Randy Jacobs, M.D. Patient Education

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Chicken Pox


CHICKENPOX (Varicella)


General Information

Chickenpox  is usually mild, but it is a highly contagious disease. It is caused by a virus. Exposure to someone who has it will almost always result in the exposed child "catching it". There is no specific medication for killing the virus, so treatment must be directed toward preventing possible complications rather than curing the disease itself. At first, for 1 or 2 days, there will be fever, abdominal pain, or a general feeling of ill health. Then skin eruptions will appear almost anywhere on the body. Do not be alarmed if they appear on the mouth, throat, nose, scalp, vagina, or penis. Within 24 hours, the blisters collapse and scab over. New crops erupt over a 3 to 4 day period, spreading to face and scalp and tending to spare the arms and legs. The mouth, throat, and conjunctiva (whites of eyes) are sometimes affected. At any given time the child is likely to have old crusted spots and some fresh new red ones, as well as some which are still in the blister stage. The scabs may last for 1 or 2 weeks before detaching. Fine scars may remain for several months following the detachment of scabs. In black children the scars are light and more noticeable because of the contrasting darkness of the surrounding normal skin. These white spots may persist for several years. There are all degrees of severity in chickenpox. At one extreme, the child may have only one or two spots, detectable only after a deliberate search. Other children may be literally covered with the pox, with little uninvolved skin remaining. Most cases fall somewhere in between and offer no mystery to the observant parent. Our impression is that children exposed to a family member with chickenpox are prone to develop more severe cases, presumably because of more prolonged exposure to the initial case and a heavier dose of virus. This is not invariably true and seems to depend upon individual characteristics of the child's own response to infection. Complications, if there are any, usually develop during the 2 weeks of the illness itself. The only permanent effect that may possibly result from uncomplicated chickenpox is scarring. This may occur at the site of a particularly large eruption or one that becomes infected with bacteria. Anyone who has chickenpox is infectious to others who have not had the disease. The infectious period begins during the 1 or 2 days before the skin eruptions appear and continues until new eruptions stop appearing. Symptoms of infection in others appear approximately 2 weeks after exposure to the patient. There is no way to protect a person who has never been infected with chickenpox, once exposure to the virus has taken place. Newborns are protected for several months from chickenpox, assuming that they received protective antibodies from a mother who had chickenpox before pregnancy or before going into labor. These antibodies diminish and are practically gone in 10 to 12 months. By their first birthdays, almost all children are susceptible to chickenpox. Once infection has occurred, the child develops antibodies, giving almost 100 percent immunity to reinfection by this virus. After chickenpox runs its course, the virus itself goes into hiding, so to speak, remaining perhaps for life. These same viruses are thought to be later responsible in some way for herpes zoster (shingles).

Chicken Pox: Discussion

Acyclovir (tradename Zovirax) is a drug which disrupts replication of the DNA of the chicken pox virus. When the DNA can't replicate, neither can the virus. Studies have shown that early use of Acyclovir (started within the first 24 hours of the rash) does seem to modify the symptoms of the infection but only modestly. What does Acyclovir do?: 1. Acyclovir decreases the number of chicken pox lesions. The number of lesions goes down a little bit but is certainly not eliminated. 2. Acyclovir decreases the length of time new lesions show up. 3. Acyclovir decreases the number of days children have a fever. The fever goes away about one day earlier with Acyclovir. What Acyclovir does not do: 1. Acyclovir does not decrease the complications of chicken pox (e.g. infected skin lesions) 2. Acyclovir does not make the person less infectious to other people since the most infectious period of chicken pox occurs before the rash shows up. 3. Acyclovir does not seem to lower the immunity to chicken pox after the infection. However, the long term effects

