Chickenpox

By: Maress Mahinay

TABLE OF CONTENTS
What is checkinpox? How checkinpox spread? What are the symtoms of checkinpox? Is checkinpox iis contagious? How is Chickenpox Transmitted? What is shingles? What is the link between chickenpox and shingles? Prognosis of Chicken Pox Children checkinpox Adults chekinpox Pregnant Women Exposed to Chicken Pox Testing for Immunity in Pregnancy Maternal Complications of Chicken Pox in Pregnancy Infant Complications of Chicken Pox in Early Pregnancy Infant Complications of Chicken Pox in Late Pregnancy Medical exams Immunofluorescence assay Polymerase chain reaction (PCR) Virus culture Can Chickenpox be prevented? How is chickenpox treated? Treatment Chicken Pox Treatment - Acetaminophen Chicken Pox Treatment - Lotions Chicken Pox Treatment Antihistamines Chicken Pox Treatment - Preventing Scratching Chicken Pox Treatment - Acyclovir Chicken Pox Treatment - Other Anti-Virals Treatment of Pregnant Women with Chicken Pox

CHICKENPOX

Child with varicella disease

What is chickenpox?

Chickenpox is a highly infectious disease, which causes a blistering rash. Chickenpox is caused by the varicella zoster virus, which is a member of the herpes family.
Description: Chickenpox is a common, very contagious viral infection that over 90% of people get during childhood. Immunisation against chicken pox is now recommended.

STATISTICS:

Prevention statistics: 81% of children aged 19-35 months were vaccinated for chickenpox annually inthe US 2002 (National, State, and Urban Area Vaccination Levels Among Children- US, 2002, NCHS, CDC) Prevalence and incidence statistics for Chickenpox:

Inc ence (annual) of Chic enpox: 120 624 annually (1995); 46 016 annual cases notifie in US 1999 (MMWR 1999); 199 14 pe 100 000 in Canada 20001 Incidence Rate: approx 1 in 2 254 or 0 04 or 120 624 people in US [about data] Incidence extrapolations for US for Chic enpox: 120 624 per year, 10,052 per month, 2,319 per wee , 330 per day, 13 per hour, 0 per minute, 0 per second. Note: this extrapolation calculation uses the incidence statistic: 120,624 annually (1995); 46,016 annual cases notified in US 1999 (MMWR 1999); 199.14 per 100,000 in Canada 20001 Prevalance of Chic enpox: Almost everyone gets chic enpox by adulthood (more than 95 of Americans). Chic enpox is highly contagious. CDC estimates that 4 million cases occur each year. (Source: excerpt from Facts About Chic enpox (Varicella): CDC -OC) Death and mortality statistics for Chic enpox: Deaths from Chic enpox: approximately 100 deaths (CDC -OC) Death rate extrapolations for USA for Chic enpox: 99 per year, 8 per month, 1 per wee , 0 per day, 0 per hour, 0 per minute, 0 per second. Note: this extrapolation calculation uses the deaths statistic: approximately 100 deaths (CDC-OC) Deaths from Chic enpox: Every year there are approximately 5,000 -9,000 hospitalizations and 100 deaths from chic enpox in the United States. (Source: excerpt from Society statistics for Chic enpox:: Costs for Chic enpox: estimated $918 million in 1993 Costs for Chic enpox: In the United States, the annual cost of caring for children of normal health who contract chic enpox was estimated as $918 million in 1993. (Source: excerpt from Facts About Chic enpox (Varicella): CDC-OC) Hospitalizations for Chic enpox: approximately 5,000 -9,000 hospitalizations After routine vaccinations in the U.S.: Nine out of 10 are immune if vaccinated with the recommended two doses 90 percent decline in number of reported cases some ar eas 66 percent drop in annual death rate

Chic enpox is spread in fine droplets of moisture, which contain the virus. The droplets are produced when the infected person coughs or sneezes, another person then inhales these droplets and may become infected. It can also be spread by direct contact with an infected person.


Wha are he symptoms of chickenpox? The symptoms of chic enpox vary from individual to individual. Some people may experience all of these symptoms while others experience one or two. The most common symptoms of chic enpox are: Mild fever. The fever varies between 101 F to 105 F and returns to normal when the blisters have disappeared. bac ache headache sore throat a rash (red spots) blisters filled with fluid
    

Is chickenpox contagious?
Chic enpox is contagious from about 2 days before the rash appears until all the blisters are crusted over. A child with chic enpox should be kept out of school until all blisters have dried, usually about 1 week. If you're unsure about whether your child is ready to return to school, ask your doctor. Chickenpox is very contagious most kids with a sibling who's been infe cted will get it as well (if they haven't already had the disease or the vaccine), showing symptoms about 2 weeks after the first child does. To help keep the virus from spreading, make sure your kids wash their hands frequently, particularly before eating and after using the bathroom. And keep a child with chickenpox away from unvaccinated siblings as much as possible.
 

