Health News • Chickenpox

Since the advent of the varicella vaccine, few present day parents can recognize the rash of chickenpox as a classic disease. Because the child does not feel particularly sick and because the child is highly contagious, our grandmothers often purposely encouraged group play with those infected and those not. This made sense in a very naïve way as usually chickenpox concurs a lifetime immunity. More on this later.

The rash (similar to insect bites) appears after 14-16 days of incubation. It usually starts with many crops of blisters widely separated on the torso or neck; then quickly spreads outward to the arms, legs face, scalp and even into the mouth and eyes. The only parts of the body which may be spared are the palms of the hands and the soles of the feet.

This rash is intensely itchy. The itch is caused by the spontaneous release of histamine at the site of the pox lesion and by the mechanical act of scratching. A scratch-itch-scratch cycle occurs. The patient scratches, histamine is released , the pox itches, the itch more intense, there’s more scratching and so on.

Often a strong antihistamine diphenhydramine (benadryl) or hydroxyzine (atarax) is prescribed to be taken either orally or as a spray. Fingernails should be cut as short as possible to prevent scarring. Hot baths should be avoided as heat releases more histamines. Acetamenophen or ibuprofen can be given not only for the treatment of fever but also to relieve the pain of the itch. Presumably less scratching will result in less trauma to the lesions and thus less scarring.

Most victims are young (2-10 years of age) and suffer very little except for the discomfort of the intensely itchy rash. Fever is present in the first few days but the child does not appear sick. Rarely does chickenpox occur younger than one year of age. The baby is usually protected by the mother’s antibodies which are passed down to the baby though the placenta during preg- nancy. The course of the disease is mild and the duration is approximately 7-10 days when the pox lesions are scabbed over.

It is at the scabbing over stage the virus is no longer contagious. Exposure to someone who has it almost always results in the non-immune child’s catching it. Contagion is particularly high 1-2 days before and after the blisters appear. A child with open lesion should not enter into any social situations be it church, family gatherings nor school. To limit this contagion, your pediatrician may ask your child to enter the exam room via a separate door and certainly not through the waiting room. Anyone who is immunosuppressed and who does not have immunity can become seriously ill. Examples of this include children or adults on chemotherapy for cancer or leukemia and very young AIDS patients.

An anti-varicella vaccine is now available which is usually given as part of the childhood immunization program. First one at 12-15 months of age, then a second at 5-10 years age as a booster. The booster is particularly important for girls because waning immunity from the vaccine may render the fetus susceptible to birth defects.

Unfortunately, 5-10% of chickenpox cases follow an atypical course. A high fever and an excruciating body rash along with possible bronchitis or pneumonia may occur. These patients need to be watched carefully for a superimposed bacterial infection requiring antibiotics.

Other serious complications occur which super-imposed bacterial infections especially when methicillin resistant staphalococcus germs get into the pox lesions or pneumonia. Progressive sclerosing encephalitis, which occurs in very few but unfortunate patients renders the patient mentally deficient. Another danger is the possibility of Reye’s Syndrome, where during the convalescing days, the child suddenly begins to suffer delirium, vomiting, etc. (Seek medical help immediately if you suspect witness such symptoms. Early diagnosis is crucial.)

There probably is a lifetime immunity. Once you have had chicken pox you will not get them again, but the disease can reappear in a different form called shingles (herpes zooster). This is a painful eruption along a nerve route usually 10-40 years after the patient has suffered the original chicken pox. The belief is that the virus lies dormant along the nerves and erupts when the immune system is extra stressed or upset. Prednisone, a steroid, is often used to suppress this reaction. We have a vaccine available for parents who have had chickenpox but want to prevent the shingles called ZoosterVax.

It is because of these complications that the vaccine was developed and that the practice of purposely exposing unimmunized children to chicken pox is discouraged. Additionally, the vaccinated patients tend to have less problems with later in life shingles. Hence, we have many reasons to respect the varicella virus. The risks are greater than you think.