Varicella (chickenpox) (2023)

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Chickenpox, also known as varicella, is a highly infectious disease caused by the varicella-zoster virus and is most commonly seen in children.

Introduction

Very few people avoid chickenpox in countries where the disease is common. This is because more than 8 out of 10 people susceptible to chickenpox will become infected after exposure to the virus. It is very rare for a person to get chickenpox more than once.

After recovery from chickenpox, the virus stays dormant (inactive) in the nerves near the spine. Years later the virus can become active again and cause herpes zoster, commonly known as shingles. Shingles usually affects adults 50 years of age or older and people of any age with a weakened immune system (see herpes zoster).

How you get it

The virus can spread from person to person through droplets in the air from coughing, sneezing or laughing. It can also be transferred by direct contact with the fluid that is in the chickenpox or shingles rash blisters.

A person with chickenpox can pass the virus on for 1-2 days before they get the rash until after the rash blisters have dried up, which usually takes 5-7 days.

Symptoms

The early symptoms of chickenpox may include a mild fever, loss of appetite, headache and feeling tired, followed by the appearance of a red rash that becomes blistered and itchy, mostly on the trunk, head and face with some on the arms and legs. The blisters can occur in the eyes, mouth and throat, vagina and urinary tract. For up to 5-7 days, new blisters appear, filled with liquid containing the virus which then form crusts that fall off after 1-2 weeks.

Chickenpox is usually mild in children, with most healthy children recovering fully. However for some it can be more severe requiring hospitalisation, and in rare cases, death. Complications can include skin infections, inflammation of the brain, pneumonia and blood infections. Chickenpox tends to be more severe in adolescents and adults, pregnant women and their unborn babies and people of any age with poorly functioning immune systems.

Those who catch the disease from another household member often have more severe chickenpox than the person they caught it from.

Treatment

For healthy children the main treatment measures include reducing pain, discomfort and itching associated with the blisters, preventing dehydration and skin infection, and as necessary providing early antibiotics if skin infection does occur.

For healthy adolescents and adults, the use of antiviral medicine, such as acyclovir, should be considered in addition to comfort measures. Antiviral medicine started within 24 hours of the rash appearing may reduce the severity of the disease. (See ‘After exposure’ below.

(Video) Chickenpox | Varicella Zoster Virus | Pathogenesis, Signs and Symptoms, Diagnosis, and Treatment

Tips for managing chickenpox symptoms:

  • Drink plenty of fluids
  • Trim nails short and consider using mittens or clean socks, to decrease the risk of scratching, especially overnight
  • A cool or lukewarm bath every 3-4 hours. Do not use soap. Try adding oatmeal, baking soda or non-irritating moisturising bath lotion to the bath water. Pat dry, do not rub, after bathing
  • Moisturise with non-irritating skin lotion. Calamine lotion is not recommended as it can dry out the skin.
  • Dress in loose fitting clothing and change the bed linen daily
  • If blisters in the mouth and throat affect drinking and eating, take clear cool drinks and soft bland foods and avoid acidic drinks such as fruit juices
  • Use paracetamol if needed to relieve discomfort and pain
  • If itching is severe, ask your doctor about antihistamine medicine in liquid or tablet form

Aspirin or any medicine with an ingredient name including the words ‘salicylate’ or ‘salicylic acid’ MUST NOT be given to children with chickenpox because of the risk of Reye’s Syndrome.

Risks

Changes in skin colour after the blister crusts fall off may last for months. Permanent scarring may also occur.

Around one in every 20 healthy children with chickenpox will develop a bacterial skin infection, usually from scratching, that needs to be treated with antibiotics. If untreated, bacterial skin infections can lead to bacterial infection in other parts of the body, including the blood (septicaemia). This can be serious and lead to death.

Although rare, chickenpox infection can cause inflammation in other parts of the body, such as the central nervous system, joints (arthritis), bones, lungs (pneumonia), liver (hepatitis), blood vessels supplying the brain with blood and brain.

