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  • 1.Chickenpox (Varicella)
    • Ana Corona, PHN
  • July 2002

2. What is Chickenpox (Varicella)?

  • Chickenpox is an acute viral infectious disease
  • Varicella-zoster virus (VZV)
  • VZV is a DNA virus
  • A member of Herpes virus group.
  • Primary infection results in Varicella.
  • Recurrent infection results in herpes zoster (shingles).

3. Pathogenesis of Varicella

  • Infection of skin and appearance of
  • vesicular rash
  • Secondary Viremia
  • Primary Viremia
  • Viral replication in liver, spleen,
  • and other organs
  • Infection of conjunctivae and/or
  • mucosa of the upper respiratory tract
  • Viral replication in regional lymph
  • nodes

Day 14 Days 10 12 Day 4 6 Day 0 3 4. Clinical Features

  • Mild prodrome (fever, malaise) for 1-2 days
  • Successive crops (2-4 days) of pruritic vesicles
  • Generally appear first on head; most concentrated on trunk
  • Can spread over the entire body causing between 250 to 500itchy blisters
  • Generally mild in healthy children

5. What is The Chickenpox Illness Like?

  • Chickenpox most commonly causes an illness that lasts about 5-10 days.
  • Children usually miss 5 or 6 days of school or childcare due to chickenpox.
  • 1 child in 10 has a complication from chickenpox serious enough to visit a health care provider
  • Including infected skin lesions and other infections.
  • Dehydration from vomiting or diarrhea
  • Exacerbation of asthma
  • More serious complications such as pneumonia

6. The Lesions

  • Each lesion progresses through a series of characteristic stages over about a week.
  • Papules and vesicles develop into pustules, which then crust over prior to healing.
  • A prominent feature of chickenpox is the development of several crops of spots.
  • The peak of the illness, 3-4 days after first appearance of the rash, there are lesions at all stages of development, from new vesicles through to crusts.

7. Transmission: How do you get Chickenpox?

  • Acquired by inhaling virus-containing particles, trapped in tiny droplets released into the air from the nose or throat of an infected person.
  • The virus (VZV) enters the body by infecting cells in the respiratory tract.
  • It spreads to many other parts of the body, including the skin, where it causes the characteristic rash.
  • A person with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs.
  • It takes from 10-21 days after contact with an infected person for someone to develop chickenpox

8. Incubation period and prodromal illness

  • The wide range commonly quoted for the incubation period:7-23 days.
  • Time of contact and true source of infection may be difficult to pinpoint.
  • General constitutional symptoms sometimes precede the rash. This is called a prodrome.
  • Young children generally have either no or a very mild prodrome.
  • Older children and adults: the prodrome may be more pronounced.
  • Symptoms include fever (which may precede the rash by up to 6 days), headache, backache and sore throat

9. The Stages of Chickenpox Incubation PeriodUsually (14-17 days) Prodrome (1 3 days) Vesicles PustulesScabsRecovery typically 7 days afterrash appears (ranges 5 - 35 days) 10. Herpes Zoster (Shingles)

  • Reactivation of Varicella Zoster Virus
  • Associated with:
    • Aging
    • Immunosuppression
    • Intrauterine exposure
    • Varicella at 12 months with chronic cutaneous or pulmonary disorders or on salicylate therapy
    • Children receiving short intermittent or aerosolized steroids
    • IV in Immunocompromised children and adults with viral-mediated complications
    • Not recommended for post-exposure prophylaxis

    20. What home treatments are available for chickenpox?

    • Fingernails trimmed short
    • Calamine lotion and Aveeno (oatmeal) baths may help relieve some of the itching
    • Aspirin or aspirin-containing products to relieve your child's fever are not recommended.
    • The use of aspirin has been associated with development of Reye syndrome (a severe disease affecting all organs - most seriously affecting the liver and brain, that may cause death).
    • The use of non aspirin medications such as acetaminophen is recommended.

    21. Complications

    • Certain groups of persons are more likely to have more serious illness with complications.
    • These include adults, infants, adolescents and people with weak immune systems from either illnesses or from medications such a long-term steroids.

    22. What Complications Result From Varicella?

    • The most common complications are:
    • Bacterial infections of the skin and soft tissues in children
    • Septicemia
    • Toxic Shock Syndrome
    • Necrotizing Fascitis
    • Osteomyelitis
    • Bacterial pneumonia
    • Septic arthritis.

    23. Complications: Continued

    • Varicella is a well described risk factor for invasive group A streptococcus infections.
    • Other complications:
    • Cerebellar ataxia
    • Encephalitis
    • Hemorrhagic complications leading to bleeding disorders including disseminated intravascular coagulation (DIC).

    24. Morbidity and mortality

    • Since 1999, states have been encouraged to report chickenpox deaths to CDC.
    • In 1999 and 2000, CDC received reports that showed that deaths from chickenpox continue to occur in healthy, unvaccinated children and adults.
    • Most of the healthy adults who died from chickenpox contracted the disease from their unvaccinated children.

    25. How serious a disease is varicella?

    • Prior to the availability of varicella vaccine there were approximately 4 million cases of varicella a year in the U.S.
    • Many health care providers are not aware that 11,000 hospitalizations and 100 deaths occurred every year in the United States before varicella vaccine became available.
    • The majority of deaths and complications occurred in previously healthy individuals.

    26. When is it necessary to go to the doctor for treatment?

    • If a fever lasts longer than 4 days or rises above 102 F.
    • Lesions which become very red, warm, tender, or is leaking pus may mean there is a bacterial infection.
    • Lethargy
    • Difficulty walking
    • Stiff neck
    • Severe Vomiting
    • Difficulty breathing
    • Severe cough.

    27. Can chickenpox be prevented ?

    • Yes, chickenpox can
    • now be prevented by vaccination

    28. Varicella Vaccine 1 dose (7 years Duration of Immunity 95% (range 65%-100%) Efficacy Live Virus (Oka-Merck strain) Composition 29. Varicella Vaccine Recommendations

    • Routine vaccination at 12 to 18 months of age
    • Recommended for all susceptible children by the 13 thbirthday
    • Persons> 13 years of age without history of Varicella
    • Two doses separated by 4 8 weeks

    30. Varicella Vaccine: Post-exposure Prophylaxis

    • Varicella vaccine is recommended for use in susceptible person after exposure to Varicella
    • 70% - 100% effective if given within 72 hours of exposure
    • Not effective if >5 days but will produce immunity if not infected

    31. Varicella Vaccine: Adverse Reactions

    • Injection site complaints:20%
    • Rash: 3% - 4%
    • May be maculopapular rather than vesicular
    • Average 5 lesions
    • Systemic reactions uncommon

    32. Zoster Following Vaccination

    • Most cases in children
    • Risk from wild virus 4 to 5 times higher than from vaccine virus
    • Mild illness without complications

    33. Varicella Vaccine: Contraindications and Precautions

    • Severe allergy to vaccine component or prior dose of vaccine
    • Pregnancy
    • Immunosuppression
    • Moderate or severe acute illness
    • Recent blood product
    • Immunocompromised persons should not be vaccinated
    • Vaccinate persons with humoral immunodeficiency

    34. Varicella Zoster Immune Globulin (VZIG)

    • May modify or prevent disease if given

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