Recognize Chickenpox

Chickenpox is a disease caused by the varicella zoster virus, which is a member of the herpes group of viruses. Chickenpox used to be considered one of the classic childhood diseases, but since the release of the chickenpox vaccine the rate of infection has significantly decreased. Regardless, you or your child may experience an outbreak. In order to identify chickenpox, you'll need to know what symptoms are associated with the disease.

Steps

Identifying Chickenpox

1. Watch for symptoms on the skin. Approximately one or two days after developing a runny nose and sneezing, you may see red spots on your skin. These dots often start on the chest, face, and back, are often itchy, and can quickly spread to the rest of the body.
   • These red spots will turn into red bumps and then small blisters (vesicles). These spots contain the virus and are highly contagious. These blisters will crust over in several days. After all the blisters are crusted, the person will no longer be contagious.
   • Insect bites, scabies, other viral rashes, impetigo, and syphilis may look like chickenpox.
2. Be suspicious of cold symptoms. Chickenpox may first present as a mild cold, with a runny nose, sneezing, and a cough. You may even develop a fever up to around 101 degrees Fahrenheit. If the infected person were exposed to someone with chickenpox or breakthrough chickenpox (a milder form of the illness in someone who has received the vaccine), mild cold symptoms may really be the initial symptoms of the chickenpox.
3. Recognize early symptoms to reduce exposure to persons at risk. Chickenpox is highly contagious and dangerous to persons who have problems with their immune system, such as people undergoing chemotherapy for cancer or who have HIV or AIDS, and most babies, because children are not vaccinated against chickenpox until they are at least 12 months old.

Understanding the Virus

1. Understand how the virus is transmitted. The chickenpox virus is spread through the air or through direct contact, normally the product of unsanitary sneezing or coughing practices. The virus is transported in the fluid (i.e. saliva or mucus).
   • Touching an open sore caused by the virus or breathing it in (such as kissing a person with chickenpox) will also infect you.
   • If you've encountered someone else who has a confirmed case of chickenpox, this will help you identify your own symptoms.
2. Know the incubation period. The chickenpox virus does not produce symptoms immediately. In general, it can take 10 to 21 days after being exposed to develop any noticeable symptoms. The macular-papular rash will continue to appear over several days and the blisters will take several days to resolve. This means that you can have papular rash, vesicles and open blisters which are crusting over all at the same time.
   • Approximately 90% of susceptible close contacts not vaccinated will develop the illness after exposure.
3. Recognize that older adolescents and adults have more complications. Although the chickenpox illness is not severe, it will cause more hospitalizations, deaths and complications in people who are adolescents and adults. The rash and vesicles can appear in the mouth, anus and vagina.
4. Call your doctor if the person with chickenpox is at higher risk for severe illness. Children older than 12 years, pregnant women or anyone with a compromised immune system (including the use of steroids which compromise the immune system) or who has asthma or eczema, are at greater risk for experiencing more severe symptoms.
5. Call the doctor if the person with chickenpox has these symptoms:
   • Fever that lasts longer than 4 days or goes over 102 F
   • Any area of the rash that becomes warm, red, tender or begins leaking pus since this indicates a secondary bacterial infection
   • Difficulty waking up or becoming confused
   • Stiff neck or difficulty walking
   • Frequent vomiting
   • Severe cough
   • Difficulty breathing

Treating Chickenpox

1. Ask your doctor for medication if you have an extreme case or are at high risk for severe illness. The medications used to treat chickenpox are not given to everyone. In many cases, doctors won't prescribe harsh medicines to children, unless the infection looks like it could lead to pneumonia or another equally serious issue.
   • For best results, antiviral medication must be given within the first 24 hours of the appearance of the rash.
   • If you have skin conditions such as eczema, lung conditions like asthma, were recently treated with steroids or have a compromised immune system, antiviral medication will be considered.
   • Some women who are pregnant may also qualify for administration of antiviral medication.
2. Do not take aspirin or ibuprofen. Children especially should not take either and babies under six months old should not take ibuprofen at all. Aspirin has been associated with another serious condition called Reyes syndrome and Ibuprofen may lead to other secondary infections. Instead, take acetaminophen (Tylenol) to treat headaches or other pain or fevers resulting from chickenpox.
3. Do not scratch the blisters or remove the scabs. Although the blisters and scabs are very itchy, it is important that you do not remove the scabs or scratch the rash. Removing a scab will cause that pox to scar and itching increases the risk of bacterial infections. Cut your child's finger nails if they cannot help scratching their blisters.
4. Cool your blisters. Place cold compresses over the blisters. Take cooler bathes. The cooler temperature will help alleviate both the itching and fever that may accompany chickenpox.
5. Use calamine lotion to ease the itching. Take cool baths with baking soda or colloidal oatmeal or apply calamine lotion to help to ease the itching. If this doesn’t relieve the itching call your doctor for medication. The baths and calamine lotion will relieve itching (reduce the severity) but there isn’t anything that will completely take it away until the blisters have healed.
   • Calamine lotion can be purchased at any grocery store or pharmacy.

