CHICKENPOX (Varicella)
Chickenpox is due to varicella-zoster-virus.
The incubation period is from 10 to 21 days (most commonly 14 to 16)
The illness has a short prodrome of fever, lethargy and anorexia followed by
eruption of the rash that occurs over the next three to five days. The rash
consists of crops of small papules that quickly become vesicular and then
crust over
after the vesicles have ruptured. Usually the lesions are all fully
crusted over by 10 days. The lesions may occur anywhere but the scalp,
face, trunk,
mouth and conjunctivae are the most typical locations.
Chickenpox is generally a benign and self limiting disease but may be
associated
with complications including bacterial superinfection (particularly
group A beta haemolytic streptococcus and Staph aureus), pneumonia,
encephalitis,
cerebellitis, hepatitis, arthritis and Reye syndrome.
Complications are more common in infants, people over 15 years of age and
immunocompromised children.
Bacterial cellulitis tends to be over-diagnosed. Chickenpox lesions
normally have
significant erythema around them, particularly in the crusting
stages of development.
Recurrence of infection results in the localised phenomenon known as
herpes zoster
or shingles. In children zoster can spread over more than one
dermatome, but is usually milder than in adults and post-herpetic
neuralgia is less
common.
Therapy
In immunocompetent children no specific therapy is indicated. Symptomatic
treatment
consists of Calamine lotion, cool compresses, possibly oral
antihistamines at night to improve sleep. Keeping the skin cool may reduce
the
number of lesions. Scratching increases the risk of secondary
bacterial infection - cut the child's nails short at the first sign of the
disease.
Avoid aspirin.
Aciclovir is indicated in children with impaired immunity, certain
neonates (see
diagram), and possibly severe eczema.
Infection precautions
The patient is infectious from one to two days before the onset of the
rash until
the lesions have fully crusted over. Children must be excluded from
school until fully recovered (all lesions crusted over) or at least one
week after
the eruption first appears.
If possible, hospitalisation should be avoided, because of the infectious
risk to
other patients. Any admitted child with active chickenpox or zoster
should be isolated.
Vaccination
Despite a relatively low complication rate, varicella is an important
contributor to
hospitalisations and mortality. The vaccine is effective in the
prevention of varicella in children, has few side effects (mainly local
reactions,
low grade fever and mild varicella rash) and is recommended for
children over 12 months of age without a history of varicella, and for
seronegative
adults.
Varicella vaccine has been used to prevent infection following exposure in
some
small studies. This was successful if the vaccine was given within
three days of exposure.
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