CHICKENPOX

DEFINITION

Chickenpox, also called varicella (pronounced VAR-ih-SEL-uh), is a common and very infectious childhood disease, which sometimes affects adults. Chickenpox produces an itchy rash with blisters that lasts about a week. Fever and other symptoms may also be present. A single attack of chickenpox generally produces lifelong immunity (protection) against the disease, which means once you have chickenpox you usually never have it again.

Chickenpox can almost always be treated at home. The symptoms are unpleasant, but they are rarely dangerous. If complications develop, professional medical attention is essential.

DESCRIPTION

Chickenpox is caused by the varicella-zoster virus (a herpes virus; see herpes infections entry) and affects about four million Americans each year. Of this number, five thousand to nine thousand require hospitalization. About one hundred people die of the disease each year.

A person becomes infectious (able to pass on the virus) a day or two before a rash first appears. He or she remains infectious until the blisters have formed scabs. Scabs form four to seven days after the rash first appears. During this period, a child with chickenpox is expected to stay home from school so that he or she will not pass the disease to other children.

Chickenpox has always been a common disease among children in the industrialized world. The disease can occur at any age. However, about 80 to 90 percent of all American children under the age of ten have already been infected. Because a single attack of the virus provides immunity, chickenpox occurs in only 5 percent of adults in the United States. If an adult contracts chickenpox he or she is more likely to experience complications than children; more than half of all deaths from chickenpox occur among adults.

CAUSES

Chickenpox is caused by a virus that is transmitted through the air or by direct contact with an infected person. Once the virus enters a person's body, there is an incubation period of ten to twenty-one days. During this period, the virus reproduces and grows in the body, but no symptoms appear.

SYMPTOMS

The first signs of chickenpox are usually a slight fever and a general feeling of illness. Within a few hours or days, small red spots begin to appear on the scalp, neck, or upper half of the body. About twelve to twenty-four hours later, these spots become itchy and develop into fluid-filled bumps. These bumps, called vesicles, go through a series of changes. First they turn into blisters. Then they break open, and scabs begin to form on top of them. This process goes on for a period of two to five days.

Blisters can also form on other parts of the body, including the insides of the mouth, nose, ears, vagina, and rectum. Some people develop only a few blisters. In most cases, however, the number reaches 250 to 500. Toward the end of the disease, scabs begin to fall off. Scarring normally does not occur unless the blisters are scratched and become infected.

Chickenpox: Words to Know

Acetaminophen:

A drug for relieving pain and fever. Tylenol is the most common example.

Acyclovir:

An antiviral drug used for combating chickenpox and other herpes viruses.

Reye's syndrome:

A rare but often fatal disease that involves the brain, liver, and kidneys.

Shingles:

A disease that causes a rash and a very painful nerve inflammation. An attack of chickenpox eventually gives rise to shingles in about 20 percent of the population.

Varicella-zoster immune globulin (VZIG):

A substance that can reduce the severity of chickenpox symptoms.

Varicella-zoster virus:

The virus that causes chickenpox and shingles.

Varivax:

A vaccine for the prevention of chickenpox.

The amount of itchiness caused by the blisters can range from barely noticeable to severe. People with chickenpox may also have headaches, stomach pain, and a fever. Full recovery usually takes five to ten days after symptoms first appear. Again, the most severe cases of the disease are usually found among older children and adults.

Some groups of people are at risk for developing complications in connection with chickenpox. The most common of these complications are bacterial infections of the blisters, pneumonia (see pneumonia entry), dehydration (loss of water from the body), encephalitis (brain fever; see encephalitis entry), and hepatitis (inflammation of the liver; see hepatitis entry). The groups at risk for these complications include:

• Infants. Complications occur more often among children less than one year old than among older children. The risk is greatest to newborns, among whom the death rate is greater than for any other age group. Babies are especially at risk when born to women who had chickenpox while they were pregnant. In such cases, the child faces the risk of physical disorders, brain damage, or death.
• Children with damaged immune systems. A child's immune system can be damaged by many factors, including genetic disorders or disease. Children in this group have the second highest death rate from chickenpox.
• Adults and children over the age of 15. Chickenpox is generally more serious in these age groups than it is among younger children.

DIAGNOSIS

It is usually quite easy to diagnose chickenpox in children. A school nurse or a parent is often able to recognize the disease. A doctor can sometimes diagnose the disease over the telephone. The doctor should also be called if:

• The child's fever goes above 102°F (39°C) or lasts more than four days.
• The child's blisters appear to be infected. Signs of infection include leakage of pus from blisters, or excessive redness, warmth, tenderness, or swelling around the blisters.
• The child seems nervous, confused, unresponsive, or unusually sleepy. A stiff neck or severe headache, poor balance or trouble walking, sensitivity to bright lights, breathing problems or excessive coughing, and chest pain or vomiting could be signs of more serious illnesses, such as Reye's syndrome (see Reye's syndrome entry) or encephalitis.

