Varicella (aka Chickenpox)

Varicella, or what we commonly call chickenpox, is an infectious communicable viral disease that mostly affects children. However, it can also occur in adults – particularly those who have not had chickenpox during their childhood or have not been vaccinated.

Symptoms

Chickenpox is typically characterised by the appearance of around 250-500 itchy blisters all over the body, sometimes including the mouth, throat, nose, eyelids genitals and anus in severe cases. Blisters usually first appear on the chest, back and face areas first before spreading to the rest of the body. The blisters first begin as a rash of raised red bumps known as papules, which, after a few days, develop into fluid-filled blisters known as vesicles, which eventually break open to form a crust and scabs. As new bumps continue to appear for several days, all three phases of blistering may be present at a given time. Understandably, it can be rather painful and uncomfortable as these blisters burst, exposing damaged skin.

About a day or two prior to the appearance of the initial rash, the following symptoms may be observed which may then continue on until a recovery is made:

  • headache
  • fever
  • malaise (feeling unwell and tired)
  • loss of appetite

These symptoms begin to appear roughly two weeks following exposure to the pathogen.

Causes

Chickenpox is caused by exposure to the varicella-zoster virus, which is the same pathogen that is responsible for the incidence of shingles.

Complications

More often than not, the patient recovers about a week after the initial onset of blisters, without any specific treatment or complications except for the obvious pain, discomfort and weakness. However, on rare occasions complications may occur in infants, pregnant women or immunocompromised patients and may include:

  • dehydration
  • bacterial infection of skin and tissues
  • pneumonia
  • encephalitis
  • haemorrhage (bleeding) issues
  • sepsis (infection in bloodstream)

Additionally, since the virus inactively remains in the nerve cells in parts of the brain and spinal cord after recovery, there is a possibility of the incidence of shingles sometime later on in the individual’s life. However, this is rare and reactivation is usually triggered by some sort of stressful or immunocompromising event.

Transmission

Spread of chickenpox can occur by means of:

  • direct contact (most common)
  • fomites, particularly clothes and linen
  • inhalation or ingestion of infected droplets released from a patient when they sneeze or cough

An individual infected with the varicella-zoster virus is believed to be contagious from about two days prior to the onset of symptoms up to the point where the last blister has crusted and formed a scab.

Prevention

The best preventive measure to take against chickenpox is to vaccinate children. This ideally involves two live-attenuated doses which for children are administered at 12-15 months and 4-6 years, and four weeks apart for adults and adolescents. Since the introduction of the varicella vaccine in 1995, the CDC reports that there are an estimated 3.5 million less cases and 100 less deaths per year in the USA. Vaccination is key particularly for those working in health services and child care or education. However, there are instances where an individual may still develop chickenpox despite being vaccinated – known as breakthrough chickenpox. Symptoms are usually much milder in such cases.

The other means of defence is through natural immunity following the incidence of chickenpox. The viral pathogens become inactive following recovery and are stored in the nerves of the brain and spinal cord where they act as a sort of memory storage to quickly and efficiently ward off infection if future exposure to the varicella zoster-virus occurs. In other words, it works a natural, in-built vaccination.

The recurrence of chickenpox is very rare.

If an individual who has not been vaccinated or has not previously contracted chickenpox becomes aware that they have been exposed to an infected person, it is recommended that they get vaccinated immediately as this could prevent infection from occurring.

[Chickenpox PartiesIn what might be perceived as a bizarre practice, back in the pre-vaccine days, some parents used to intentionally expose their children to a chickenpox patient/s at what they referred to as a ‘chickenpox party’. This was done in order to make their children contract chickenpox and thereby attain natural immunity for their adulthood. While this is still continued by some conservative sects of society, this practice is strongly discouraged by health organisations such as the WHO and CDC as there is no control over the extent of sickness once it has been contracted. Prevention by vaccination or immunity by non-deliberate infection are considered much safer practices.]

If contracted, it is important to take care to prevent spread of disease to others. Some good practices to follow (or for parents to have their children follow) include:

  • staying at home from onset of symptoms until the last blister has dried
  • staying away from immunocompromised individuals, infants, pregnant women
  • not sharing clothes or linen
  • calling ahead and informing the hospital/clinic if you intend on making a visit to the doctor so as to be advised on any precautionary measures that should be taken
  • keeping nails trimmed and wearing sock gloves (particularly at night for children) to avoid scratching blisters and making them susceptible to secondary bacterial infection and facilitating easier spread
  • wearing loose clothing and carefully drying the body with a soft towel after bathing so as to prevent infection and spread

Treatment

There is no specific treatment recommended for chickenpox unless there are severe symptoms (such as fever above 102oF) or complications – in which case a GP’s advice should be sought at the earliest. The following practices may help to alleviate some of the discomfort experienced by the patient during the course of the infection:

  • applying calamine lotion to soothe blistered skin and itching
  • bathing with baking soda or raw turmeric added to cool water
  • sleeping on a bed of neem tree (kohomba) leaves to soothe blistered skin
  • if advised by a doctor, using an anti-histamine to ease itching
  • consuming soft, cooled food and drink that are easy to swallow and digest

It is NOT recommended to take NSAIDS or any other painkillers unless advised by a medical professional.

Cover illustration adapted from Dreamstine and CanStock.

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