after the rash appears. A child will have to stay home from child care or school until she is no longer contagious. An adult or child who has never had chickenpox is at risk of getting it and may not show symptoms for 10 to 21 days after being exposed to the virus. Within households, 80% to 90% of at-risk persons will develop chickenpox if they are exposed to a family member who has it. 

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Treatment for chickenpox 

• Relieve itching: Lukewarm tub baths with baking soda or oatmeal preparations (i.e. Aveeno or CVS Oatmeal Bath) in the water often provide great relief from itching. Baths can be taken several times a day if they are helpful. Often a medication to decrease itching such as Benadryl or Atarax will be recommended. Both medications are very effective, especially at bedtime when itching is most bothersome. Both medications can cause drowsiness. If neither Benadryl nor Atarax was prescribed and bathing has not relieved itching, then contact your healthcare provider. 
• Use of skin lotion for itching: Calamine lotion can be applied to the rash if it provides relief. Do not use Caladryl Lotion when a child has chickenpox. 
• Control fever: Acetaminophen (Tylenol, Panadol, Tempra...) should be used to manage fever. Give a dose of acetaminophen based on your child's weight, rather than age for best effect. Acetaminophen can be repeated every 4 hours as needed for fever. Never use aspirin or aspirin-containing medications when a child has chickenpox. 
• Prevent dehydration: Because appetite is likely to be decreased and there may be sores in the mouth and throat, most children need encouragement to take fluids when they have chickenpox. The child will be most likely to take cold, clear liquids, and soft bland foods such as applesauce, soup, noodles, eggs, etc., while ill. Popsicles, jello, and ice cream will be soothing to a painful throat. Avoid spicy, hot, citrus based, or carbonated drinks because they irritate mouth sores and increase pain. A child who refuses to drink is more worrisome than a child whose appetite is decreased for several days. The child may be most willing to drink after receiving acetaminophen because their pain will be decreased. 
• Decrease risk of infection and scarring: Keep fingernails cut short so that scratching causes less trauma to the skin. Putting cotton socks or mittens on infants' hands at night may help to limit scratching. Keeping the child distracted by activities during the day will also be helpful. Chicken pox can leave the skin darkened, these marks generally fade away in 6-12 months. Permanent scars may occur occassionally and are more common if the pox were infected. 
• Increase comfort: Dress the child in lightweight, cotton clothing to decrease irritation to the skin. Change clothing daily to decrease risk of skin infection.

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Complications Of Chickenpox
Most healthy children who get chickenpox won't have any complications from the disease. The most common complication from chickenpox is a bacterial infection of the skin. The next most common problems are pneumonia and encephalitis, an infection of the brain. The following groups of people are at higher risk of developing these problems: 

• People who have weak immune systems or low resistance to disease 
• Infants under 1 year of age 
• Adolescents and adults 
• Newborns whose mothers had chickenpox around the time of delivery 
• Premature infants whose mothers have not had chickenpox 
• Children with eczema and other skin conditions 
• Children receiving therapy with salicylate (a compound found in aspirin) 

When an adult gets chickenpox, the disease is usually more severe, often developing into pneumonia. Adults are almost 10 times more likely to be hospitalized for chickenpox than children under 14 years of age, and adults are more than 20 times more likely to die from the disease. If a pregnant woman gets chickenpox, her unborn baby may have complications. 

What is "shingles"? 
Once someone has had chickenpox, the virus stays in the body of the infected person permanently. Later in life, the virus can reappear and cause shingles. Shingles can occur at any age, but usually occur after a person is 50 years old. About 10% to 20% of all people who have had chickenpox develop shingles. People with shingles typically feel numbness and itching or severe pain in the skin areas where the affected nerve roots are. Within 3 to 4 days, clusters of blister-like sores develop and last for 2 to 3 weeks. 

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About the Vaccine
Chickenpox vaccine is the best way to protect against chickenpox. About 70-90% of people who get the vaccine are protected from chickenpox.
If vaccinated children do get chickenpox, it is usually very mild. They have fewer spots, lower fever, and recover more quickly.
Vaccinated children who get this milder form of chickenpox can still spread the disease to others who are not protected.
Who Should Get Chickenpox Vaccine?
Children between 12 and 18 months of age: Most children in this age group should have one dose of chickenpox vaccine.
Children between 19 months and their 13th birthday: All children who have not had chickenpox or gotten chickenpox vaccine should be vaccinated before their 13th birthday. Many doctors will give the vaccine at 11 or 12 years of age to children in need. However, vaccine may be given any time between 19 months and 12 years. Your doctor or clinic can tell you whether your child should be vaccinated. 
People 13 and older: Some people 13 or older who have not had chickenpox or gotten chickenpox vaccine should get two doses of the vaccine 4 to 8 weeks apart. Ask your doctor for details.
Chickenpox vaccine may be given at the same time as other vaccines.