Pneumonia is more likely to occur as a complication in adults, particularly women in the last trimester of pregnancy.

Maternal chickenpox during pregnancy can infect the fetus. The highest risk period is during the first 20 weeks of pregnancy. Up to two in 100 infants exposed to chickenpox before birth will be born with congenital varicella syndrome and may have skin scarring, eye, limb and brain abnormalities, developmental delay and a poor outcome. Maternal chickenpox, within five days before and two days after delivery, can infect the newborn infant. Up to 30 in 100 newborns with chickenpox develop severe disease that can result in death.

Prevention

Prior to exposure

Chickenpox vaccine is delivered to children on the immunisation schedule at 15 months of age. Vaccination isrecommended for non-immune adolescents and adults, and non-immune woman prior to pregnancy. People with a weakened immune system are at high risk, but may not be able to have the vaccination themselves, so close contacts of these people are recommended to be vaccinated. The vaccine is funded for certain high-risk individuals and/ or their close contacts.

After exposure

  • Varicella vaccine can be given, if necessary, after exposure to the disease to people over nine months of age. Studies have shown that giving the vaccine to children 12 years or younger within 72 - 96 hours of exposure to chickenpox can prevent the disease developing or reduce the severity of the disease. In older age groups, vaccination upon exposure may be less effective. Receiving the vaccine after exposure to the disease will not make the disease more severe at any age.
  • Varicella-zoster (zoster) immunoglobulin (ZIG), a human blood product, should be given to certain high-risk people as soon as possible after, and within 96 hours of, exposure to the virus::
    • pregnant, non-immune women*
    • newborn infants whose mother had onset of chickenpox within seven days before or after delivery
    • hospitalised premature infants whose mothers have no history of chickenpox, or who were born before 28 weeks’ of pregnancy or with a birth weight less than 1000 grams, irrespective of maternal history
    • children and adults with weakened immune systems and no reliable history of chickenpox

*Pregnant women with no reliable history of chickenpox should have an urgent blood test to check for immunity after exposure to chickenpox. If the blood test suggests no immunity against chickenpox, they can receive ZIG within 96 hours of exposure, or wait for the onset of symptoms and begin antiviral medicine immediately.

Varicella-zoster

Complications of disease

  • Permanent skin scarring
  • Bacterial skin infection in around 1 child out of 20 child cases
  • Nerve inflammation (cerebral ataxia) for around 1 child out of 4000 child cases
  • Bone, joint, liver, blood vessel inflammation
  • Encephalitis (brain inflammation) for around 4 people out of 10,000
  • Pneumonia in adults, especially pregnant women
  • Hospitalisation for 2—6 people out of 100,000 cases
  • Death for 2—4 people out of 100,000 cases
  • Chickenpox during pregnancy can cause severe abnormalities in unborn babies including skin scarring, eye, limb or brain abnormalities, developmental delay, and a poor outcome
  • Maternal chickenpox close to delivery can infect the newborncausing severe disease and death
  • Shingles in later life

Responses to vaccine

Common responses

  • Headache and/or tiredness
  • Mild rash 6—43 days after immunisation

Rare responses

  • High fever
  • Transfer of vaccine virus from a vaccine rash to another person - 6 cases in more than 48 million doses.

As with any medicine, very rarely, severe allergic reactions occur following immunisation

