Chickenpox
Some children have only a
few spots, but other children can have spots that cover their entire body.
These are most likely to appear on the face, ears and scalp, under the arms, on
the chest and belly, and on the arms and legs.
Chickenpox (known medically as
varicella) is caused by a virus called the varicella-zoster virus. It's
spread quickly and easily from someone who is infected. Chickenpox is most common in children
under the age of 10. In fact, chickenpox is so common in childhood that
over 90% of adults are immune to the condition because they've had it before. Children usually catch
chickenpox in winter and spring, particularly between March and May.
What to do
To prevent spreading the
infection, keep children off nursery or school until all their spots have
crusted over. Chickenpox is infectious from one to
two days before the rash starts, until all the blisters have crusted over
(usually five to six days after the start of the rash).
If your child has chickenpox, try
to keep them away from public areas to avoid contact with people
who may not have had it, especially people who are at risk of serious problems,
such as newborn babies, pregnant women and anyone with a weakened immune system
(for example, people having cancer treatment or taking steroid tablets).
Chickenpox treatment
Chickenpox in children
is considered a mild illness, but your child will probably feel
pretty miserable and irritable while they have it. Your child may have a fever
for the first few days of the illness. The spots can be incredibly itchy.
There is no specific treatment
for chickenpox, but there are pharmacy remedies that can alleviate
symptoms. These include paracetamol to relieve fever, and
calamine lotion and cooling gels to ease itching. In most children, the blisters crust
up and fall off naturally within one to two weeks.
When to see a doctor
For most children, chickenpox is a
mild illness that gets better on its own. However, some children can become
more seriously ill with chickenpox and need to see a doctor. Contact your doctor straight away if your
child develops any abnormal symptoms, such as:
- if
the blisters on their skin become infected
- if
your child has a pain in their chest or has difficulty breathing.
Chickenpox in adults
Chickenpox may be a childhood
illness, but adults can get it too. Chickenpox tends to be more
severe in adults than children, and adults have a higher risk of
developing complications. Adults with chickenpox should stay
off work until all the spots have crusted over. They should seek medical advice
if they develop any abnormal symptoms, such as infected blisters. Adults with chickenpox may benefit
from taking antiviral medicine if treatment is started early in the course of
the illness.
Who's at special risk?
Some children and adults are at
special risk of serious problems if they catch chickenpox. They include:
- pregnant
women
- newborn
babies
- people
with a weakened immune system.
These people should seek medical
advice as soon as they are exposed to the chickenpox virus or they develop
chickenpox symptoms. They may need a blood test to check if they are protected
from (immune to) chickenpox.
Chickenpox in pregnancy
Chickenpox occurs in approximately 3
in every 1,000 pregnancies. It can cause serious complications for both the
pregnant woman and her baby.
Chickenpox and shingles
Once you have had chickenpox,
you usually develop antibodies to the infection and become immune to
catching it again. However, the virus that causes chickenpox, the varicella-zoster
virus, remains inactive (dormant) in your body's nerve tissues and can
return later in life as an illness called shingles. It's possible to catch chickenpox
from someone with shingles, but not the other way around.
Is there a vaccine against chickenpox?
There is a chickenpox vaccine,
but it is not part of the routine childhood vaccination schedule. The vaccine
is only offered to children and adults who are particularly vulnerable to
chickenpox complications. The recommended two doses of the
vaccine is estimated to offer 98% protection from chickenpox in children and
75% protection in adolescents and adults.
So it may be possible to develop the infection
after vaccination. Similarly, there is a chance that someone who has received
the vaccine could develop chickenpox after coming in close contact with a
person who has shingles.
Symptoms of chickenpox
The most commonly recognised chickenpox symptom
is a spotty, blistering red rash that can cover the entire body.
Chickenpox spots
The spots normally appear in
clusters and tend to be:
- behind
the ears
- on
the face
- over
the scalp
- on
the chest and belly
- on
the arms and legs.
However, the spots can be anywhere on
the body, even inside the ears and mouth, on the palms of the hands, soles of
the feet and inside the nappy area. Although the rash starts as
small, itchy red spots, these develop a blister on top and become intensely
itchy after about 12-14 hours. After a day or two, the fluid in the
blisters gets cloudy and they begin to dry out and crust over.
After one to two weeks, the crusting
skin will fall off naturally.
New spots can keep appearing in
waves for three to five days after the rash begins. Therefore, different
clusters of spots may be at different stages of blistering or drying out.
