By Mae Lyn M. Caberte

Chickenpox is a common childhood skin disease caused by a viral infection. The virus involved is called the varicella-zoster virus. Today, chickenpox is less common in the United States due to universal vaccination with the varicella virus vaccine, though it still occurs in populations that are not routinely vaccinated. Varicella-zoster virus is often categorized with the other common so-called "viral exanthems" (viral rashes) such as measles (rubeola), German measles (rubella), fifth disease (parvovirus B19), mumps virus, and roseola (human herpesvirus 6), but these viruses are unrelated except for their tendency to cause rashes.

Symptoms tend to appear 14 to 16 days after the initial exposure but can occur anytime from 10 days up to 21 days after contact with the virus. Chickenpox is characterized by one to two days of mild fever up to 102 F, general weakness, and a rash, often the first sign of the disease. Rarely, a person may have the disease without the rash. The rash of chickenpox develops in crops with raised red spots arriving first, progressing to blisters that burst, forming open sores, before crusting over. This process usually starts on the scalp, then the trunk (its area of greatest concentration), and finally the arms and legs. Any area of skin that is irritated (by diaper rash, poison ivy, eczema, sunburn, etc.) is likely to be hard hit by the rash. The rash is typically very itchy (pruritic).

Chickenpox is very highly contagious. It is easily passed between members of families and school classmates through airborne particles, droplets in exhaled air, and fluid from the blisters or sores. It also can be transmitted indirectly by contact with articles of clothing and other items exposed to fresh drainage from open sores. Patients are contagious up to five days (more commonly, one to two days) before and five days after the date that their rash appears. When all of the sores have crusted over, the person is usually no longer contagious.

Most of the treatments for chickenpox are aimed at decreasing the symptoms, such as severe itching. Acetaminophen (Tylenol) can be used to decrease the fevers and aches often associated with the initial presentation of the viral infection. Children should never be given acetylsalicylic acid (Aspirin) or aspirin-containing cold medications because of the risks for developing Reye's syndrome (a severe acquired metabolic disease associated with liver and brain dysfunction and death).

Complications can and do occur from chickenpox. Infection of the open pox sore by bacteria can injure the skin, sometimes causing scarring, especially if the patient scratches the inflamed area. Bacterial skin infection is, in fact, the most common complication of chickenpox in children. The next most common complications in children affect the central nervous system and include a disorder of the cerebellar portion of the brain (cerebellar ataxia with wobbliness, dizziness, tremor, and altered speech), encephalitis (inflammation of the brain with headaches, seizures, and decreased consciousness), damaged nerves (nerve palsies), and Reye's syndrome, a potentially fatal combination of liver and brain disease that can be associated with aspirin. (Children with fever should not take aspirin.) Especially serious complications can occur in patients with AIDS, lupus, leukemia, and cancer. Complications also occur in people taking immune-suppressing drugs, such as cortisone-related medications. Newborn infants whose mothers have chickenpox in the last trimester of pregnancy are at increased risk from the disease. If the mother develops the disease from five days before to two days after delivery, the fatality rate for the baby is up to 30%.

Most people develop lifetime immunity to chickenpox after the first occurrence and never experience it again. But the virus can sometimes resurface later in life as shingles (zoster). The current aim in the U.S. and many other countries is to achieve universal (or nearly universal) immunization of children with the chickenpox vaccine. The vaccination requires only two shots. The first vaccination is given at about 1 year of age, and the second (booster) is given at 4 years of age. If an older person has not had chickenpox, the shot may be given at any time. There have been few significant adverse reactions to the chickenpox vaccine. All children, except those with a compromised immune system, should have the vaccination. Vaccination has been associated with a 90% decrease in the incidence of chickenpox and significantly lower complication rates in those who do develop the symptoms.

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles.

Dengue goes by other names, including "breakbone" or "dandy fever." Victims of dengue often have contortions due to the intense joint and muscle pain, hence the name breakbone fever. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their postures and gait.