Preventing Chickenpox

1. Ask your doctor about the chickenpox vaccine. The vaccine is considered safe and given to young children before they are exposed to the illness. The first dose is given at 15 months and the second dose between 4 and 6 years of age.
   • Getting chickenpox vaccine is much safer than getting chickenpox disease. Most people who get the chickenpox vaccine do not have any problems with it. However, a vaccine, like any medicine, is capable of causing serious problems, like severe allergic reactions. The risk of chickenpox vaccine causing serious harm, or death, is extremely small.
2. Expose your child to the chickenpox early if you do not give the vaccine. Make sure to talk to your doctor about your decision. Vaccination is a personal choice for the parents. However, the older the child is when they get the illness, the worse they feel. If you choose to not give the vaccination, or if your child is or could be allergic to the vaccine, then try to expose them to the illness after age three and before age 10 to reduce symptoms and severity of the condition.
3. Be aware of breakthrough cases of the chickenpox. Children who have had a vaccination can develop a milder form of the illness. They may only get approximately 50 spots and blisters which are less intense. This makes a diagnosis more difficult. However, they are as contagious as if they had the full blown illness.
   • Adults are at risk for more severe disease and have a higher incidence of complications.
   • By far, the vaccination is preferable to so-called "pox parties" wherein parents purposefully infect their children. The vaccination may cause a mild case of chickenpox, but attending a pox party will most likely guarantee you or your child a full-blown case, which can lead to pneumonia and other terrible afflictions. In this case, you don't want to attend the party.

Watching Out for Other Complications

1. Be vigilant with children who have other skin problems, such as eczema. Children who have a history of skin problems can develop thousands of blisters. This can be painful and increase the risk of scarring. Use the treatments described above to reduce the itching and talk with your physician about other topical and oral medications to reduce the discomfort and pain.
2. Watch for secondary bacterial infections. Areas of blisters can become infected with bacteria. They will be warm, redder, tender to touch and can also leak pus. The pus is darker in color and not clear the way the fluid from the vesicles is. Call your doctor if you notice these changes to areas of the skin. This bacterial infection must be treated with antibiotics.
   • Bacterial infections can also affect other tissue, bone, joints and even include the bloodstream, called sepsis.
   • Each of these infections are dangerous and require immediate medical attention.
   • Symptoms of more generalized infection to the bone, joint or bloodstream include:
   • Fever over 101 F
   • Area is warm and tender to touch (bone, joint, tissue)
   • Joint is tender or painful to use.
   • Trouble breathing
   • Chest pain
   • Worsening cough
   • General feeling of being really sick. Most children have a fever that resolves early with the chickenpox and although they have symptoms of a cold, they will often still play, smile and want to go for a walk. Children who are septic (infection in the blood) will be quiet, want to sleep often, have a fever over 101 F, increased heart rate and increased rate of respirations (more than 20 breaths per minute).
3. Be aware of other serious complications from chickenpox. Although not common, these complications are very dangerous and can result in death.
   • Dehydration during which the body does not have enough fluid to function properly. This affects the brain, blood and kidneys first. Signs of dehydration include decreased or concentrated urination, being tired, weak, or dizzy, or having a fast heart rate
   • Pneumonia with symptoms of increased cough, fast or troubled breathing, or chest pain
   • Bleeding problems
   • Infection or inflammation of the brain. Children will become quiet, sleepy and complain of a headache. They may be confused or difficult to arouse.
   • Toxic shock syndrome
4. Watch for shingles in adults, especially over the age 40, if you had chickenpox as a child. Shingles is a painful, blistered rash that happens on one side of the body, trunk or face that can cause numbness and which is caused by the same virus which causes Chickenpox. The virus remains dormant in the body until later years when the immune system is not as strong. Pain, often burning pain, and numbness often resolves within weeks but other long-term damage can occur to the eyes and organs if they are affected. Post-herpetic neuralgia is a painful neurological condition that is difficult to treat and can result from shingles.
   • Call your doctor right away if you think you may have shingles, as antiviral medications are often prescribed for this, especially if it is caught early. Older adults may benefit from a vaccination for shingles.

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