Feeling unwell
Before the rash appears, you or
your child may have some mild flu-like symptoms, including:
- feeling
sick
- a
high temperature (fever) of 38C (100.4F) or over
- aching,
painful muscles
- headache
- generally
feeling unwell
- loss
of appetite.
These flu-like symptoms, especially
the fever, tend to be more common and worse in adults than in children.
Unusual symptoms
Most healthy children (and adults)
recover from chickenpox with no lasting ill-effects simply by resting, just as
with a cold or the flu. However, some children
and adults are unlucky and have a more severe bout.
Contact your doctor straight away if you
or your child develop any abnormal symptoms, such as:
- the
skin surrounding the blisters becoming red and painful
- pain
in the chest or difficulty breathing
- signs of dehydration, such as fewer wet nappies,
drowsiness and cold hands and feet.
In cases such as this, prescription
medicine or hospital treatment may be needed.
Causes of chickenpox
Chickenpox is caused by the
varicella-zoster virus. You catch it by coming into contact with someone
who is infected. Chickenpox is a very contagious infection.
Around 90% of people who have not previously had chickenpox will become
infected when they come into contact with the virus.
How you catch the virus
The chickenpox virus is spread most
easily from someone who has the rash. The blisters are very itchy and break
open easily, which can contaminate surfaces or objects. The virus may then
be transferred by touching the surface or object, then touching your face.
The virus is also contained in
the millions of tiny droplets that come out of the nose and mouth when an
infected person coughs or sneezes. This can also contaminate surfaces or
objects. It normally takes 14 days for
the symptoms of chickenpox to show after you
have come into contact with the virus. However, this can vary from person to
person – from as little as 7 days, up to 21 days. This is called the
"incubation period".
Someone with chickenpox is most
infectious from one to two days before the rash appears, until all the blisters
have crusted over. This usually takes five to six days from the start
of the rash.
Shingles
If you have not had chickenpox
before, you can also catch chickenpox from someone with shingles
(an infection caused by the same virus). However, it's not possible to catch
shingles from someone who has chickenpox.
Diagnosing chickenpox
You or your child should not
usually need any medical tests to diagnose chickenpox. You can be pretty sure
that it is chickenpox if there are the key symptoms of a mild fever
followed by an itchy rash, with blisters and scabs.
Chickenpox spots
are usually distinctive enough to distinguish from other rashes,
although they can be confused with other conditions that affect the skin, such
as insect bites or scabies (another contagious skin
condition that causes intense itching). If you're still
uncertain about what is causing the symptoms, your doctor can carry out a
simple blood test to identify the virus.
When to contact your doctor
1. See your doctor if you're not sure
whether you or your child have chickenpox.
2. Contact your doctor urgently if
you have been in contact with someone who has chickenpox, or you have
chickenpox symptoms and:
- you
are pregnant
- you
have a weakened immune system (the body’s defence system)
- your
baby is less than four weeks old.
Chickenpox in these instances
can cause serious complications, if left untreated. It is essential to seek
medical advice so that you can receive any necessary treatment.
3. Contact your doctor if you have
chickenpox and are breastfeeding. They can advise about whether you should
continue breastfeeding your baby.
Having a blood test
Once you have contacted your
doctor, you may need a test to see if you're
already immune from chickenpox. If you have had chickenpox in the
past, it is extremely unlikely that you will develop chickenpox for a second
time. If you've never had chickenpox, or you're unsure whether you've had it,
you may need an immunity test.
This is a blood test that checks whether you are
producing the antibodies to the chickenpox virus. If your blood test result shows that
you have the antibodies, you'll be naturally protected from the virus. If you
don't have the antibodies, you'll need to be monitored closely to see if you
develop chickenpox symptoms. If you do, further
treatment may be needed.
Preventing the spread of
chickenpox
If your child has chickenpox, Public
Health England recommends that you inform their school or nursery, and keep
them at home for five days. If you have chickenpox, stay off
work and at home until you're no longer infectious, which
is until the last blister has burst and crusted over. This
usually happens five or six days after the rash begins.
If either you or your child has
chickenpox, it is also a good idea for you, or them, to
avoid contact with:
- pregnant
women
- newborn
babies
- anyone
who has a weak immune system, such as people who are having chemotherapy
(a treatment for cancer) or taking steroid tablets.
If you or your child have recently
been exposed to the chickenpox virus, you may not be able to visit friends or
relatives in hospital. Telephone the ward to check first.
Travelling on a plane
If you or your child have chickenpox,
you may not be allowed to fly until six days after the last spot has appeared. You and your child should be safe to
fly once you're past the infectious stage and all of the blisters have crusted
over. However, it's best to check the policy of your airline first. Inform the
airline as soon as chickenpox is diagnosed.
