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Tuesday, October 10, 2017

Chicken Pox


Chickenpox

Overview

Chickenpox consists of an itchy, red rash that breaks out on the face, scalp, chest, back and, to a lesser extent, arms and legs. The spots quickly fill with a clear fluid, rupture and then turn crusty.

Chickenpox (varicella) is a viral infection that causes an itchy rash with small, fluid-filled blisters. Chickenpox is highly contagious to people who haven't had the disease or been vaccinated against it. Before routine chickenpox vaccination, virtually all people had been infected by the time they reached adulthood, sometimes with serious complications. Today, the number of cases and hospitalizations is down dramatically.

For most people, chickenpox is a mild disease. Still, it's better to get vaccinated. The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications.
Commonly Affected Areas
Symptoms

Chickenpox infection appears 10 to 21 days after exposure to the virus and usually lasts about five to 10 days. The rash is the telltale indication of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include:

  • Fever
  • Loss of appetite
  • Headache
  • 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 several more days to heal

New bumps continue to appear for several days. As a result, you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over.

The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, 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.


Risk factors

Chickenpox, which is caused by the varicella-zoster virus, 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 higher 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. A few people can get chickenpox more than once, but this is rare.

Complications

Chickenpox is normally a mild disease. But it can be serious and can lead to complications or death, especially in high-risk people. Complications include:

  • Bacterial infections of the skin, soft tissues, bones, joints or bloodstream (sepsis)
  • Dehydration
  • Pneumonia
  • Inflammation of the brain (encephalitis)
  • Toxic shock syndrome
  • Reye's syndrome for people who take aspirin during chickenpox

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
  • Adults
  • 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
  • People who are taking steroid medications for another disease or condition, such as children with asthma
  • People taking drugs that suppress their immune systems

Chickenpox and pregnancy

Other complications of chickenpox affect pregnant women. Chickenpox early in pregnancy can result in a variety of problems in a newborn, including low birth weight and birth defects, such as limb abnormalities. A greater threat to a baby occurs when the mother develops chickenpox in the week before birth or within a couple of days after giving birth. Then it can cause a serious, life-threatening 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

If you've had chickenpox, you're at risk of another disease caused by the varicella-zoster virus called shingles. After a chickenpox infection, some of the varicella-zoster virus may remain in your nerve cells. Many years later, the virus can reactivate and resurface as shingles — a painful band of short-lived blisters. The virus is more likely to reappear in older adults and people with weakened immune systems.

Shingles can lead to its own complication — a condition in which the pain of shingles persists long after the blisters disappear. This complication, called postherpetic neuralgia, can be severe.

A shingles vaccine (Zostavax) is available and is recommended for adults age 60 and older who have had chickenpox.

Prevention

The chickenpox (varicella) vaccine is the best way to prevent chickenpox. 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. When the vaccine doesn't provide complete protection, it significantly lessens the severity of the disease.

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.

If you've had chickenpox, you don't need the chickenpox vaccine. 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

Talk to 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.

Is it safe and effective?

Parents typically wonder whether vaccines are safe. Since the chickenpox vaccine became available, studies have consistently found it safe and effective. Side effects are generally mild and include redness, soreness, swelling and, rarely, small bumps at the site of the shot.

Diagnosis

Doctors generally diagnose chickenpox based on the telltale rash.

If there's any doubt about the diagnosis, chickenpox can be confirmed with laboratory tests, including blood tests or a culture of lesion samples.

Treatment

In otherwise healthy children, chickenpox typically requires no medical treatment. Your doctor may prescribe an antihistamine to relieve itching. But for the most part, 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 duration 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 — child or adult — any medicine containing aspirin because this combination has been associated with a condition called Reye's syndrome.

Treating complications

If complications do develop, your doctor will determine the appropriate treatment. Treatment for skin infections and pneumonia may be with antibiotics. Treatment for encephalitis is usually with antiviral drugs. Hospitalization may be necessary

Lifestyle and home remedies

To help ease the symptoms of an uncomplicated case of chickenpox, follow these self-care measures.

Don't scratch

Scratching can cause scarring, slow healing and increase the risk that the sores will become infected. If your child can't stop scratching:

  • Put gloves on his or her hands, especially at night
  • Trim his or her fingernails

Relieve the itch and other symptoms

The chickenpox rash can be very itchy, and broken vesicles sometimes sting. These discomforts, along with fever, headache and fatigue, can make anyone miserable. For relief, try:

  • A cool bath with added baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for soaking.
  • Calamine lotion dabbed on the spots.
  • A soft, bland diet if chickenpox sores develop in the mouth.
  • Antihistamines such as diphenhydramine (Benadryl, others) for itching. Check with your doctor to make sure your child can safely take antihistamines.
  • Acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, Children's Motrin, others) for a mild fever.

Don't give aspirin to anyone with chickenpox because it can lead to a serious condition called Reye's syndrome. And don't treat a high fever without consulting your doctor.

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