Chickenpox (varicella) is a common and extremely infectious childhood disease that also occasionally affects adults. It produces an itchy, blistery rash that typically lasts about a week and is sometimes accompanied by a fever or other symptoms.
About four million Americans contract chickenpox each year, resulting in roughly 5,000-9,000 hospitalizations and 100 deaths. Chickenpox is caused by the varicella-zoster virus (a member of the herpes virus family), which is spread through the air or by direct contact with an infected person. Once someone has been infected with the virus, symptoms appear in about 10-21 days. The period during which infected people can spread the disease is believed to start one or two days before the rash appears until all the blisters have formed scabs, usually four to seven days after the rash breaks out. For this reason, doctors recommend keeping children with chickenpox away from school for about a week.
Chickenpox has been a typical part of growing up for most children in the industrialized world (although this may change because of the new varicella vaccine). The disease can strike at any age, but by ages nine or 10 about 80-90% of American children have already been infected. U.S. children living in rural areas and many foreign-born children are less likely to be immune. Because almost every case of chickenpox leads to lifelong protection, adults account for less than 5% of all cases in the United States. Study results reported by the Centers for Disease Control and Prevention (CDC) indicate that more than 90% of American adults are immune to the chickenpox virus. Adults, however, are much more likely than children to suffer dangerous complications. More than half of all chickenpox deaths occur among adults.
Causes & symptoms
A case of chickenpox usually starts without warning or with only a mild fever and a slight feeling of unwellness. Within a few hours or days small red spots begin to appear on the scalp, neck, or upper half of the trunk. After a further 12-24 hours the spots typically become itchy, fluid-filled bumps called vesicles, which continue to appear for the next two to five days. In any area of skin, lesions of a variety of stages can be seen. These blisters can spread to cover much of the skin, and in some cases may also be found inside the mouth, nose, ears, vagina, or rectum. Some people develop only a few blisters, but in most cases the number reaches 250-500. The blisters soon begin to form scabs and fall off. Scarring usually does not occur unless the blisters have been scratched and become infected. Occasionally a minor and temporary darkening of the skin (called hyperpigmentation) is noticed around some of the blisters. The degree of itchiness can range from barely noticeable to extreme. Some chickenpox sufferers also have headaches, abdominal pain, or a fever. Full recovery usually takes five to 10 days after the first symptoms appear. The most severe cases of the disease tend to be found among older children and adults.
Some groups are at risk for developing complications, the most common of which are bacterial infections of the blisters, pneumonia, dehydration, encephalitis,
- Infants. Complications occur much more often among children less than one year old than among older children. The threat is greatest to newborns, who are more at risk of death from chickenpox than any other group. Children born to mothers who contract chickenpox just prior to delivery face an increased possibility of dangerous consequences, including brain damage and death. If the infection occurs during early pregnancy, there is a small (less than 5%) risk of birth defects.
- Immunocompromised children. Children whose immune systems have been weakened by a genetic disorder, disease, or medical treatment usually experience the most severe symptoms of any group. They have the second-highest rate of death from chickenpox.
- Adults and children 15 and older. The typical symptoms of chickenpox tend to strike this group with greater force.
Where children are concerned, especially those with recent exposure to the disease, diagnosis can usually be made at home, by a school nurse, or by a doctor over the telephone if the child's parent or caregiver is unsure that the disease is chickenpox. A doctor should be called immediately if:
- The child's fever goes above 102°F (38.9°C) or takes more than four days to disappear.
- The child's blisters appear infected. Signs of infection include pus drainage or excessive redness, warmth, tenderness, or swelling.
- The child seems nervous, confused, unresponsive, or unusually sleepy; complains of a stiff neck or severe headache; shows signs of poor balance or has trouble walking; finds bright lights hard to look at; is having breathing problems or is coughing a lot; is complaining of chest pain; is vomiting repeatedly; or is having convulsions. These may be signs of Reye's syndrome or encephalitis, two rare but potentially very dangerous conditions.
Treatment focuses on reducing symptoms of chickenpox. The patient should drink plenty of fluids and eat simple, nutritious foods. Soups (especially mung bean), herbal teas, and fruit juices are good choices.
Applying wet compresses or bathing the patient in cool or lukewarm water once a day can help the itch.
Adding four to eight ounces of baking soda or one or two cups of oatmeal to the bath is helpful. Only mild soap should be used and patting, not rubbing, is recommended for drying the patient. The patient should not scratch the blisters as this can lead to infection or scarring. For babies, light mittens or socks on the hands can help guard against scratching. If mouth blisters are present, cold drinks and soft, bland foods can make eating less painful.
