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Chickenpox

Chickenpox is an infection caused by the varicella zoster virus. It gives you a rash and can make you feel generally unwell. Anyone can catch chickenpox, but it mainly affects children under 14. These days, with the introduction of the vaccine, it's less common and symptoms are generally milder.

Symptoms of chickenpox 

You will start to get symptoms around 10 to 21 days after you catch the virus.

The first symptoms of chickenpox include:

  • headache
  • fever
  • sore throat
  • backache
  • feeling generally unwell.

You may have these symptoms for a few days before you get any spots. Chickenpox spots are usually very itchy. They vary in size and appear in clusters on your skin, forming a rash. You will usually get small red spots on your face and scalp first, then they may spread to your chest, arms and legs. You may also get spots inside your mouth and nose.

The spots quickly become fluid-filled blisters surrounded by reddened skin. They may develop into pustules (blisters containing pus). After three to four days the blisters or pustules will then dry out and crust over to form scabs. The spots usually take around 16 days to heal completely.

Chickenpox is usually more severe in adults than children. Adults are more likely to have complications as a result of chickenpox and are more likely to be left with rounded, hollowed-out scars on the skin, known as 'pockmarks'.

Complications of chickenpox 

In otherwise healthy people, chickenpox is usually a mild infection and serious problems are rare.

The most common problem linked with chickenpox in children is a bacterial infection in the spots. This causes the surrounding skin to become more red and sore. Your child's GP may prescribe antibiotics to treat the infection.

Some children who have chickenpox are also at higher risk of developing otitis media (a middle ear infection). This is a common childhood infection where bacteria trapped in the Eustachian tube of the ear causes it to become red, swollen and inflamed. Hearing loss is a very rare result of this complication.

Chickenpox can cause encephalitis (inflammation of the brain) or pneumonia (an infection of the lungs), but this is rare. Varicella pneumonia is the most common complication in adults and causes wheezing and rapid breathing three to four days after the rash appears for the first time. Your GP will discuss appropriate treatment with you, which may include antiviral medication.

Up to eight days after the chickenpox rash develops, some people may become clumsy and unable to walk properly. This is called ataxia. It's caused by inflammation in a part of the brain called the cerebellum. This usually settles down on its own, but occasionally, other parts of the brain become affected and this can cause longer-term problems.

Causes of chickenpox 

Chickenpox is caused by the varicella zoster virus, which is very contagious. If you haven't had chickenpox before and someone you come into prolonged contact with has it, you're likely to catch it too.

The virus is usually transferred from person to person through the air in the fine spray of saliva or mucous droplets when you cough or sneeze. It can also be passed from person to person through contact with the fluid from chickenpox blisters, either from a person who is infected or by items such as clothing that have been in contact with broken blisters.

If you have chickenpox, you can pass the virus on about one to two days before the rash breaks out. You'll remain infectious until your spots have crusted over, usually five to six days after the illness starts. Avoid contact with others and keep infected children at home away from school or day care during this time.

Once you've had chickenpox, you will usually be immune and probably won't catch it again. However, it is possible to become re-infected. The virus can also remain dormant in your body, even after symptoms have cleared, and cause shingles later in life.

If you've never had chickenpox before, it's possible to get chickenpox from someone who has shingles, through contact with fluid from the shingles rash. However, it's not possible to catch shingles from someone who has chickenpox.

Treatment of chickenpox 

Self help

It can be difficult to resist, but try not to scratch your spots as this can lead to scarring. Keep you and your children's nails short and clean to minimise the damage from scratching. Gently patting the spots may help relieve the itch.

Keeping your skin cool may also help relieve the itchiness – wear light clothing, apply cool damp compresses to the blisters, and bathe or sponge your skin with tepid water. Adding half to one cup of bicarbonate of soda or a suitable bath oil or an oatmeal-based bath product to a bath can be soothing.

Drink plenty of fluid to stay hydrated and get as much rest as possible.

Medicines

Most people with chickenpox get better without any treatment. However, non-prescription treatments are available to help relieve your symptoms of itching, fever and discomfort.

