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Varicella (Chickenpox)

Chicken pox is a mild, self-limited illness in most children. The child can feel feverish, and itchy. The pox usually make their appearance on the torso, and spread all over the body over several days. They then crust over. For the next seven days, until all the lesions are crusted over, the child is considered contagious. He/she has to stay out of any public place: schools, restaurants, stores, airplane, where they might give chickenpox to an unknown person. People who are immunosuppressed from chemotherapy can get life threatening forms of chickenpox such as varicella pneumonia. Adults tend to be sicker with chickenpox than children. Other stressors, chronic disease, or medications like steroids can make chickenpox more of a risk for them. Chickenpox is also a hazard to pregnant women especially in the first or second trimester. There are many women who have had chickenpox late in their pregnancies and the babies seemed unharmed.

When a child has chickenpox they can be around people who have had chickenpox, or the chickenpox vaccine. In fact, being exposed to someone with natural chickenpox after having had a vaccine acts as a “booster”, and enhances the person’s antibodies. There is a special caution about being around people with strep throat. Group A strep can grow on chickenpox lesions and cause severe forms of strep. In fact, most cases of severe, life threatening forms of chickenpox in children is due to secondary group A strep infections.

The child is most contagious at the very beginning of the illness, and the 24 hours before the first spots appear. It is spread through fine respiratory droplets that can cling to dust. After exposure, the illness usually appears about two weeks later (usual incubation 7-21 days).

The severity of the illness can vary widely among people. One factor is how many viral particles (virions), the child inhales during the first contact. Often the second child in a family gets a worse case if the first child “breathed all over” him/her during the first wave of the illness. If the child gets exposed to chickenpox at school, the illness is often less.
For example, if a first grader inhales a few virions from a child across the room, he/she is likely to be less affected than the toddler who catches it from a preschooler. There are people who become immune to chickenpox without ever having a memorable case. It is thought they built immunity by being serially exposed to minute packets of virus. This could happen in a school setting with assigned seats wherein a child inhales chickenpox dust from kids coming down with the illness after exposure to an index case.

Treatments

The immune system does the job, and you have to wait for the tincture of time. The antiviral medication Zovirax can be given if is within the first 24-36 hours of the illness. It is usually given to adults who come acquire the illness from the own child.

Try to keep the lesions clean, and try to distract the child. If the parents spend too much applying “salves” the child will focus more on the spots and feel itchier. Younger children don’t seem to have as much discomfort as adults.
Tylenol can be given for fever/headache that can be present in the beginning of the illness. Aspirin should never be given to anyone with chickenpox. It was thought to contribute to an unusual post-viral/inflammatory disorder called Reye’s Syndrome.

Benadryl can be given at bedtime/nap time to alleviate the itchiness.

Calamine lotion can be applied to the lesions. However, be sure to wash your hands before applying any lotion.

Oatmeal baths with Aveeno have been used for years.

Children who develop chickenpox after having had the vaccine usually have an extremely mild case. They usually only have a few pox, and little if any fever. The lesions tend to be smaller and resolve sooner. They usually don’t require any anti-itch medications but keeping the lesions clean is still very important. The children with these mild forms of chickenpox can go back to school after about two days.

If the child has a sore throat or is developing high fevers after the first day or two of illness fever, they should be checked for a secondary strep infection. However, they can not come into the doctor’s office, in that this can ‘contaminate’ the dust with chickenpox particles. The child should wait outside the office and be seen in the open air or the parents’ car.

Shingles

Shingles is the reappearance of a person’s own childhood chickenpox virus. Over the years, the virus has been “hiding out” in the nerve root of the spine, and if the virus comes out of “hiding” it causes shingles. Shingles occurs when a person’s immune system is weakened, or stressed. It also occurs in the elderly whose immune system is becoming fatigued.

A person with shingles can spread the virus, when the lesions are weepy. Grandparents can be around children who have had the chickenpox vaccine, but should cover their lesions when near infants.