TREATMENT

With children, treatment of chickenpox usually takes place in the home and focuses on reducing fever and discomfort. Because chickenpox is caused by a virus, antibiotics are not effective against the disease. Applying wet compresses (folded cloths) can help relieve itching. Cool or lukewarm baths once a day may also help. The addition of baking soda or oatmeal to the bath water makes the bath more soothing. Only mild soaps should be used for the bath. The child should be patted dry, not rubbed, to prevent irritating the blisters. Calamine lotion also helps to reduce itching.

The child's fingernails should be kept short during the disease. That will prevent scratching of the blisters, which can lead to infection. Older children should be warned not to scratch. For babies, light mittens or socks on the hands can help guard against scratching.

Blisters in the mouth can make eating and drinking uncomfortable. Children may find it easier to have cold drinks and soft, bland foods. Genital blisters can be treated with an anesthetic (pain-killing) cream recommended by a doctor or pharmacist. Antibiotics are used if blisters become infected.

Acetaminophen (pronounced uh-see-tuh-MIN-uh-fuhn) and other drugs can be used to treat fever and discomfort. Aspirin should be avoided when treating children. It has been shown to cause Reye's syndrome in children, a serious disease of the nervous system.

Children with weakened immune systems may be given antiviral (viruskilling) drugs, such as acyclovir (pronounced a-SI-klo-veer, trade name Zovirax). The drug has been recommended by some doctors for the relief of chickenpox symptoms in children and adults with normal immune systems, but experts still disagree about the use of acyclovir for this purpose.

Alternative Treatment

Along with cool or lukewarm baths, alternative practitioners recommend the use of various natural products, such as aloe vera, witch hazel, or a combination of rosemary and calendula, for treating itching caused by blisters. Some common homeopathic remedies include windflower, poison ivy, and sulfur.

PROGNOSIS

Most cases of chickenpox last about a week without causing lasting harm. One long-term effect of chickenpox is seen in about 20 percent of the population, however. This effect occurs most often in people over the age of fifty, and is the disease known as shingles. Shingles is caused by the same virus that causes chickenpox. After a chickenpox infection has disappeared, the virus may remain in a person's body. At some time later in life, the virus may once again become active. It produces a new form of infection—shingles.

Shingles is a very painful inflammation of the nerves caused by the chickenpox virus. It is accompanied by a rash that covers the trunk of the body (the part of the body that does not include the arms, legs, or head) and the face for ten days or more. In some cases, the pain caused by shingles can last for months and even years.

In 1998 two new drugs for the treatment of shingles were introduced. They are valacyclovir (trade name Valtrex) and famciclovir (trade name Famvir). Both prevent the virus from reproducing if taken within seventy-two hours after the rash first appears. Certain restrictions apply to the use of both drugs.

PREVENTION

A vaccine for chickenpox called Varivax was approved for use in the United States in 1995. The vaccine consists of live, but weakened, viruses and is effective in preventing chickenpox in 70 to 90 percent of all cases. In the remaining 10 to 30 percent of cases, the severity of a chickenpox infection is lessened by the vaccine. The U.S. Centers for Disease Control and Prevention recommend that all children (with a few exceptions) be given the vaccine between the ages of twelve and eighteen months. It can be combined with their measles-mumps-rubella vaccination. The vaccine is also recommended for older people who may be at risk for the disease. Health care workers and women of childbearing age are examples of such groups.

Children under the age of twelve receive one dose of the vaccine. Those over the age of twelve receive a second dose four to eight weeks after the first dose. The vaccine is useful when given soon after someone has been exposed to chickenpox. It can also prevent the disease if given during the incubation period.

The Varivax vaccine is still not widely used. Some doctors believe that a second dose later in life may be necessary to protect individuals and worry that individuals may not remember to get the second dose once they grow up. Other doctors are concerned that the live virus in the vaccine might cause shingles later in life. Because of such fears, only 20 percent of all two-yearolds had been vaccinated for chickenpox as of 1997. Health professionals are still debating the best way to use Varivax.

A substance known as varicella-zoster immune globulin (VZIG) is also available for the treatment of children with weakened immune systems and others at risk for complications from chickenpox. To be effective, the drug must be given within ninety-six hours after a person has been exposed to the virus. In such cases, it can reduce the severity of chickenpox symptoms.

FOR MORE INFORMATION

Books

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Puyallup, WA: Future Medicine Publishing, 1993.

Silverstein, Alvin, Virginia Silverstein, and Laura Silverstein Nunn. Chicken Pox and Shingles. Hillside, NJ: Enslow Publishers, Inc., 1998.

Weitzman, Elizabeth. Let's Talk about Having Chicken Pox. Powerkids Press, 1997.

Periodicals

Kump, Theresa. "Childhood without Chickenpox? Why Parents Are Still Wary of This New Vaccine." Parents Magazine (April 1996): pp. 39–40.

Napoli, Maryann. "The Chickenpox Vaccine." Mothering (Summer 1996): pp. 56–61.

Organizations

Centers for Disease Control and Prevention. National Immunization Hotline. 1600 Clifton Road, NE, Atlanta, GA 30333. (800) 232–2522 (English).(800) 232–0233 (Spanish). http://www.cdc.gov.