You may find crotamiton cream or lotion helps to soothe itching, and hydrogel wound dressings can also help to soothe itching and reduce scarring. You can buy these products from your local pharmacy. They are suitable for children over three years. Calamine lotion, which is the traditional alternative, may not be as effective.

Antihistamine products may help to ease itchiness. Some antihistamines can trigger drowsiness, which may help you sleep and therefore stop you scratching at night. Sedating antihistamines may help to ease the itching of chickenpox. However they are only available on prescription for children under two years of age, so talk to your doctor or your local pharmacist for more information and advice.

Non-prescription` painkillers such as paracetamol may help ease discomfort and pain, lower a fever and relieve a sore throat. People with chickenpox should not take or be given aspirin, particularly children under the age of 16, because of the risk of a serious condition called Reye's syndrome that affects the brain and liver.

Always read the accompanying consumer medicine information leaflet and don't take more than the recommended dose. If you have any questions, ask your pharmacist for advice.

Prevention of chickenpox 

If you have chickenpox, try to stay away from public areas to avoid contact with people who haven't had it, especially babies under 12 months, pregnant women and people with a weakened immune system.

To prevent chickenpox spreading, children should be kept off school until all of the spots have crusted over, which is when they stop being contagious.

There is a vaccine for chickenpox and the National Health and Medical Research Council (NHMRC) recommends vaccination for all children at 18 months. One dose of this vaccination is free of charge to all eligible children at 12 to 18 months of age from the Immunise Australia program, the National Immunisation Program (NIP). The NIP also provides a free 'catch-up' vaccination for children between 10 to 13 years old who haven't yet been vaccinated and haven't had chickenpox. This free vaccination is available from local doctors and immunisation clinics, so talk to your GP for more information.

If you're over the age of 14 years and not yet had chickenpox you should get vaccinated. This is especially recommended for healthcare workers, child care workers, teachers and people who are in contact with others who have a reduced immune system. This is to protect others from catching chickenpox from an infected carer. You can talk to your GP for more information.

Special considerations 

If you're pregnant

Most women of childbearing age will have had chickenpox and be immune. However, if you haven't had chickenpox before and catch it when you're pregnant it can make you feel very unwell and some women can even develop pneumonia.

If you've been in contact with someone who has chickenpox and you haven't already had it yourself, contact your GP as soon as possible. The NHMRC advises you to have an injection called varicella zoster immunoglobulin (VZIG), which contains antibodies against the virus. This will prevent you catching chickenpox, but you must have the injection within 10 days of exposure to the virus.

If you do develop chickenpox, then depending on your stage of pregnancy, it may affect your unborn baby too.

Chickenpox in the first half of pregnancy

If you catch chickenpox in the first 20 weeks of pregnancy, it may, in rare cases, affect the development of your baby's arms, legs, brain or eyes, cause scarring on their skin and poor growth. This is called foetal varicella syndrome.

Chickenpox in the second half of pregnancy

If you're between 20 and 28 weeks pregnant and get chickenpox, your doctor may prescribe an antiviral medicine called acyclovir. Although this doesn't cure the infection, it reduces its severity. You need to start taking this medicine within 24 hours of the rash appearing. Acyclovir is sometimes prescribed for newborn babies.

If you get chickenpox after 28 weeks of pregnancy, there doesn't seem to be a risk of it causing your baby to develop an abnormality. However, your baby may catch it from you and contract a type of chickenpox called symptomatic varicella infection. This means your baby may be ill when he or she is born. Your baby's infection may be worse if you develop chickenpox within five days before delivery or up to two days after.

Contact your GP as soon as possible if you're pregnant and think you have chickenpox or if you develop symptoms within seven days of giving birth.

If you have a weakened immune system

You're more at risk of severe complications from chickenpox if you have a weakened immune system - for example if you're having treatment for cancer, you have HIV/AIDS or you're over 65.

Contact your GP as soon as possible if you have come into contact with someone who has chickenpox and you haven't had it before. Your GP can then prescribe the appropriate treatment.

Further information 

The National Immunisation Program

http://www.immunise.health.gov.au/

Sources 

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Last published: 30 July 2011

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