  • Centers for Disease Control and Prevention. Prevention of varicella recommendations of the Advisory Committee on ImmunizationPractices (ACIP). MMWR Recomm Rep. 2007;56(RR-04):1-40.
  • Chaves SS, Haber P, Walton K, Wise RP, Izurieta HS, Schmid DS, et al. Safety of varicella vaccine after licensure in the United States:Experience from reports to the Vaccine Adverse Event Reporting System, 1995–2005. J Infect Dis. 2008;197(Suppl 2):S170-7.
  • Civen R, Chaves SS, Jumaan A, Wu H, Mascola L, Gargiullo P, et al. The incidence and clinical characteristics of herpes zoster amongchildren and adolescents after implementation of varicella vaccination. Pediatr Infect Dis J. 2009;28(11):954-9.
  • Gershon AA, Gershon MD. Pathogenesis and current approaches to control of varicella-zoster virus infections. Clin Microbiol Rev.2013;26(4):728-43.
  • Gershon A, Marin M, Seward J. Varicella vaccines. In: Plotkin S, Orenstein W, Offit P, Edwards K, editors. Plotkin’s Vaccines. 7th ed.Philadelphia: Elsevier; 2018. p. 1145-80.
  • Goulleret N, Mauvisseau E, Essevaz-Roulet M, Quinlivan M, Breuer J. Safety profile of live varicella virus vaccine (Oka/Merck): Five-yearresults of the European Varicella Zoster Virus Identification Program (EU VZVIP). Vaccine. 2010;28(36):5878-82.
  • Heininger U, Seward JF. Varicella. Lancet. 2006;368(9544):1365-76. Tarlow MJ, Walters S. Chickenpox in childhood: A review preparedfor the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect. 1998;36(Suppl 1):39-47.
  • Levin MJ, Murray M, Zerbe GO, White CJ, Hayward AR. Immune responses of elderly persons 4 years after receiving a live attenuatedvaricella vaccine. J Infect Dis. 1994;170(3):522-6.
  • Macartney K, Heywood A, McIntyre P. Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults.Cochrane Database Syst Rev. 2014;(6):Art. No.: CD001833.
  • Ministry of Health. Immunisation handbook [Internet]. Wellington: Ministry of Health; 2020 [updated 2020 September 25; cited 2020 September 28]. Available from: https://www.health.govt.nz/publication/immunisation-handbook-2020
  • Ozaki T, Nishimura N, Muto T, Sugata K, Kawabe S, Goto K, et al. Safety and immunogenicity of gelatin-free varicella vaccine inepidemiological and serological studies in Japan. Vaccine. 2005;23(10):1205-8.
  • Pace D. Review of varicella zoster virus: Fromepidemiology to prevention. Malta Medical Journal. 2008;20(3):7-11.
  • WHO Strategic Advisory Group of Experts on Immunisation (SAGE) Working Group on Varicella and Herpes Zoster Vaccines. Systematic review of available evidence on effectiveness and duration of protection of varicella vaccines [Internet]. Geneva: World Health Organization; 2014 [cited 2020 July 20]. Available from: http://www.who.int/immunization/sage/meetings/2014/april/presentations_background_docs/en/
(Video) Varicella zoster virus - causes, symptoms, diagnosis, treatment, pathology

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Anna had chicken pox when she was 18 weeks pregnant. Two weeks later her three year old daughter Lily also came out in spots.

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FAQs

Is one varicella vaccine enough? ›

CDC recommends 2 doses of varicella (chickenpox) vaccine for children, adolescents, and adults to protect against varicella. Children are routinely recommended to receive the first dose at age 12 through 15 months and the second dose at age 4 through 6 years old.

How do you read the results of chicken pox titers? ›

0.90 ISR or less: Negative - No significant level of detectable varicella-zoster virus IgM antibody. 0.91-1.09 ISR: Equivocal - Repeat testing in 10-14 days may be helpful. 1.10 ISR or greater: Positive - Significant level of detectable varicella-zoster virus IgM antibody. Indicative of current or recent infection.

What does it mean if you test negative for varicella? ›

The test is intended as an aid in the determination of previous infection with VZV. Performance in individuals vaccinated with VZV is not defined. Results are reported as negative, positive or equivocal. A negative result indicates no detectable VZV antibody, but does not rule out acute infection.

How many doses of varicella do I need? ›

CDC recommends two doses of chickenpox vaccine for children, adolescents, and adults. Children should receive two doses of the vaccine—the first dose at 12 through 15 months old and a second dose at 4 through 6 years old.