It is also important to let your
travel insurer know if you or your child has chickenpox. You need to make sure
that you'll be covered if you have to delay or cancel your holiday, or if you
need to extend your stay until your child is well enough to fly home.
Stop the virus spreading
Chickenpox can sometimes be spread
through contact with objects that have been contaminated with the virus, such
as children's toys, bedding or clothing. If someone in your household has
chickenpox, you can help stop the virus spreading by wiping any objects or
surfaces with a sterilising solution and making sure that any infected clothing
or bedding is washed regularly.
Vaccination
There is a chickenpox vaccine that is
used to protect people who are most at risk of a serious chickenpox infection
or of passing the infection on to someone who is at risk. People who may be considered for
chickenpox vaccination include:
- healthcare
workers who are not already immune – for example, a nurse who has never
had chickenpox and who may pass it to someone they are treating if they
become infected
- people
living with someone who has a weakened immune system – for example, the
child of a parent receiving chemotherapy.
The vaccine is not suitable for
pregnant women. Avoid getting pregnant for three months after having the
vaccine. The vaccine is also not suitable for people with weakened immune
systems.
How effective is the vaccine?
The recommended two doses of the
vaccine is estimated to offer 98% protection from chickenpox in children and
75% protection in adolescents and adults. So it may be possible to develop the
infection after vaccination.
Caring for your child with
chickenpox
There is no cure for chickenpox, and
the virus usually clears up by itself without any treatment. However, there are ways of easing the
itch and discomfort, and there are important steps you can take to stop chickenpox spreading.
Painkillers
If your child is in pain or has a
high temperature (fever), you can give them a mild painkiller, such as paracetamol (available over the counter
in pharmacies). Always read the manufacturer's dosage instructions. Paracetamol is the preferred
painkiller for treating the associated symptoms of chickenpox. This is due to a
very small risk of non-steroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen, causing adverse skin reactions
during chickenpox.
Avoid giving your child ibuprofen if
they have asthma or a history of stomach problems.
If you're not sure whether ibuprofen is suitable, check with your doctor or
pharmacist. If your child is younger than three months old, you should always
speak to your doctor before giving your child any kind of pain relief.
Never give your child aspirin if
you suspect or know that they have chickenpox (see box at the bottom of
this page). If you're pregnant and need to take
painkillers, then paracetamol is the first choice. You can use it at any
stage of pregnancy. Only take ibuprofen during the second trimester (weeks
14-27 of the pregnancy).
If you're pregnant and have
chickenpox, you should visit your doctor as soon as possible. You may need to have
antiviral medicine or immunoglobulin treatment to prevent your
symptoms from getting worse (see below).
Keeping hydrated
It is important for children
(and adults) with chickenpox to drink plenty of water to avoid dehydration. Sugar-free ice lollies are a
good way of getting fluids into children. They also help to soothe a sore mouth
that has chickenpox spots in it. Avoid anything that may make
the mouth sore, such as salty foods. Soup is easy to swallow as long as it
is not too hot.
Stop the scratching
Chickenpox can be incredibly itchy,
but it's important for children (and adults) to not scratch the
spots, to avoid future scarring. One way of stopping scratching
is to keep fingernails clean and short. You can also put socks over your
child's hands at night to stop them scratching the rash as they sleep.
If your child's skin is very itchy or
sore, try using calamine lotion or cooling gels. These are available
in pharmacies and are very safe to use. They have a soothing, cooling effect. A stronger medicine called
chlorphenamine can also help to relieve the itching. It's
available from your pharmacist over the counter or it can be prescribed by
your doctor. Chlorphenamine is taken by mouth and is suitable for children
over one year old.
Cool clothing
If your child has a fever, or if
their skin is sore and aggravated, dress them appropriately so that they don't
get too hot or too cold. Loose-fitting, smooth, cotton fabrics are best
and will help stop the skin from becoming sore and irritated.
If your child has chickenpox, avoid
sponging them down with cool water. This can make your child too cold and may
make them shiver.
Stronger treatments
Antiviral medicine
Aciclovir is an antiviral medicine
that is sometimes given to people with chickenpox. Aciclovir may be prescribed to:
- pregnant
women
- adults,
if they visit their doctor within 24 hours of the rash appearing
- newborn
babies
- people
with a weakened immune system (the body’s defence system).
Ideally, aciclovir needs to be
started within 24 hours of the rash appearing. It does not cure
chickenpox, but it makes the symptoms less severe. You normally need to
take the medicine as tablets five times a day for seven days. If you are taking aciclovir, make
sure you drink plenty of fluids. Side effects are rare, but can include nausea
and diarrhoea.
