Varicella (Chicken Pox)

Chicken pox (Varicella) is a highly communicable viral disease caused by the varicella-zoster virus. Varicella is a member of the herpes family, and, like all herpes viruses, stays in the body for life once acquired. It is uncommon to get chicken pox more than once. For most people, one infection confers lifelong immunity. If you have never had the disease, you can get it at any age. Ninety percent of all cases and 40% of deaths due to varicella occur in children young than ten. Fewer than 5% of cases occur in adult ages twenty and older, but 55% of varicella-related deaths occur in this age group.

SYMPTOMS
If you have chicken pox, you may have fever, severe itching, uncomfortable rash, dehydration, or headache. You will notice a red rash on your face, trunk, scalp, or in your mouth. Later, you may find lesions on your arms and legs. Your rash will go through three stages: initially, it will be a red spot, next a blister (vesicle), and finally a scab. You may have "old" spots that are healing and "new" spots that are just beginning to blister. Your rash will probably itch. In fact, your skin may begin to itch before you notice the rash. After your lesions have healed, you may notice "red spots." These spots are not scars and will fade within a few weeks.

HOW IS CHICKEN POX SPREAD?
The infection is usually transmitted through inhalation of infectious respiratory secretions from an infected person (droplet infection), direct physical contact with vesicular lesion and by vertical (mother to baby) transmission during pregnancy. It is contagious two days before the onset of the rash and may be spread until all blisters have formed scabs. After you are exposed to the disease, it may take from ten days to three weeks before you notice a rash. Transmission via inanimate objects is unlikely.

To avoid spreading the illness, stay in your room or apartment until all your lesions have dried up (approximately five to seven days). Do not use public transportation, attend classes or social events. You may have visitors who have had chicken pox in the past. Avoid friends who have not had the disease.

Do not share eating utensils, food, smoking materials or allow others to drink after you.

HOW CAN THIS DISEASE BE PREVENTED?
For those individuals who do not have a known history of varicella, a blood titer is recommended, followed by the live varicella vaccine if the titer is negative. Research indicates the vaccine is 85% effective in preventing disease, and, if a vaccinated person gets varicella, it is usually a very mild case. The CDC recommends this vaccine for college students without a reliable history of chicken pox.

Persons in these categories who are exposed to chicken pox should contact a physician to see if they require varicella zoster immune globulin (VZIG). VZIG should be administered as soon as possible, but no later than 96 hours after exposure to chicken pox. If you have had a varicella exposure and you fit into one of these groups, contact your doctor.

• Newborns whose mothers have chicken pox five days prior to two days after delivery
• Children with leukemia or lymphoma who have not been vaccinated
• Persons with cellular immunodeficiencies or other immune problems
• Persons receiving drugs, including steroids, that suppress the immune system
• Pregnant women

WHAT ARE THE COMPLICATIONS OF CHICKEN POX?
Serious complications from chicken pox include bacterial infections which can involve many sites of the body including the skin, bone, lungs (pneumonia), points and blood. Other serious complications are due directly to the virus and include viral pneumonia, bleeding problems, and infection of the brain (encephalitis). Many of the deaths and complications occur in previously healthy children and adults.

If a fever lasts long than four days or rises above 102° F, call your health care provider. Also take note of areas of the rash or any part of your body which become very red, warm, tender, or is leaking pus (thick, discolored fluid) as this may mean there is a bacterial infection.

Call your doctor immediately if the individual with chicken pox seems extremely ill, is difficult to wake up or is confused, has difficulty walking, has a stiff neck, is vomiting repeatedly, has difficulty breathing, or has a sever cough.

WHAT SHOULD I DO IF I HAVE CHICKEN POX?
Acyclovir (a medicine that works against herpes viruses) is recommended for persons who are more likely to develop serious disease including persons with chronic skin or lung disease, otherwise healthy individuals thirteen years of age or older, and those persons receiving steroid therapy. In order for Acyclovir to be effective it must be administered within 24 hours of the onset of the chicken pox rash. Persons with weakened immune systems from disease or medication should contact their doctor immediately if they are exposed to or develop chicken pox. If you are pregnant and are either exposed to, or develop chicken pox, you should immediately discuss prevention and treatment options with your doctor.

The following measures may help you feel more comfortable

• Scratching the blisters may cause them to become infected. Therefore, keep fingernails trimmed short. Calamine lotion and Aveeno (oatmeal) baths may help relieve some of the itching. Also, scratching increases the likelihood of crater-like scars (scarring).
• Cool compresses and cool to tepid baths with baking soda and calamine lotion can help soothe itching. If these do not relieve the itching, ask about medication.
• Using a humidifier, sleeping with your head elevated, and taking decongestants can help relieve your stuffy nose.
• Acetaminophen (Tylenol, Panadol, and Datril) can help relieve body aches and fevers. AVOID ASPIRIN PRODUCTS due to the risk of Reye’s syndrome.
• Cool juice, popsicles and cool liquids can soothe your throat. Avoid spicy foods, citrus drinks, chocolate and hot sauces, sharp foods such as potato chips or crackers.
• Clean cotton sheets can increase your comfort. Wear cotton T-shirts or gowns. Polyester can be too warm and other fabrics can irritate your lesions.

IN ADDITION

• Stay confined to your room until the lesions are all scabbed over. Keep any follow-up appointment before returning to class.
• Make sure any visitor is aware you have chicken pox and allow only visitors that have had chicken pox or are know to be immune.
• Do not allow any visitor who may be pregnant or have an immunosuppressive illness or treatment, such as cancer, AIDS, Lupus, organ transplants.
• You need to make food service arrangements. Do not go to the dining area.
• When showering, use the community bathroom when there are the fewest other people present.
• Wear a mask when going to and from the bathroom – leave mask on unless you are showering or brushing your teeth. A mask is not necessary when you are confined to your room.
• Notify your instructors that you will be confined for 7-10 days. Contact the Emergency Dean at 333-0050.
• Do not leave your residence room unless there is a fire. You should not go to public places such as movie theaters, or restaurants, or use buses or other public transportation.

References
ImmunoFacts Vaccine and Immunologic Drugs, 1997.
Pediatric On Call Web site, search for varicella, chicken pox
Centers for Disease Control Web site, search for varicella, chicken pox

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