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Childhood Illnesses and Conditions
: Chickenpox and its Prevention in Children: An Update


What is chickenpox?

Chickenpox or varicella is a very contagious or easy to spread infection caused by the varicella zoster virus.

This virus is spread form one person to another in one of two ways:

  • By direct contact with the actual rash or
  • Through the air by coughing or sneezing, just like a cold

    How common is chickenpox?


    Varicella is a very common childhood infection. Most children by the age of 9 will have had chickenpox. In Canada there are about 350,000 cases of chickenpox each year.

    What are the symptoms of chickenpox?

    This varies from child to child. Some children develop such a mild form of chickenpox that their parents do not even realize that they have had it. However in the typical cases, the disease starts with one or more of the following:

  • Fever
  • Cold-like symptoms
  • Fatigue or
  • Irritability

    Within a day or so, the typical chickenpox rash develops, which is a very characteristic one and usually easy to identify. The rash begins as a red round or oval spot that develops a "blister-like" center full of a yellowish fluid containing the varicella virus. The rash which can be quite itchy, may occur anywhere on the body. Some children develop very few blisters while others seem to have their whole body covered.

    When is chickenpox contagious?

    A child developing chickenpox is considered to be contagious a couple of days before the rash actually breaks out. This is why the disease spreads so easily, as children are contagious before the rash comes out and generally still attend school or daycare. Once the rash appears, the child is contagious for about 3 - 5 days, or until all of the blisters have dried or crusted off. Only when all the lesions are crusted can a child return to school or day care.

    Incubation Period:

    Parents often wonder how long it takes to develop the illness after being exposed to a child with chickenpox. This period known as the "incubation period", ranges between 11 to 20 days, although for most children it develops within 14 days. If a child does not develop chicken pox after this period, then he or she has not been infected this time.

    What are the complications of chickenpox?

    Fortunately most children do not suffer any serious consequences from chickenpox infections. From a cost-to-society point of view, chicken pox can be expensive and inconvenient. Children miss school, parents have to miss work, causing inconvenience and a loss of productivity all around. However, approximately 1 in 2000 children may develop more serious complications, which account for 1900 children a year requiring hospitalization. These complications include:

  • Pneumonia
  • Bacterial infection of the rash, and rarely "flesh eating disease"
  • Brain inflammation or encephalitis
  • Balance problems related to infection of a specific part of the brain(cerebellitis)
  • Death (very rare)

    Who is particularly susceptible to chickenpox?

    Varicella zoster infections are more serious or dangerous in the following groups(high risk individuals):

  • Adults
  • Very young children
  • Adults or children with weak immune systems(such AIDS, or cancer)
  • People on medications that weaken their immune system(such as oral cortisone)

    What is the treatment of chickenpox?


    There is no specific recommended treatment or medicine for normal children who develop chickenpox.

    The general approach to uncomplicated chicken pox infections include:

  • Calamine lotion application and soothing baths(oatmeal, baking soda or cornstarch) to help relieve the itch

  • Cool compresses may also help

  • Making sure children have short nails so they don't scratch and infect the rash(young babies may need mittens)

  • For temperature control Acetaminophen can be given as needed for age and weight

  • ASA or Aspirin SHOULD NEVER BE GIVEN TO CHILDREN WITH CHICKENPOX

  • Making sure they are drinking well(and enough).

  • If a child is having difficulty eating because of chickenpox in the mouth offer him/her cold fluids(avoid acid drinks like apple or orange juice ) and a soft diet

    For high risk individuals who either develop or are exposed to varicella infection, there are certain anti-viral medications and other treatments that may need to be given to protect their weakened body. In many cases, this will require hospitalization.

    When to seek medical attention?

    You should see a doctor of your if:

  • Signs of infection around the blisters develop such as redness or swelling

  • There is a very high fever

  • The child vomits more than 3 times

  • The child is confused, difficult to waken or has trouble walking

  • You are worried that your child is not following the typical course of chickenpox(say as compared to another child)

    Can chickenpox be prevented by a vaccine?

    Yes, now there is a vaccine that protects children from chickenpox. Although chickenpox in most cases is not serious, the potential for complications, have prompted the American Academy of Paediatrics and the Canadian Paediatric Society to recommend the Varicella vaccination for children between 12 and 18 months of age who have not had chickenpox. They have also recommended a universal catch-up vaccination program for older children who have not yet had chickenpox. The vaccine has been proven to be 85% effective in preventing the disease and almost 100% effective in preventing severe disease. Obviously, this results in a decrease of potential complications.

    As with all vaccines, safety is a concern. Having been administered to 29 million people worldwide and studied in over 90,0000 children and adults, the varicella vaccine is considered to be safe. Only a few mild, temporary side-effects were reported including soreness, tiredness, fussiness, fever, nausea and a bit of swelling where the shot was given. Also, in a small percentage of people who were vaccinated, a rash may develop over the body.

    For children aged 12 month to 12 years, only one dose is needed. For older children and adults two doses, 4 to 8 weeks apart are recommended.

    Can chickenpox infection recur?

    Technically no. However after a chickenpox infection, the varicella virus remains in the body forever. The virus, for reasons not clearly understood, lives "asleep" in the nerves. For a variety of reasons, usually in older people or those with weakened immune systems the virus appears on the skin again. However, this time it only comes out in the area that specific nerve feeds, called a dermatome. It looks like a patch of varicella blisters. This is called Herpes Zoster(Zona) or shingles. People who have not yet had chickenpox or have not had the varicella vaccination can actually contract the virus and develop typical chickenpox infection if they come into contact with someone who has shingles. People who have had the disease or have been vaccinated will be protected from the virus whether they come into contact with someone who has either active typical chickenpox or shingles.

    Are there any tests to prove that someone has had chickenpox?

    Sometimes people do not remember if they have had chickenpox. This may be especially important in persons who work with children. There is blood test that can confirm whether or not a person has been infected by chickenpox in the past. In many cases the test is usually positive signifying that they have had a varicella virus infection but it was so mild that they didn't realize they had it.

    MORE DR.PAUL VARICELLA(CHICKENPOX)LINKS:

    Chickenpox Vaccination or Not?
    Zoster(Shingles) and Chickenpox


    Other Childhood Illnesses and Conditions

    The information provided in this site is designed to be an educational aid only. It is not intended to replace the advice and care of your child's physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition, always consult a physician.

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