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  • Chickenpox(Varicella)

    Ana Corona, FNPMore presentations @:www.nurseana.com

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

  • Pathogenesis of Varicella

    Day 0 3Infection of conjunctivae and/or mucosa of the upper respiratory tractViral replication in regional lymph nodesDay 4 6Primary ViremiaViral replication in liver, spleen, and other organsDays 10 12Secondary Viremia Day 14Infection of skin and appearance of vesicular rash

  • Clinical FeaturesMild prodrome (fever, malaise) for 1-2 daysSuccessive crops (2-4 days) of pruritic vesiclesGenerally appear first on head; most concentrated on trunkCan spread over the entire body causing between 250 to 500 itchy blistersGenerally mild in healthy children

  • 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 providerIncluding infected skin lesions and other infections.Dehydration from vomiting or diarrheaExacerbation of asthmaMore serious complications such as pneumonia

  • 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.

  • 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

  • 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

  • The Stages of ChickenpoxIncubation Period Usually (14-17 days)Prodrome (1 3 days)VesiclesPustules Scabs Recovery typically 7 days after rash appears (ranges 5 - 35 days)

  • Herpes Zoster (Shingles)Reactivation of Varicella Zoster VirusAssociated with: AgingImmunosuppressionIntrauterine exposureVaricella at
  • Can chickenpox be caught from someone with Herpes Zoster (Shingles)?Yes. The rash of shingles contains VZV particles, just like the rash of chickenpox. Shingles carries a small risk of transmitting chickenpox to someone who has not had chickenpox before. An infant might acquire chickenpox by very close contact with a grandparent with shinglesThe risk of transmission is low - because VZV is not excreted from the throat during shingles.

  • ComplicationsBacterial infection of lesionsCNS manifestationsPneumonia (rare in children)Hospitalization: 3 per 1000 casesDeath: 1 per 60,000 cases

  • Groups at Increased Risk of ComplicationsNormal AdultsImmunocompromised personsNewborns with maternal rash onset within 5 days before to 48 hours after delivery

  • Chickenpox during pregnancy may result in:Congenital Varicella syndromeSevere Varicella syndromeRisk of neonatal death

  • Congenital Varicella SyndromeResults from maternal infection during pregnancyPeriod of risk may extend through first 20 weeks of pregnancyAtrophy of extremity with skin scarring, low birth weight, eye and neurologic abnormalitiesRisk appears to be small (
  • Laboratory DiagnosisLaboratory diagnosis is not routinely requiredUseful if confirmation of the diagnosis or determination of susceptibility is necessaryMost frequent source of isolation is vesicular fluidStained smears from vesicular scrapings (Tzanck Smear).Serology Tests for Varicella IgM antibodyELISA and Latex Agglutination (LA) useful in screening for varicella immunity

  • Can you get chickenpox more than once? YesBut it is uncommon to do so.For most people, one infection is thought to confer lifelong immunity.

  • Management Interventions designed to minimize fever and discomfort: Antipyretic medicinesCool baths and soothing lotions Chickenpox is not usually treated with a specific antiviral compound owing to its short duration and generally mild, uncomplicated nature. Antiviral medication may be appropriate for older patients, in whom the disease tends to be more severe.

  • Acyclovir TherapyHealthy nonpregnant persons >13 years of ageChildren >12 months with chronic cutaneous or pulmonary disorders or on salicylate therapyChildren receiving short intermittent or aerosolized steroidsIV in Immunocompromised children and adults with viral-mediated complicationsNot recommended for post-exposure prophylaxis

  • What home treatments are available for chickenpox? Fingernails trimmed shortCalamine lotion and Aveeno (oatmeal) baths may help relieve some of the itchingAspirin 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.

  • ComplicationsCertain 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.

  • What Complications Result From Varicella? The most common complications are:Bacterial infections of the skin and soft tissues in childrenSepticemiaToxic Shock SyndromeNecrotizing FascitisOsteomyelitisBacterial pneumoniaSeptic arthritis.

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

  • Morbidity and mortalitySince 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.

  • 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.

  • 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. LethargyDifficulty walkingStiff neckSevere VomitingDifficulty breathingSevere cough.

  • Can chickenpox be prevented? Yes, chickenpox can now be prevented by vaccination

  • Varicella Vaccine

  • Varicella Vaccine RecommendationsRoutine vaccination at 12 to 18 months of ageRecommended for all susceptible children by the 13th birthdayPersons >13 years of age without history of VaricellaTwo doses separated by 4 8 weeks

  • Varicella Vaccine: Post-exposure ProphylaxisVaricella vaccine is recommended for use in susceptible person after exposure to Varicella70% - 100% effective if given within 72 hours of exposureNot effective if >5 days but will produce immunity if not infected

  • Varicella Vaccine: Adverse ReactionsInjection site complaints: 20%Rash: 3% - 4%May be maculopapular rather than vesicularAverage 5 lesionsSystemic reactions uncommon

  • Zoster Following VaccinationMost cases in childrenRisk from wild virus 4 to 5 times higher than from vaccine virusMild illness without complications

  • Varicella Vaccine: Contraindications and PrecautionsSevere allergy to vaccine component or prior dose of vaccinePregnancyImmunosuppressionModerate or severe acute illnessRecent blood productImmunocompromised persons should not be vaccinatedVaccinate persons with humoral immunodeficiency

  • Varicella Zoster Immune Globulin (VZIG)May modify or prevent disease if given
  • What problems can occur after chickenpox vaccination? Soreness, redness, or swelling at injection site is the most common side effect, occurring about 20% of the time. A very mild rash or several small bumps can result in about 1% to 4% of vaccine recipients.It may be possible for someone who gets a rash from chickenpox vaccine to give vaccine strain chickenpox to another person. The vaccin

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