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The chicken pox virus is widespread and most UK children have been infected by adolescence. Spread is by droplets and direct contact so being in the same room as someone with chicken pox, can lead to infection in those who are susceptible. Once infection has occurred, lifelong immunity ensues in most and those previously infected will not contract the virus or transmit it after contact with someone who has it.
For most children, chickenpox, or Varicella zoster (VZ), is a benign disease. For a small minority the disease can prove to be a nightmare
Groups who are more likely to suffer badly include older people; pregnant mums; babies less than a month old; anyone with an immune function problem such as AIDS, those on steroid treatment or on chemotherapy; people with eczema (in whom the rash can be particularly severe known as eczema herpeticum). If someone develops chicken pox and is away from school or work, it is important to inform the appropriate people there because there may be others who have come into contact who need to be aware because there is treatment available should they develop symptoms.
In USA since 1995 a vaccination programme has reduced the infection rate drastically. Booster immunization is required and waning immunity in those who have been immunized in childhood much later in life may leave the very old, who are at severe risk of complications, vulnerable. In UK it is not felt that the benefits of the vaccination outweigh the cost of giving it. The vaccination is available privately.
Most affected children do not require specific anti viral treatment. For those at risk of severe disease it is important to start treatment early and effectively which may mean admission to hospital for intravenous treatment. Non specific treatment to reduce the discomfort may include gentle bathing in water that is not too hot and patting dry rather than rubbing; keeping fingernails short, using mittens and socks to stop deep scratching and subsequent scarring; keeping up with fluid intake; DO NOT USE IBUPROFEN (JUNIFEN / NUROFEN) as this may increase the possibility of the pox becoming infected with bacteria and DO NOT USE ASPIRIN as this can increase the possibility of a rare serious complication called Reyes syndrome. Paracetamol (Calpol) in appropriate doses may help fever. Calamine lotion may make it even more itchy.
Unusual redness or swelling around the rash may indicate secondary infection requiring antibiotics; refusal to drink or frequent vomiting (the rash can involve mouth, eyelids and genitals making it painful to swallow, blink and pass urine) leading to dehydration; confusion, unusual irritability, extreme drowsiness or unsteadiness on walking, severe headache, stiff neck or back pain, photophobia, (may indicate VZV has infected the brain); difficulty in and rapid breathing, chest pain, wheezing or severe cough (may indicate lung complications); fever lasting more than four days or recurrence of fever once it has settled; unusual deterioration in symptoms. You should request an urgent home visit and if especially worried go to A&E but please ring them first to tell them you are coming in order that they may take appropriate precautions to prevent spread of infection.
The chicken pox incubation period comes 10–21 days after catching the virus. Then, a non-specific viral type fever with mild cough, sore throat and sometimes abdominal pain can begin. After another one to two days the rash begins. It starts as individual flat red spots which become small blisters with dimples measuring < 0.5cm and are hugely itchy, the blisters become reddened then pustular and eventually scab over five to six days later. They come in crops anywhere over the body appearing over three to five days so that at any stage there can be new spots developing whilst older spots are becoming scabbed. Once they have stopped appearing and have all scabbed they are no longer infectious. The lesions have usually healed by 16 days but may take up to five weeks. Those with prolonged healing are more likely to have some immune function defect. Infected individuals are infectious to others for one to two days before the rash develops. If three weeks after the initial contact no fever develops it is unlikely that infection has occurred.
About one in 4000 can develop post infectious cerebellitis causing unsteadiness in gait two to three weeks after the initial infection. No specific treatment is available. After infection chicken pox can remain dormant in the sensory cells of the spinal cord. For no clear reason and sometimes decades later, these dormant virus particles can reactivate, move down the nerves and reappear at the skin in a patch supplied by the infected nerve as the painful shingles rash (or herpes Zoster). Shingles is contagious to those who have never had chicken pox but not as contagious as chicken pox itself. Other uncommon potential late effects include kidney, heart and eye problems.
This was very informative and I do think that the chicken pox vaccine is good for those who are older and vulnerable, but as with young children it is better for them to get it over and done with to develop a lifelong immunity to it. I think the idea of only making it available privately is wise.
A really helpful and informative article.