Chickenpox (varicella) is a common, childhood infection caused by the varicella-zoster virus. It’s most common in children and is usually mild, but can be very uncomfortable for your child. When adults get it they can be very unwell.
Chickenpox can be severe and even life threatening in children and adults with immune system problems such as leukaemia, and HIV or for people who are taking drugs that weaken the immune system such as steroids.
What are the symptoms?
Chickenpox usually begins with a temperature and symptoms of a cold with a runny nose.
Within 1 to 2 days your child will get a rash that can be very itchy. It starts with flat red spots that change into fluid-filled blisters. Some children have only a few blisters. Others can have many. These blisters dry and form scabs in 4 or 5 days, but can persist for up to 10 days.
How is it spread?
Chickenpox is very easily spread. It is infectious from 2 days before the rash appears but is most catching 12 to 24 hours before the rash appears, so it’s easy to spread it without knowing. It usually develops 2 to 3 weeks after contact with an infected person. It spreads from child to child through direct contact with the virus. You can get chickenpox if you touch a blister, or the liquid from a blister. You can also get chickenpox if someone with the virus coughs over you. The virus enters the body by the nose or mouth. It can also spread through the air.
A pregnant woman with chickenpox can pass it on to her baby before birth. Mothers with chickenpox can also give it to their newborn babies after birth.
Chickenpox doesn’t spread through indirect contact. That means it doesn’t live on objects like sheets, counters or toys.
Is there a vaccine against chickenpox?
Yes. There is a vaccine available, but it is not part of the UK schedule although it can be obtained privately. In the US, Canada and parts of Europe, it is recommend that all healthy 12-month-old children get it.
What is shingles?
The reason why shingles may occur is because the virus does not completely go after you have chickenpox. Some virus particles remain inactive in the nerve roots next to your spinal cord. They do no harm there, and cause no symptoms. For reasons that are not clear, the virus may begin to multiply again (reactivate). This is often years later. The 're-activated' virus travels along the nerve to the skin to cause shingles. Shingles occurs in people who have already had chickenpox, usually many years after the original chickenpox infection. It looks like chickenpox and is caused by the same virus. But it usually appears on only one part of the body. Shingles is contagious, and can cause chickenpox in a child, but is less contagious than chickenpox because it doesn’t spread through the air.
You can catch chickenpox from someone with shingles through contact with their saliva or their skin rash. You cannot get shingles from someone with chickenpox.
Can you have chickenpox twice?
In most cases, you can only get chickenpox once. This is called life-long immunity. But in rare cases, a person might get it again, especially if you were very young when you had it the first time.
What can I do to protect my child?
The best way to protect your child from chickenpox would generally be by vaccination, but this is not routinely available in the UK.
If one of your children has chickenpox, it will probably spread to other members of the household who have not already had chickenpox or the vaccine.
How can I treat chickenpox?
If you want to control your child’s fever, use a paracetamol or ibuprofen containing medicine. If your child gets chickenpox, do not give aspirin or any products that contain aspirin. Taking aspirin increases the risk of getting Reye’s syndrome. This severe illness can damage the liver and brain.
Encourage your child not to scratch. Scratching can cause infection from bacteria that get into the skin. Calomine lotion applied to the spots and cool bathing under close supervision can reduce discomfort . Your doctor may recommend an antihistamine to help reduce the itch.
When should I call the doctor?
If your child’s fever lasts more than 2 days and is over 38.5°C.
A new fever develops after the first couple of days. That is, the fever goes away for a day or so and returns.
Your child develops a skin infection and looks ill, especially if combined with a high fever. Your doctor will decide if your child has developed a bacterial infection that needs antibiotics.
A chickenpox spot becomes enlarged, red or very sore.
Your child seems very ill.
Your child has an immune system disorder or is on steroids, or has been or is receiving a cancer treatment. The doctor can give a special type of immune globulin (VZIG) with a large number of antibodies to help prevent infection, or early treatment with an antiviral drug.
Can my child with chickenpox go to child care, nursery or school?
Many schools and daycare centres have policies that require children with chickenpox to stay home for five days after their rash appears. The goal is to protect other children from the disease. Unfortunately, this does not stop chickenpox from spreading.
Chickenpox is contagious from 2 days before the rash appears, and most infectious from 12 to 24 hours before the rash appears. It spreads through the air, not just by direct contact with the rash. Exclusion policies (policies that require that your child stay home for a period of time) don’t work because by the time it’s known that a child has chickenpox, it has already been passed on to other children.
If your child is too sick to take part in regular activities, or has a fever, he/she should stay home. Many children with mild chickenpox are otherwise well. For mild cases (low fever for a short period of time and only a little rash, less than 30 spots) children can go to child care or school as long as they feel well enough to take part in regular activities, even if they still have the rash. This of course will also be influenced by the day-care provider's rulings.
Should I let my child catch chickenpox?
Some parents encourage their children to mix with others who have chickenpox in order to catch it. Some arguments for this:
Chickenpox is usually a milder illness in a child than in an adult.
The risk of serious complications is higher in adults. In particular, chickenpox during pregnancy can cause serious complications to both mother and baby.
Most people get chickenpox at some stage. As the risks are less if you have it as a child, it may be better to get it over with.
Some arguments against this:
"I could not willingly let my child develop an illness."
Although rare, some children do have serious complications.
Different parents have different views on this issue. Remember, children who develop a chickenpox rash today will have been just as infectious over the previous two days when they were well, but were incubating the virus.
Also note: if someone in the family or home is temporarily at high risk of complications, then it is best to put off deliberately catching it.
What if I’m pregnant?
Pregnant women can develop severe chickenpox. Most adult women are already protected against chickenpox by antibodies in their blood. If you are thinking of getting pregnant and have not had chickenpox, ask your doctor about whether you can be vaccinated.
If you are pregnant and have not had chickenpox, or if you have not lived in the same house with someone who has had chickenpox or shingles, call your doctor right away if you are exposed to chickenpox. Your doctor may want to give you a special type of immune globulin (VZIG) injection to help prevent you from getting a severe infection.
If you catch chickenpox early in your pregnancy, there is a very small chance of it harming your unborn baby.
It is safe to vaccinate your child against chickenpox, if you are pregnant again and even if you haven't had natural chickenpox or the vaccine previously.
Dr Raffles has recently been asked for his expert opinion in the following Mail Online articles regarding chickenpox and the value of vaccinating against:
If you would like your child to receive the chickenpox vaccination, our Practice would be happy to provide. This can be given to those over 12 months of age and is given as two separate injections, a minimum of 8 weeks apart and should be either simultaneously with MMR, or at least 31 days between MMR & VZV, as they are both live virus vaccines. Click Here to Book