How

chickenpox p ead?

People who haven't had chickenpox or the vaccine also can catch it from someone with shingles, but they cannot catch shingles itself. That's because shingles can only develop from a reactivation of VZV in someone who has previously had chickenpox.

Ho

is Chickenpox Transmitted?

Children usually recover from chickenpox without any problems. However in adults the infection may be severe or even fatal, especially in those people with an impaired immune system as they may go on to develop pneumonia. If you develop chickenpox as an adult you should always consult your doctor. Try not to scratch the spots as this can lead to infection and scarring. Infected blisters look very red and painful and they may ooze a yellow or g reen fluid. To prevent a child from scratching and causing infection, cut their fingernails and cover their hands with socks or gloves, especially at night.

What is the link between chickenpox and shingles?

nce a person has had chickenpox they will develo an immunity to it and will not contract p it again. However, the virus lays dormant in your nervous system and if you had chickenpox as a child it may cause you to develop shingles later in life. You can only get shingles if you have previously had chickenpox.


What is shingles?
Shingles is a painful rash, caused by an inflamed nerve. The actual rash is similar to that of chickenpox though it only affects one side of the body. Youmay also have headaches and feel very tired and run down. Unlikle chickenpox, shingles is not very contagious, though you should stay away from those who have not had chickenpox.

Prognosis o Chicken Pox

The prognosis for adults and children who have contracted chicken pox is different now compared to what it was in the pre-vaccine era. The vaccine has reduced the incidence of the virus and the complications associated. Studies are currently assessing whether the risk of shingles (the nasty successor o f chickenpox,), will also decrease however results so far have been inconclusive. The most common complication for a vaccinated person is breakthrough disease. Breakthrough varicella occurred more commonly before the introduction of the second vaccine dose

in 1995. However, it is still reported even in immunocompetent and highly vaccinated individuals. Breakthrough varicella is defined as onset of chick en pox between 42 days to 5 years after vaccination to the disease. The symptoms associated with breakthrough varicella are less severe; with little or no fever and only around 50 skin lesions. The lesions that are present are usually maculopapular in nature, that is, a rash comprised of small red bumps instead of pustules and lesions. That said, 25 of individuals will experience breakthrough varicella symptoms that are similar to chicken pox. Breakthrough varicella is around 50 less contagious than chicken pox. Before the chicken pox vaccine became available, the complications associated with chicken pox had greater prevalence, especially for immunocomp romised individuals. This is not to say that immunocompetent individuals did not also carry the risk for the following: Otitis media; Subclinical hepatitis; Cerebellar ataxia; (inability to coordinate voluntary movements) and Bacterial superinfection of the rash.
 

Rare complications of varicella include: Encephalitis; Pancreatitis; Orchitis; Bleeding diathesis; Nephritis; Myocarditis; Pericarditis; and Cranial nerve palsies.

The risk of complications associated with chicken pox increases with increasing age of contracting the disease. If a woman contracts the disease when pregnant her child will have a2


Children chickenpox

If oral acyclovir is started within 24 hours of rash onset it decreases symptoms by one day but has no effect on complication rates. Use of acyclovir therefore is not currently recommended for immunocompetent individuals (i.e., otherwise healthy persons without known immunodeficiency or on immunosuppressivemedication). Children younger than 12 years old and older than one month are not meant to receiveantiviral medication if they are not suffering from another medical condition which would put them at risk of developing complications.[29] Treatment of chicken pox in children is aimed at symptoms whilst the im mune system deals with the virus. With children younger than 12 years cuttingnails and keeping them clean is an important part of treatment as they are more likely to deep s cratch their blisters. [30] Aspirin is highly contraindicated in children younger than 16 years as it has been related with a potentially fatal condition known as Reye's syndrome.[31]

Adults chickenpox
Infection in otherwise healthy adults tends to be more severe and and may be fatal. Treatment with antiviral drugs (e.g. acyclovir or valacyclovir) is generally advised, as long as it is started within 24 48 hours from rash onset.[29] Remedies to ease the symptoms of chicken pox in adults are basically the same as those used on children. Adults are more often prescribed antiviral medication as it is effective in reducing the severity of the condition and the likelihood of developing complications. Antiviral medicines do not kill the