Most doctors recommend chickenpox vaccine for almost all young children. But there are some cautions. Tell your doctor or nurse if the person getting the vaccine: 

• Ever had a serious allergic reaction to chickenpox vaccine, neomycin, or gelatin 
• Now has moderate or severe illness 
• Is pregnant 
• Is unable to fight serious infections because of:
  o a disease (like HIV/AIDS)
  o treatment with drugs such as long-term steroids
  o any kind of cancer
  o cancer treatment with x-rays or drugs
• Has gotten blood products (such as immune globulin or a transfusion) during the past several months 
  If you are not sure, ask your doctor or nurse. 

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What are the risks from chickenpox vaccine?
As with any medicine, there are very small risks that serious problems, even death, could occur after getting chickenpox vaccine. 

However, almost all people who use the vaccine have no problems. It has not been shown to cause any serious problems. 
The risks from the vaccine are smaller than the risks from the disease. 
Mild Problems 

• Soreness, redness or swelling where the shot was given (about 1 out of 5 doses) 
• Very mild rash or several small bumps (3-4 out of 100 doses) [NOTE: It may be possible for someone who gets a rash from chickenpox vaccine to give chickenpox to another person. If the person getting the vaccine is in close contact with anyone whose immune system is not working properly, tell your doctor or nurse.]
• Fever of 102° (15 out of 100 doses) [NOTE: Do not use aspirin to reduce fever in children. Ask your doctor or nurse about medicines to control fever.] 
  Moderate Problems 
• A seizure (jerking and staring spell) usually caused by fever (less than 1 out of 1,000 doses).

This may not be related to the vaccine. 
What to do if there is a serious reaction: 

• Call a doctor or get the person to a doctor right away. 
• Write down what happened and the date and time it happened. 
• Ask your doctor, nurse, or health department to file a Vaccine Adverse Event Report form, or you can call: (800) 822-7967 (toll-free) 

If you find that you were pregnant when you got the chickenpox vaccine, or if you get pregnant within 3 months after getting the vaccine, contact your doctor or call this number: (800) 986-8999 (toll-free).
If you want to learn more, ask your doctor or nurse. She/he can give you the vaccine package insert or suggest other sources of information.

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Benefits of vaccinating child against chickenpox. 
Although chickenpox is usually mild, vaccinating all children at age 1 can prevent serious medical problems and reduce the costs related to the disease. Chickenpox can be expensive and inconvenient. Parents may have to miss work while their children are home from school or child care. In the average household, a child with chickenpox misses 8 or 9 days of school, and adult caretakers lose up to 2 days of work. 

Immunization with the chickenpox vaccine will prevent most children from getting chickenpox. If vaccinated children do get chickenpox, they generally have a much milder form of the disease. They have fewer skin lesions (15 to 32), a lower fever, and recover more quickly. In fact, the disease may be so mild that the skin lesions look like insect bites. Even so, vaccinated children with a mild case of chickenpox can still infect others at risk of getting chickenpox. 

Currently, revaccination with the chickenpox vaccine is not recommended. However, studies are underway to determine how long protection from the vaccine lasts and whether a person will need revaccination in the future. 

Who should NOT receive the vaccine? 
Although the chickenpox vaccine is approved for use in healthy children, there are certain groups of people who should not receive it, such as: 

• Children with a weakened immune system 
• Children with a life-threatening allergy to gelatin or the antibiotic neomycin 
• Pregnant women 

Talk to your pediatrician about whether your child falls into any of the high-risk categories and should not be vaccinated against chickenpox.

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Helpful tips 

• If your child has painful spots in the mouth, one suggestion is to make tea twice as strong as usual (double the tea bags in the same amount of water), add a little sugar, and use this liquid as a mouthwash or gargle.
• It's very important to keep children calm, cool, and dry. Getting warm and sweating will only make the itching worse. Stay out of the sun.
• Give plenty of fluids. Good choices are cool liquids such as water, milk and apple juice. Avoid salty foods and orange juice. 

Conclusion
Most people develop lifetime immunity to chickenpox after the first occurrence and never experience it again. But the virus can sometimes resurface later in life as shingles (zoster). The current aim in the U.S. and many other countries is to achieve universal (or nearly universal) immunization of children with the chickenpox vaccine. The vaccination requires only one shot given at about one year of age. If an older person has not had chickenpox, the shot may be given at any time. There have been few significant adverse reactions to the chickenpox vaccine. All children, except those with a compromised immune system, should have the vaccination.

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More Information

MEDLINEplus: Chickenpox
Ask the Mayo Physician - Chickenpox immunity
The Official Site For The Swedish Ska Band Chickenpox
Virtual Hospital: Iowa Health Book: Chickenpox (Varicella)
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Medinfo: Chickenpox
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The Vaccine for Chickenpox / AAFP Patient Information Handout
OnHealth: Chickenpox Shot Protects Adults
Virtual Hospital: Iowa Health Book: Chickenpox (Varicella)
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Chickenpoxinfo.com
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