Vitamin A may help to heal skin. Vitamin C and bioflavinoids help to reduce fever and stimulate the immune system. Zinc stimulates the immune system and promotes healing. Zinc can cause nausea and vomiting. Calcium and magnesium help to relieve restlessness and sleeping difficulties. Magnesium has a laxative effect at high doses.
Herbals and Chinese medicine
The following herbals are ingested to treat chickenpox:
- Echinacea and goldenseal (Hydrastis canadensis) support the immune system, and soothe skin and mucous membranes. Echinacea is also an antiviral.
- Chamomile tea is a sleep aid.
- Chinese cucumber (Trichosanthes kirilowii) root tea is used to relieve symptoms of chickenpox.
- Elder flower, peppermint, and yarrow reduce fever.
- Garlic has antiviral activity.
- Mullein (Verbascum thapsus) treats chickenpox.
- Yin Qiao Jie Du Wan (Honeysuckle and Forsythia Pill).
- Ban Lan Gen Chong Ji (Isatis Infusion).
The following herbals are used externally to treat chickenpox:
- Aloe leaf, calendula, and plantain relieve the itching of the chickenpox rash.
- Turmeric powder mixed with lime juice treats chickenpox rash.
- Garlic clears skin infection.
The acupressure points Four Gates, Large Intestine 11, Spleen 10, and Stomach 36 help alleviate symptoms associated with chickenpox.
Treatment usually focuses on reducing discomfort and fever. Because chickenpox is a viral disease, antibiotics are ineffective. Antibiotics may be prescribed if the blisters become infected. Calamine lotion helps to reduce itchiness. Painful genital blisters can be treated with an anesthetic cream recommended by a doctor or pharmacist.
Fever and discomfort can be reduced by acetaminophen (Tylenol) or other medications that do not contain aspirin. Aspirin (or any aspirin-containing medications) must not be used with chickenpox, because it increases the chances of developing Reye's syndrome. The best idea is to consult a doctor or pharmacist if one is unsure about which medications are safe.
Most cases of chickenpox run their course within a week. The varicella-zoster virus lies dormant in the nerve cells, where it may be reactivated years later by disease or age-related weakening of the immune system. The result is shingles (herpes zoster), a very painful rash and nerve inflammation, that strikes about 20% of the population, particularly people 50 and older.
A substance known as varicella-zoster immune globulin (VZIG), which reduces the severity of chickenpox symptoms, is available to treat persons at high risk of developing complications. It is administered by injection within 96 hours of known or suspected exposure to the disease.
A vaccine for chickenpox (Varivax) has been found to prevent the disease in 70-90% of the vaccinated population, to reduce the severity of disease in the remaining cases. CDC and the American Academy of Pediatricians recommend vaccination of all children (with some exceptions) at 12-18 months of age. For older children, up to age 12, the CDC recommends vaccination when immunity cannot be confirmed. Vaccination is also recommended for any older child or adult considered susceptible to the disease, particularly those who face a greater likelihood of severe illness or transmitting infection. A single dose of the vaccine is sufficient for children up to age 12; older children and adults receive a second dose four to eight weeks later.
Pattishall, Evan G., III. "Chickenpox." In Primary Pediatric Care. edited by Robert A. Hoekelman, et al. St. Louis: Mosby, 1997.
Ying, Zhou Zhong, and Jin Hui De. "Common Diseases of Pediatrics." In Clinical Manual of Chinese Herbal Medicine and Acupuncture. New York: Churchill Livingston, 1997.
Kump, Theresa. "Childhood Without Chickenpox? Why Parents Are Still Wary of This New Vaccine." Parents. (April 1996): 39-40.
Napoli, Maryann. "The Chickenpox Vaccine." Mothering. (Summer 1996): 56-61.
Shapiro, Eugene D., and Phillip S. LaRussa. "Vaccination for Varicella—Just Do It!" Journal of the American Medical Association 278 (1997): 1529-1530.
Centers for Disease Control and Prevention. National Immunization Hotline. 1600 Clifton Rd. NE, Atlanta, GA 30333. (800) 232-2522 (English). (800) 232-0233 (Spanish). http://www.cdc.gov.
Centers for Disease Control and Prevention." Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP)." http://aepo-xdvwww.epo.cdc.gov/wonder/prevguid/m0042990/entire.htm (12 December 1997).
Zand, Janet. "Chickenpox." HealthWorld Online. http://www.healthy.net/library/books/smart/chcknpox.htm.