virus, but stop it from multiplying. Adults are also advised to increase water intake to reduce dehydration and to relieve headaches. Painkillers such as paracetamol and ibuprofen are also recommended as they are effective in relieving itching and other symptoms such as fever or pains. Antihistamines relieve itch and may be used in cases where the itch prevents sleep, because they are also sedative. As with children, antiviral medication is considered more useful for those adults who are more prone to develop complications. These include pregnant women or people who have a weakened immune system. [32] Sorivudine, a nucleoside analogue has been reported to be effective in the treatment of primary varicella in healthy adults (case reports only), but large scale clinical trials are still needed to demonstrate its efficacy. [ Pregnant Women Exposed to Chicken Pox Pregnant women who have a history of a previous chicken pox infection or who have been immunized have antibodies to the virus. These antibodies are transferred to the infant through the placenta throughout the pregnancy. Therefore, pregnant women who are immune and are exposed to someone with chicken pox do not need to worry about complications for themselves or their infant. Testing for Immunity in Pregnancy All women should be questioned about previous chicken pox infection or immunization at their first prenatal visit. Of those women who do not remember a past infection or immunization, 80 to 90 have antibodies and are considered immune. For this reason, testing for antibodies is controversial, but many practitioners obtain this test at the first prenatal visit. Maternal Complications of Chicken Pox in Pregnancy A primary chicken pox infection occurs in only 0.05 to 0.07 of pregnancies because most women of childbearing age have immun ity to the varicella virus because of a previous infection or immunization. Women who do acquire chicken pox while pregnant, especially in the third trimester, are at a greater risk of developing varicella pneumonia. Varicella pneumonia is a potentially life -threatening infection of the lungs by the varicella virus. Infant Complications of Chicken Pox in Early Pregnancy Primary chicken pox infection in the first trimester of pregnancy, esp ecially weeks 8 to 12, carries a 2.2 risk of congenital varicella syndrome, a syndrome of birth defects in the infant. The most common manifestation of congenital varicella syndrome is scarring of the skin. Other abnormalities that can occur include a smaller than normal head, eye problems, low birth weight, small limbs, and mental retardation. Infant Complications of Chicken Pox in Late Pregnancy If a woman acquires a primary chicken pox infection within 5 days before and 2 days after delivery, her newborn is at risk for disseminated varicella infection. Disseminated varicella
    

infection occurs when the virus infects a newborn before the transfer of protective maternal antibodies. This overwhelming viral infection leads to death in 25% of cases.
Medical exams

Medical tests usually aim to distinguish between varicella -zoster and herpes simplex viruses. The doctor may take a sample scraping from a lesion or blister to send to a pathologist for microscopic analysis. Most dermatologists can make this diagnosis without any special tests, but blood tests can be re uested in those uestionable cases. Furthermore, if symptoms are not straightforward (ex. immunosuppressed people), the doctor performs one or more additional tests to detect the virus itself.
Immuno luorescence assa - this diagnostic techni ue aims to identify antibodies
   

to a specific virus. Specific characteristics of how light behaves as seen through a microscope helps identify antibodies. This test is less expensive than a culture, more accurate, and results are faster.
Polymerase chain reaction (PCR) - this techni ue replicates the DNA of a sample
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virus millions of times until the virus is detectable. PCR is expensive but is useful for unusual cases, such as identifying possible infection of the cent nervous system. ral
Virus culture - A viral culture uses blister, fluid or sometimes spinal fluid samples to

detect possible viruses. Cultures are also used to determine if a varicella -like infection is caused by a natural virus or by the vaccine in vaccin ated people. This test is useful, but it is sometimes difficult to recover the virus from the samples. Most doctors recommend the all children who haven't had chickenpox be vaccinated against the virus. Plus, early treatment of chicken pox (during the first day of the rash) can help prevent scarring that results after itching. your doctor can also prescribe medications to lessen the severity of disease and treat complications, ifnecessary. But which treatments are now available Continue reading the Chicken Pox Treatment section that follows too learn more about treatment options including thechicken pox vaccine.
Can Chickenpox be prevented?
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Chickenpox can be prevented . The easiest way to prevent catching chicken pox is to get vaccinated. However, vaccination is only successful in 70% to 90% of all vaccinations. Individuals who have been vaccinated butstill ac uire chickenpox, usually have a milder disease that heals more uickly than non vaccinated individuals.
How is chickenpox treated?
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Chickenpox is a virus and therefore will not be helped by antibiotics. Adults with chickenpox should always consult their doctor. If your child has chickenpox and is not ill, you should ask

your pharmacist for advice. Do however phone and tell your doctor that your child has chickenpox, he/she will then decide if they need to see the child. If you have chickenpox you sh ould try and rest and apply a soothing lotion like calamine to ease the itchiness of the rash. If you or your child has a temperature take paracetamol liquid to bring the temperature down and to relieve any aches and pains. Treatment A virus causes chickenpox, so the doctor won't prescribe antibiotics. However, antibiotics may be required if the sores become infected by bacteria. This is pretty common among kids because they often scratch and pick at the blisters. The antiviral medicine acyclovir may be prescribed for people with chickenpox who are at risk for complications. The drug, which can make the infection less severe, must be given within the first 24 hours after the rash appears. Acyclovir can have significant side effects, so it is only given wh en necessary. Your doctor can tell you if the medication is right for your child.