Dengue hemorrhagic fever is a more severe form of the viral illness. Manifestations include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red or purple blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life-threatening and can progress to the most severe form of the illness, dengue shock syndrome

After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear. Dengue starts with chills, headache, pain upon moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with relative low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are often swollen.

Fever and other signs of dengue last for two to four days, followed by a rapid drop in body temperature (defervescence) with profuse sweating. This precedes a period with normal temperature and a sense of well-being that lasts about a day. A second rapid rise in temperature follows. A characteristic rash appears along with the fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen.

Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical dengue, the treatment is purely concerned with relief of the symptoms (symptomatic). Rest and fluid intake for adequate hydration is important. Aspirin and nonsteroidal anti-inflammatory drugs should only be taken under a doctor's supervision because of the possibility of worsening hemorrhagic complications. Acetaminophen (Tylenol) and codeine may be given for severe headache and for the joint and muscle pain (myalgia).

Typical dengue is fatal in less than 1% of cases. The acute phase of the illness with fever and myalgias lasts about one to two weeks. Convalescence is accompanied by a feeling of weakness (asthenia), and full recovery often takes several weeks.

The transmission of the virus to mosquitoes must be interrupted to prevent the illness. To this end, patients are kept under mosquito netting until the second bout of fever is over and they are no longer contagious.

The prevention of dengue requires control or eradication of the mosquitoes carrying the virus that causes dengue. In nations plagued by dengue fever, people are urged to empty stagnant water from old tires, trash cans, and flower pots. Governmental initiatives to decrease mosquitoes also help to keep the disease in check but have been poorly effective.

To prevent mosquito bites, wear long pants and long sleeves. For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic. Limiting exposure to mosquitoes by avoiding standing water and staying indoors two hours after sunrise and before sunset will help. The Aedes aegypti mosquito is a daytime biter with peak periods of biting around sunrise and sunset. It may bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas.

There is currently no vaccine available for dengue fever. There is a vaccine undergoing clinical trials, but it is too early to tell if it will be safe or effective. Early results of clinical trials show that a vaccine may be available by 2012.

Personal protective equipment (PPE) is used by healthcare providers to protect themselves from injury or infection. There is personal protective equipment to keep rescuers safe from physical injuries, from chemical hazards, and from infection. Lay rescuers should follow their professional counterparts by practicing universal precautions and using PPE to provide protection from infection when assisting victims in an emergency.

The best way to prevent the spread of disease is to wash hands with soap and warm water after every contact with a medical victim. Unfortunately, soap and water are not always available. Make sure your medical supplies include a form of waterless hand cleaner.

Exam gloves come in three common types: latex, nitrile, and vinyl. Many people develop allergies to the protein found in latex. Nitrile and vinyl are much more hypoallergenic. Find out more about exam gloves.

Many lay rescuers do not want to perform the rescue breathing part of CPR because of the close contact required with the victim. The best way to avoid that squeamish feeling is to be prepared. CPR masks provide an important barrier between rescuer and victim.

Blood or other potentially infectious material sprayed or splashed in the face of a rescuer can enter the mouth or nose and spread an infection. Use a face mask whenever blood or other body fluids may become airborn.

Protect your eyes from injury as well as infection by obtaining the correct type of eye protection. Rescuers can choose from combination mask and eye protection that does not provide protection from injury, or they can choose more robust protection. Pick the correct eye protection for you.

Contaminated sharps must be deposited into a puncture-proof container. These containers protect sanitation workers from injury as well as other rescuers.

Full-body gowns are not used very often outside of the hospital. There is no good reason for this, it is just common practice across the country. Put the correct gown in your first aid kit and avoid the need to dispose of your favorite shirt or blouse.

Contaminated waste should be placed into a red, bio-hazardous waste container to distinguish it from regular garbage. When working with an ambulance, it is common for the ambulance crew to allow lay rescuers to dispose of their contaminated items in the ambulance's bio-hazard container.

“Prevention is better than cure.”

Desiderius Erasmus

Caberte, Mae Lyn M.