Chicken Pox Varicella

Cause Chicken pox is an infection with the varicella-zoster virus.

Symptoms Characteristic blisters usually appear first on the trunk and face and can spread over the whole body. Blisters may also appear inside the mouth, nose, and vagina. Some children have a few blisters; others have hundreds. The blisters are about 0.2 to 0.4 inch wide, with a reddish base ("dew drop on a rose petal"). The rash is usually associated with moderate to severe itching. Some children have fever (usually mild), stomach pain, and a general ill feeling.

How It Spreads The virus is spread in nasal secretions and in fluid from inside the blisters. It is very contagious; epidemics are especially common in late winter and early spring. Ninety percent of all nonimmune children (those who haven't had chicken pox or vaccine) will catch it when exposed.

Incubation Period Typically, the incubation period is 7 to 21 days after exposure, with most cases appearing between 14 and 17 days.

How Long Symptoms Last Symptoms last for 7 to 10 days.

When to Call Your Child's Doctor If you are uncertain about the diagnosis or concerned about a possible complication, call your child's doctor. Call if there are signs that the skin blisters are infected (area around the blisters is swollen, red, or painful), the blisters are leaking thick pus-like fluid, or itching is so severe that it doesn't respond to treatment. Call your child's doctor immediately if your child is difficult to awaken or is confused, has trouble walking, has a headache, has a stiff neck, is vomiting repeatedly, has difficulty breathing, has a severe cough, or has eyes very sensitive to light. Also call immediately if fever rises above 103 degrees Fahrenheit.

How the Diagnosis Is Made Diagnosis is made through the appearance of the rash and other symptoms.

Treatment Because it is a viral infection, antibiotics are not useful unless there is a secondary bacterial infection. Children with a weakened immune system may be treated with the antiviral medicine acy-clovir. Because it must be started within 24 hours of the first sign of pox and it is usually only mildly beneficial, it is not generally recommended for otherwise healthy children.

Home Treatment If your child is uncomfortable because of a fever (most children with chicken pox have only mild fever—less than 102 degrees Fahrenheit—and don't need treatment), use a nonaspirin medicine such as acetaminophen (Tylenol). Do not use aspirin because it can lead to Reye syndrome in infected children, which can harm the brain and liver. It is also best to avoid giving ibuprofen, as some recent studies indicate it may put children at risk for developing bacterial infections on top of the chicken pox sores. To relieve itching, use wet compresses or bathe your child in cool or lukewarm water every three to four hours. Calamine lotion may help. Trim your child's fingernails to help prevent tissue injury and secondary bacterial infection of the skin from scratching. For blisters in the mouth, avoid acidic or salty foods. If your child has sores in the genital area, ask your child's doctor or pharmacist about anesthetic cream.

Prevention The vaccine against chicken pox is 70 to 90 percent effective. Vaccinated children who contract the virus have a milder case. A single injection of the vac cine is recommended for children 12 months to 12 years of age who have not already had the disease.

Contagious Periods People with chicken pox are contagious from two days before blisters appear until all blisters are crusted over. Children with chicken pox should be kept out of child care or school for about a week; it's not necessary to wait until the scabs fall off to let the child out of isolation. People with certain chronic diseases or weakened immune systems and pregnant women should avoid contact with chicken pox. Once a child has had chicken pox, she will never get it again.

Other Issues Questions remain about how long the vaccine's protection lasts. Studies indicate that it should last for at least 10 years. It is not yet known if a booster is needed later in life.

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