Chicken Pox

Chicken pox can be acquired any time during the year but is most prevalent in winter and spring. 90-95% of Americans get chicken pox in childhood and often from their own siblings. For unclear reasons, chicken pox is less common in tropical climates and many adult immigrants are not protected from this infection. Infection in adults is typically more severe and can be life threatening.

Almost all exposed children will develop a rash, described as "dewdrops on rosebuds", although some children have so few lesions that they may go unnoticed. Many children have a prodrome (sick period before the actual obvious illness appears) that included fever, malaise, headache, poor appetite, and mild abdominal pain. These symptoms may continue for 2-4 days after the rash first appears. Usually the vesicles start on the face and scalp, moving next to the trunk and then on to the extremities. They arrive in clumps so that there are clusters of lesions in various stages around the body. The average number of lesions is about 300 but as few as 10 and as many as 1500 lesions have been counted on one child! They begin as itchy raised red bumps that soon become blister like with fluid inside and then "pop" or ooze and then crust over. Second cases in the home are usually worse than the original case and children with skin conditions such as excema are also prone to worse outbreaks. The lesions can appear anywhere including the mouth, the vagina , the anus, the eyes, and although painful, it rarely has serious outcome. The healing lesions are hypopigmented for many weeks but pox rarely scar except when badly gouged and infected secondarily with bacteria in the fingernails of the "scratcher".

Staphylococcus and streptococcus infections can cause serious secondary complications in childhood chicken pox cases. Cellulitis (infected skin deep in the layers), abscesses and even gangrene can occur and be life threatening. These and other organisms can even cause pneumonia, arthritis, osteomyelitis (bone invasion), and encephalitis (infection of the brain). Nervous system involvement is highest in adults and very young infants and can occur both before , during or after the appearance and resolution of the rash so it is often misdiagnosed and therefore quite dangerous although very uncommon. A very serious complication called Reye's Syndrome was found to be linked to the simultaneous use of aspirin and chicken pox and is mostly unheard of today since aspirin has been removed form most parents lists of "must have in the medicine cabinet". It was characterized by sudden severe vomiting and change in consciousness in a child with chicken pox. Hepatitis, nephritis (kidney inflammation), blood disorders, pancreatitis and heart disease can also occur as a complication of chicken pox. These complications are thankfully rare except in children who are immune suppressed or compromised. Children on chemotherapy are especially susceptible and should be vigorously protected from contact with infected children. Antiviral drugs are available and used for these children if it is suspected that they may have been exposed. Recently doctors have begun to offer these medications to ordinary household contacts of children with chicken pox or even to the first case in a home when parents are worried about managing a potentially severely ill child. There is evidence that the infections that are treated early with antiviral medicines will be milder and of shorter duration but that the child will not be compromised in terms of lifelong immunity from this treatment and will be as protected as any other child who has had chicken pox. This is very important since chicken pox is more dangerous with age and preferably children will acquire immunity that will last a lifetime.

An immune globulin called VZIG (varicella-zoster immune globulin) is available for protection of immune compromised children pregnant women, and newborn infants exposed to maternal varicella right before or after birth. Anti-viral medicine such as Acyclovir and Fansidar may still be needed if infection occurs anyway. A live-attenuated virus has also recently been released and is available for all children above the age of one year giving temporary complete protection to the child, a booster dose being needed some time in the future. It is not now certain how long this vaccine will "last" so keep alert for information on when to get your child "boosted".

Most children with chicken pox are at least mildly uncomfortable from the itchy nature of the pox. Using soothing lotions and cool baths is helpful as is keeping the fingernails short and antihistamines available for the worst nights. Many over the counter bath solutions claim to help dry the pox and certainly make the itching milder but be careful to only gently pat dry the rash so as not to irritate the skin or spread virus particles to others. Keeping cool and clean is very helpful for the comfort and safety of the child with pox. Keeping entertained is another matter and some families have combined their sick children to keep each other company. The risk of increasing the exposure for other siblings and for spreading secondary bacterial infection between the children make this a poor idea in general. Besides, sick children need to rest and be encouraged to drink more fluids instead of becoming more active during the illness. Staying out of doors and away form sun exposure also decreases the chance of severe itching and scarring. Most children are back in school in a week or so and have many fellow students to compare notes with. This is a very common and usually manageable childhood illness.