Do you need 2 doses of varicella? ›

Those without evidence of immunity should receive 2 doses of varicella vaccine 4 to 8 weeks apart or, if previously received 1 dose, the second dose at least 4 weeks after the first dose.

Why do you only need one chickenpox vaccine? ›

Once the virus causes chickenpox, it can then “hide” in the body. Years or even decades later, the virus can reactivate and cause shingles. There is a separate vaccine to help keep the virus from reactivating and causing shingles which is recommended for adults age 50 years or older.

What does it mean if varicella IgG is high? ›

What does it mean if your Varicella-Zoster Antibody, IgG result is too high? A positive IgG result indicates the presence of antibodies to varicella zoster virus. – The test cannot distinguish between past infection and current infection though, so a positive result could indicate active infection and not immunity.

Is a positive varicella titer good? ›

If your test result comes out negative or equivocal, you need to get vaccinated. If it's positive, it means you have had the chickenpox infection previously (or the immunization) and have developed an immunity to the disease. It's best to consult with medical experts when uncovering the results of your varicella titer.

What is positive titer? ›

A titer may be used to prove immunity to disease. A blood sample is taken and tested. If the test is positive (above a particular known value) the individual has immunity. If the test is negative (no immunity) or equivocal (not enough immunity) you need to be vaccinated.

What does it mean to be positive for varicella? ›

A positive IgG ELISA result indicates that a person has antibodies to VZV either from past varicella disease or vaccination. This test cannot distinguish whether the antibodies were from a past episode of varicella or vaccination.

Can you test for varicella immunity? ›

To check for immunity, the Varicella Zoster Virus (VZV) Antibodies Blood Test, IgG can be ordered. The Measles, Mumps, Rubella (MMR) and Varicella (VZV) Immunity Blood Test Panel can be ordered to check immunity for both MMR and Varicella.

Can adults get varicella vaccine? ›

CDC recommends two doses of chickenpox vaccine for children, adolescents, and adults who have never had chickenpox and were never vaccinated.

How long is the varicella vaccine good for? ›

But, live vaccines in general provide long-lasting immunity. Several studies have shown that people vaccinated against varicella had antibodies for at least 10 to 20 years after vaccination.

Is it better to get chicken pox or vaccine? ›

Say NO to Chicken Pox Parties

The CDC and the AAP both disagree. Allowing children to be exposed to the full strength Varicella Zoster Virus creates a much greater risk of serious side effects and complications than the mild dose received in a vaccination.

Can I get chickenpox if I'm vaccinated? ›

Some people who have been vaccinated against chickenpox can still get the disease. However, they usually have milder symptoms with fewer or no blisters (or just red spots), a mild or no fever, and are sick for a shorter period of time than people who are not vaccinated.

Who should not take varicella vaccine? ›

People who should not have the chickenpox vaccine include: anyone with a weakened immune system. anyone who has had a serious allergic reaction (anaphylactic reaction) to a previous dose of the vaccine or to any of the ingredients in the vaccine – ask your GP if you're unsure whether this applies to you.

Do you need a chickenpox booster? ›

Chickenpox Immunization Schedule

They get a booster shot for further protection at 4 to 6 years of age. Kids who are older than 6 but younger than 13 who have not had chickenpox or the vaccine should get the 2 doses given 3 months apart. Kids 13 years or older should get their 2 vaccine doses 1 to 2 months apart.

How much is varicella vaccine? ›

Pediatric/VFC Vaccine Price List
VaccineBrandname/ TradenamePrivate Sector Cost/ Dose
Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis [1]Boostrix®$44.80
Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis [1]Adacel®$50.479
$50.48
Varicella [5]Varivax®$159.991
36 more rows

When did chickenpox vaccine become mandatory? ›

A vaccine for varicella received full approval from the Food and Drug Administration in 1995, and within a decade forty states and the District of Columbia added varicella as a required immunization for enrollment in public elementary schools. Today all fifty states enforce this mandate.