Immunoglobulin treatment
Immunoglobulin is a solution of
antibodies that is taken from healthy donors. Varicella-zoster immunoglobulin
(VZIG) contains antibodies to the chickenpox virus. Immunoglobulin treatment is given by
injection. It is not used to treat chickenpox, but to protect people who are at
high risk of developing a severe chickenpox infection. This includes:
- pregnant
women
- newborn
babies
- people
with weakened immune systems.
In the case of pregnant women,
immunoglobulin treatment also reduces the risk of the unborn baby becoming
infected. As the supply of VZIG is limited, it
will only be considered if a high-risk person has:
- been
significantly exposed to the virus – significant exposure could be
face-to-face contact with someone who has chickenpox
- been
in the same room for 15 minutes with someone who has chickenpox
- had
a blood test to confirm that they've not had chickenpox before.
In some cases, newborn babies may be
given immunoglobulin treatment without having a blood test first.
Complications of chickenpox
Complications of chickenpox are rare
in healthy children. The most common complication is where the
blisters become infected with bacteria. A sign that the blisters have become infected is when the
surrounding skin becomes red and sore.
If you think that your child's
blisters have become infected, contact your doctor as the child may need a course
of antibiotics.
Other complications in children
Very rarely, chickenpox can lead to
more serious complications involving the nervous system (brain and spinal cord)
in children. These include infections of the brain
(encephalitis), the protective membranes around
the brain (meningitis) or part of the brain called the
cerebellum (cerebellitis). Signs of these problems can include:
- a
lack of energy
- drowsiness
- confusion
- seizures
(fits)
- vomiting
- severe headaches
- a stiff neck
- behavioural
changes
- problems with walking, balance or speech (ataxia).
Seek medical advice as soon as
possible if your child develops any of these symptoms after having chickenpox.
At-risk groups
The people who are most at risk of
developing chickenpox complications are:
- adults
- pregnant
women
- babies
under four weeks old
- people with a weakened immune system.
Adults
Chickenpox can be more serious in
adults than in children. Adults with the virus are more likely to be admitted
into hospital. Approximately 5-14% of adults with chickenpox develop lung
problems, such as pneumonia. If you smoke, your risk of
developing lung problems is much higher.
Although it is more serious in
adults, most people will still make a full recovery from the chickenpox virus.
Pregnant women
If you're pregnant, chickenpox can
occasionally cause complications. For example, your risk of
developing pneumonia is slightly higher if you're
pregnant, especially if you smoke. The further you are into your pregnancy, the
more serious the risk of pneumonia tends to be.
If you get chickenpox while you're
pregnant, there is also a small but significant risk to your unborn
baby. If you are infected with chickenpox
during the first 28 weeks of your pregnancy, there is a risk that your unborn
baby could develop a condition known as foetal varicella syndrome (FVS).
This syndrome is rare. The risk of it
occurring in the first 12 weeks of pregnancy is less than 1%. Between weeks 13
and 20, the risk is 2%. There have only been a few reports of
FVS due to an infection from weeks 20 to 28 of pregnancy, and the risk is
thought to be much less than 1%. FVS can cause serious complications,
including:
- scarring
- eye
defects, such as cataracts
- shortened
limbs
- brain
damage.
There are also other risks from
catching chickenpox after week 20 of pregnancy. It's possible that your baby may be
born prematurely (before week 37 of the pregnancy). If you are infected with chickenpox
seven days before or seven days after giving birth, your newborn baby may
develop a more serious type of chickenpox. In a few severe cases,
this type of chickenpox can be fatal.
See your doctor urgently if you're
pregnant or have given birth in the last seven days and you think you may have
chickenpox, or if you've been exposed to someone who has chickenpox.
People with a weakened immune system
Your immune system is your
body's way of defending itself against disease, bacteria and viruses. If your immune system is weak or does
not work properly, you are more susceptible to developing infections such
as chickenpox. This is because your body produces fewer antibodies to fight off
the infection.
You may have a weakened immune system
if you take immunosuppressive medication.
Immunosuppressive medication such as
steroid tablets may be used if, for example, you have
an inflammatory condition such as rheumatoid arthritis, lupus or certain blood conditions. If you have a weakened immune system,
you're also more at risk of developing complications from chickenpox. These
complications include:
- pneumonia
- blood poisoning (septicaemia)
- meningitis.
You must see your doctor urgently if you have a weakened
immune system and you've been exposed to the chickenpox virus.
Source: NHS Choices.
Source: NHS Choices.