Acyclovir has on immunity are still being studied. By the time a child with chicken pox comes to see the pediatrician, the rash has usually been there for more than 24 hours making the decision for Acyclovir moot. However, with that scenario aside, the decision to use Acyclovir should not be routine but rather should be a joint one between the doctor and parent based upon the pros and cons. This drug must be given 4 times per day and costs anywhere between $200-270 for a five day course. If your child scars easily, this may be well worth it. However, for many, especially those without insurance, the modest, if any, effects Acyclovir has on the individual child's symptoms may not be as enticing. There are a few types of patients that I would recommend using Acyclovir because the symptoms of the disease may be more severe. These include: 1. Non-pregnant individuals over the age of 13. 2. Those people taking aspirin on a chronic basis. 3. Those people taking anti-inflammatory steroids for any number of conditions including asthma. 4. Immune suppressed individuals (e.g. patients with cancer, AIDS, etc.)  I would add also for you to be on the lookout for any pox lesions that may get infected. Any pox lesion that gets more red or oozes pus should be examined by your physician as these will continue to itch and could lead to more serious infection. Transmission and infectiousness of chickenpox: Chicken pox symptoms start like any other viral cold with symptoms of runny nose, sneezing, cough, and fever. It is at this time that chicken pox is most contagious. Then about 3-5 days later the rash shows up. The incubation time prior to the onset of the cold symptoms can be up to 24 days. The chicken pox virus is extremely contagious and the infected patient is most contagious about 3-5 days prior to the rash showing up. Chickenpox is a disease with a characteristic rash and is usually caught by children. The disease is caused by a virus known as varicella zoster. This virus is highly contagious and can spread by an airborne route, for example, coughing or sneezing, so it can spread without physical contact. This means that if you have not had chickenpox, you can easily catch it just by being around someone who is infected. After coming into contact with someone who has the chickenpox virus, it usually takes about two to three weeks before symptoms begin. This gap between contact with the virus and starting to feel sick is called an incubation period. About a day before the telltale rash of chickenpox appears, the infected person may start to feel achy and feverish, doesn't feel like eating, and generally seems to be "coming down with something." Who gets chickenpox? Nearly four million Americans get chickenpox each year. Approximately 90% of cases occur in children 1 to 14 years of age, with about 2% of cases occurring in adults. Elementary school children have the highest risk of infection, with 50% to 60% of cases occurring in children between the ages of five and nine. The disease is likely to be more severe in adults than in children. Even among children, who commonly come down with a mild form of the illness, chickenpox still takes it toll. The disease is not only physically uncomfortable, but infected children must avoid contact with others until all the pox have crusted over. Children miss not only school days, but other group activities, including sports, vacations, and special events as well. The disease has a more practical impact on caregivers. Each year chickenpox costs millions of dollars in lost workdays for parents who must stay home to care for sick children. In addition, parents must consider the possible cost of sick-child visits to the doctor and associated pharmacy expenses. Remember, don't pass chickenpox off as just another part of growing up. Chickenpox in children: Most cases of chickenpox occur in children younger than 14 years old, most often in children between the ages of five and nine. When chickenpox is in the household, the chance of a susceptible child catching the disease from an infected brother, sister, or even a parent is about 90%. In fact, infected children attending school or day care will need to be kept home and away from other susceptible children until they are no longer contagious - that is, until all the pox have crusted over. Although most children with the disease recover, sometimes complications such as skin infections or more serious conditions can occur. Chickenpox in teenagers Approximately 10% of the population in the United States is susceptible to chickenpox after the age of 15. The course of the infection is virtually the same in teenagers as it is in younger children. Teenagers contract chickenpox through contact with a contagious, infected person and go through the same incubation period, which may include a one-to-two-day period of fever, headache, general listlessness, loss of appetite, and the appearance of a rash. Finally, just as in younger children, teenagers need to stay home from school and other activities until all the pox crust over, at which point they are no longer contagious. Although most teenagers recover without much incident, sometimes complications can occur. The possibility of complications that may require hospitalization increases with age. Chickenpox in adults For adults, the risk of complications associated with chickenpox is much higher than in children or teens. Although very few cases of chickenpox (about 2%) occur in adults, these cases account for more than 13% of hospitalizations for complications including pneumonia, other lower and upper respiratory tract conditions, and encephalitis - an inflammation of the brain. So, adults who have never had chickenpox need to be especially aware of the risks of the disease. Chickenpox, when acquired during pregnancy, can also have serious consequences for both the mother and the fetus. Varicella infections during the first trimester may result in fetal abnormalities, while infection five days or less before delivery is associated with significant infant mortality. Can chickenpox be avoided? Today, medical research has developed preventative measures against chickenpox in children, teens, and adults. Ask your doctor or healthcare provider about the possibility of preventing chickenpox. Be sure to discuss with your doctor or healthcare provider the benefits as well as the risks of the available preventative measures.


Important Points in Treatment

DIET: Follow a normal, regular diet unless special circumstances do not allow it. If there is fever, give extra fluids. As is true in most illnesses, appetite is likely to drop off. Concentrate on enjoyable foods.

GENERAL MEASURES: The major complaint is itching, and finding relief sometimes becomes a problem. Older children should be encouraged not to scratch the lesions lest they become infected. The child's nails should be trimmed. With this skin condition, as with many other itchy ones, keeping the child as quiet and cool as possible minimizes heat production and sweating, which strongly stimulate itching and scratching. The child need not stay in bed, but should be allowed quiet activity and kept in a cool environment. If the weather is nice and there is a yard or play area adjacent to the home, it is perfectly all right for the child to be in a shady spot out the doors. Whether it is important to keep him away from other children to prevent the spread of the chickenpox virus is debatable, since the disease is much milder in the children than adults, and immunity is lifelong. While it is practically impossible to isolate the child from other members of his immediate household, prolonged exposure of susceptible children should be avoided, as the severity of the disease seems related to exposure. Wash with Gentle Face and Body Cleanser soapless cleanser available OTC when bathing. An Aveeno bath in a tub of warm water 2 or 3 times a day can be soothing if the itching is uncomfortable. Take temperature at bedtime, in the morning, or at any other time when the patient seems hot. If there is itching, calamine lotion with 0.25 percent menthol may be obtained from the pharmacy without prescription. Apply this to all accessible sores except those in the mouth. This may be repeated as may times per day as necessary to control the itching.  Oral Benadryl given around the clock can also control itch. Give tea, twice as strong as usual with a little sugar, for mouthwash or gargle if sores should appear in the mouth and are painful.

MEDICATIONS: Do not use aspirin to decrease fever. Use acetaminophen and cool-water sponge baths if necessary. Using aspirin in children or adolescents during some viral illnesses may lead to Reye's syndrome a form of encephalitis.


- Sores in the eyes, on either the white or the colored part.

- Temperature over 103^ F.

- Severe headache not relieved by medication.

- Convulsions or twitching movements.

 - Sores that become larger despite use of baths, calamine lotion, and antibiotic ointment.