Chicken
Pox/Varicella-Zoster Virus
DEFINITION:
A
viral illness characterized by specific symptoms. Known as
chickenpox, varicella, or varicella-zoster.
SYMPTOMS:
Fever, headache and congestion, followed by a rash. The rash
usually starts as red spots that then fill with fluid (vesicles)
and go on to crust and disappear, sometimes with a small scar.
The rash can appear anywhere on the body. The average child
gets 300 spots.
CAUSES:
A
virus called varicella-zoster virus.
DIAGNOSIS:
The
diagnosis is usually made by the symptoms. A blood test can
be checked but this is usually not necessary.
CONTAGION:
Chicken pox is contagious until the final spot on the body
has formed a scab. It is contagious from 3 days before symptoms
develop and usually lasts about two full weeks.
OUTCOME:
Generally good. There can be some complications, such as a
severe secondary bacterial infection, pneumonia, and severe
overwhelming chickenpox infection. There are about 10,000
hospitalizations and 100 deaths per year in the United States
due to chickenpox.
TREATMENT
AND DISCUSSION:
Chickenpox
is a very familiar disease. Until 1995, when the vaccine was
licensed for use in the United States, almost every child
got chickenpox. The illness is highly contagious, with 90%
of susceptible individuals contracting the illness if exposed.
Exposure is through respiratory droplets (coughing or sneezing)
or by contact with the fluid contained in the vesicles of
an infected individual. After exposure, the virus incubates
for 10 to 21 days, after which symptoms begin. Treatment typically
consists of fluids, fever medications and anti-itch creams.
Complications can occur with chickenpox, the most common of
which is a secondary bacterial infection of the skin. However,
pneumonia, liver problems, and encephalopathy (brain swelling)
can occur. If a pregnant woman contracts chickenpox in the
first trimester, the child may be born with defects, including
limb and brain abnormalities. If a woman delivers a child
while she is infected with chickenpox, the newborn can have
complications, including neurologic symptoms. Mostly, a healthy
child will get chickenpox and just feel miserable until it
passes. Typically, a child will miss 10 to 14 days of school
and a parent will usually need to stay with the child. The
costs of the creams, ointments and missed work and school
have been estimated to be in the billions of dollars each
year.
A long-term complication of chickenpox is herpes zoster, or
shingles. When a person gets chickenpox, the varicella virus
never completely leaves the body. It hides along nerve fibers
and can come back out later in the form of shingles. Shingles
is a very painful rash, and exposure to shingles can cause
chickenpox in susceptible individuals. In the elderly or the
immuno-suppressed, shingles can be very dangerous.
There
is some help for children with chickenpox. A drug called zovirax
(Acyclovir) is available both orally and intravenously. If
given orally during the first 48 hours of symptoms, it can
lessen the course of the illness by one to two days and possibly
prevent complications. Intravenous therapy is reserved for
children with immune deficiencies, severe complications, or
for newborns with infections. Acyclovir can be used for shingles
as well.
Two drugs to be avoided with chickenpox are steroids and aspirin.
Steroids, which are used for many illnesses in children ranging
from asthma to poison ivy, can suppress a person's immune
system and allow the chickenpox to disseminate, causing complications.
Aspirin and chickenpox can lead to Reye's syndrome (liver
failure). Since the relationship between Reye's syndrome and
chickenpox after aspirin treatment was noted, aspirin has
been removed from the list of recommended drugs for children
since aspirin plus other viruses may also cause the same symptoms.
So aspirin should never be given to children. Since this relationship
has been noted and aspirin has been removed from standard
therapy for children, Reye's syndrome is almost unheard of.
Vaccination
is the only way to prevent contracting chickenpox. The varicella
vaccine is given at 1 year of age. It can be given at any
time after that to susceptible individuals. If a child is
over 12 years old, two doses of vaccine are given, one month
apart. The vaccine is 90% effective. If a child does contract
chickenpox after receiving the vaccine, it is a much milder
case with no complications. The vaccine can be given to susceptible
children within 5 days after exposure to chickenpox to help
lessen the course of the illness. Vaccination will also prevent
shingles. Varicella-zoster immune globulin (VZIG) can also
be given intravenously after exposure to prevent getting the
illness. This should be given within 96 hours after exposure
to immune-depressed children, pregnant women, and newborns
whose mothers have chickenpox.
ONE
DOCTOR'S OPINION:
For
some reason, there is some reluctance to get the chickenpox
vaccine. People seem to think that this is a harmless illness
that all children should get, albeit there was the same kind
of resistance when the measles, mumps and rubella vaccines
first arrived. To me, not getting the vaccine because you
want the child to get the full illness is like not using a
seat belt because you want to experience the full effects
of a car accident. The vaccine has been around since the 1970s.
The immunity does not decrease over time, shingles is prevented,
complications are prevented, misery and scars are prevented,
and deaths are prevented. Why make the child suffer, and why
have 10,000 hospitalizations and 100 deaths per year from
an illness that is easily prevented? All groups that recommend
vaccines, including the American Academy of Pediatrics, The
Center for Disease Control, the American Academy of Family
Practice, and the World Health Organization, recommend the
vaccine unanimously. Fortunately, this vaccine is being required
for school admission, so hopefully, in 20 years a case of
chickenpox will be unheard of.