What happens if you don't get chickenpox as a kid? ›

The available vaccine is over 90% effective at preventing this once-common childhood illness. If you don't get chickenpox, you won't get shingles, a painful condition that happens because the virus that causes chickenpox stays in your body long after the rash is gone.

Why did I get chickenpox after vaccination? ›

Can you get chickenpox if you've been vaccinated? Yes. About 15% – 20% of people who have received one dose of varicella (chickenpox) vaccine do still get chickenpox if they are exposed, but their disease is usually mild.

Can you get chickenpox after one vaccine? ›

Yes. About 15% – 20% of people who have received one dose of varicella (chickenpox) vaccine do still get chickenpox if they are exposed, but their disease is usually mild.

How effective is the first chickenpox vaccine? ›

Vaccine Effectiveness

1 dose of single-antigen varicella vaccine is: 82% effective at preventing any form of varicella. Almost 100% effective against severe varicella.

Does varicella vaccine need to be repeated? ›

The second dose may be administered earlier than age 4 years (eg, during a varicella outbreak). For children <13 years, the recommended minimum interval between doses is 3 months [38]. However, if the second dose is administered at least 28 days after the first, it need not be repeated [25].

Do you need a chickenpox booster? ›

Chickenpox Immunization Schedule

They get a booster shot for further protection at 4 to 6 years of age. Kids who are older than 6 but younger than 13 who have not had chickenpox or the vaccine should get the 2 doses given 3 months apart. Kids 13 years or older should get their 2 vaccine doses 1 to 2 months apart.

Is it better to get chicken pox or the vaccine? ›

No. Catching the live virus can cause serious complications, leading to hospitalization and even death. On the other hand, getting the varicella vaccine, which contains a weakened form of the virus, increases immunity to chicken pox and helps prevent serious illness.

When did chickenpox vaccine become mandatory? ›

A vaccine for varicella received full approval from the Food and Drug Administration in 1995, and within a decade forty states and the District of Columbia added varicella as a required immunization for enrollment in public elementary schools. Today all fifty states enforce this mandate.

Is chicken pox vaccine safe? ›

Chickenpox vaccine is safe and effective at preventing chickenpox. Vaccines, like any medicine, can have side effects. The most common side effects are usually mild and go away on their own. Severe allergic reactions following vaccination are rare, but can be life threatening.

How long is varicella vaccine good for? ›

It doesn't happen often, but people can die from chickenpox. Most people who are vaccinated with 2 doses of varicella vaccine will be protected for life. Children need 2 doses of varicella vaccine, usually: First dose: age 12 through 15 months.

How long does chicken pox immunity last? ›

Most people who have had chickenpox will be immune to the disease for the rest of their lives. However, the virus remains inactive in nerve tissue and may reactivate later in life causing shingles. Very rarely, a second case of chickenpox does happen.

How long are you protected after chickenpox vaccine? ›

A clinical trial showed that children with 2 doses of varicella vaccine were protected 10 years after being vaccinated. Fewer people had breakthrough varicella after 2 doses compared with 1 dose. The risk of breakthrough varicella did not increase over time.

Who should not take varicella vaccine? ›

People who should not have the chickenpox vaccine include: anyone with a weakened immune system. anyone who has had a serious allergic reaction (anaphylactic reaction) to a previous dose of the vaccine or to any of the ingredients in the vaccine – ask your GP if you're unsure whether this applies to you.

How do you prove varicella immunity? ›

Evidence of immunity includes any of the following: Documentation of two doses of varicella vaccine; Blood tests showing immunity due to a history of disease; or. Documentation of a diagnosis or verified history of varicella (chickenpox) or zoster (shingles) from a health care provider.

What are side effects of varicella vaccine? ›

The most common side effects of the chickenpox vaccine are: soreness and redness around the site of the injection – this happens in around 1 in 5 children and 1 in 4 teenagers and adults. a mild rash – this happens in 1 in 10 children and 1 in 20 adults. high temperature.

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