Chicken Pox Treatment - Acetaminophen Patients with chicken pox typically have viral-type, prodromal symptoms such as headache, fever, fatigue, and muscle aches. These symptoms can be treated with acetaminophen (Tylenol) with doses determined by the weight of the patient. Children should never be given aspirin or medications containing aspirin for chicken pox or any other viral illness because of the risk of Reye's syndrome. Chicken Pox Treatment - Soothing Baths Frequent baths are sometimes helpful to relieve itching. Adding finely -ground (colloidal) oatmeal such as Aveeno can help improve itching. Oatmeal baths can be prepared at home also by grinding or blending dry oatmeal into a fine powder and adding about 2 cups to the bath water.One-half to one cup of baking soda may also be added to bath water to reduce itching. Chicken Pox Treatment - Lotions The most common lotion used for chicken pox is Calamine lotion. This or any similar over the-counter preparation can be applied to the blisters to help dry them out and soothe the skin. Chicken Pox Treatment - Antihistamines Over-the-counter and prescription antihistamines may be used to control severe

itching.Diphenhydramine (Benadryl) is available over-the-counter and hydroxyzine (Atarax) is available by prescription. Both of these antihistamines cause drowsiness and may be helpful at night to help the patient sle ep. The newer antihistamines such as loratadine (Claritin), certrizine (Zyrtec), and fexofenadine (Allegra) can be used to control itching but do not cause drowsiness. Chicken Pox Treatment - Pre enting Scratching Scratching increases the risk of secondary bacterial infections. All patients with chicken pox should have their nails trimmed short. In addition, small children may have to wear mittens to reduce scratching. Chicken Pox Treatment - Acyclo ir Acyclovir (Zovirax) is an anti-viral drug that may be used to treat chicken pox. In uncomplicated cases acyclovir taken 5 times a day has been shown to cause shorter periods of new lesion formation, fewer lesions, and more rapid healing but only if s tarted within 24 to 48 hours of the onset of the rash. Acyclovir has not been shown to decrease the rate of complications in otherwise healthy children who get chicken pox. Oral acyclovir is more strongly recommended for children with underlying skin disea se such as eczema, newborns, adults, and smokers since this group is at greater risk for complications. IV acyclovir is used for people with compromised immune systems. Chicken Pox Treatment - Other Anti-Virals Currently acyclovir (Zovirax) is the only FDA -approved treatment for chicken pox. However, the antiviral medications valacyclovir (Valtrex) and , used to treat herpes simplex virusinfections, have been shown to be effective for chicken pox and are often prescribed.
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Infant Complications of Chicken Pox in Early Pregnancy Primary chicken pox infection in the first trimester of pregnancy, especially weeks 8 to 12, carries a 2.2 risk of congenital varicella syndrome, a syndrome of birth defects in the infant. The most common manifestation of congenital varicella syndrome is scarring of the skin. Other abnormalities that can occur include a smaller than normal head, eye problems, low birth weight, small limbs, and mental retardation. Infant Complications of Chicken Pox in Late Pregnancy If a woman acquires a primary chicken pox infection within 5 days before and 2 days after delivery, her newborn is at risk for disseminated varicella infection. Disseminated varicella infection occurs when the virus infects a newborn before the transfer of protective maternal antibodies. This overwhelming viral infection leads to death in 25 of cases.
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Treatment of Pregnant Women with Chicken Pox Women who acquire primary chicken pox during pregnancy should be treated with the antiviral drug acyclovir (Zovirax) which seems to be safe in pregnancy. Pregnant women with varicella pneumonia should be treated with IV acyclovir and be observed in the hospital. In addition women who are not immune to varicella, but are exposed may be treated with varicella-zoster immunoglobulin (VZIG), a substance that triggers an immune response against the varicella virus. Both chickenpox (varicella) and shingles (zoster) can usually be diagnosed by a family doctor on the basis of symptoms alone. In fact, your doctor c an easily diagnose chickenpox by examining the characteristic rash and by noting the presence of accompanying symptoms. Be sure to call ahead for an appointment, to avoid waiting and possibly infecting others in a crowded waiting room. If a diagnosis is still unclear after a physical examination, you may be recommended to see a dermatologist or diagnostic tests may be required.

REFERENCES:
http://www.google.com/search?aq=0&oq=chickenpox+description&sourceid=chrome&ie=U TF-8&q=chicken+pox+description http://www.healthinsite.gov.au/topics/Chickenpox http://www.healthinsite.gov.au/idol_templates/idol_search_results_cover_page.cfm http://news.search.yahoo.com/search;_ylt=A2KJjb1vex5OXFsAJH_QtDMD?p=chicken+pox+s tatistics&fr2=sb-bot&fr=ush-newsblended