CHICKENPOX (CACAR AIR)
It seems that Chicken Pox (or “varicella”) is
the flavor of the month. Not a day goes by without a call
from a distressed parent who’s child has started to
get the characteristic spots that herald the onset of this
extremely uncomfortable illness.
WHAT IS CHICKENPOX?
Chickenpox is a common, very contagious viral infection that
over 90 % of people get during childhood. If you have suffered
from Chicken Pox as a child you may develop shingles later
in life.
Chickenpox and shingles are caused by a virus called “Varicella
Zoster”.
Most children who get chickenpox have a mild illness, but
some can become quite ill. Usually adults who get chickenpox
have a more severe illness.
The illness with chickenpox usually lasts about 7-10 days.
The illness may start with a fever and feeling unwell, like
having a cold. In some children the first sign of the infection
is the rash.
The rash usually starts on the chest, and most spots appear
on the chest and head (including in the hair), although some
children and adults can have spots all over the body (except
the palms of the hands and soles of the feet).
The spots start as red, itchy lumps, which then become blisters.
The top comes off of the blister and watery fluid escapes.
Then a crust forms on the spot. This crust takes about 5 days
to fall off.
The spots often come in waves for several days so that there
will be new lumps, blisters and crusting sores on the skin
at the same time.
HOW IS CHICKENPOX SPREAD?
The infection is spread when the person sneezes or coughs,
or when someone touches the fluid in the blisters. It can
also be spread by touching something that has touched the
fluid from the blisters (eg a dressing which covered the sore).
Chickenpox can be caught from the fluid in the blisters of
someone with shingles, though this is rare.
The person with chickenpox is contagious from the beginning
of the illness (up to 2 days before the spots appear) until
about 5 days after the first spots appear. So long as there
are no new blisters or moist crusts on spots, the person will
not be contagious even if there are still crusts on the skin.
Chickenpox is very contagious (easy to catch). Over 90% of
close contacts (such as other family members) will get chickenpox
if they have not already had it.
HOW LONG DOES IT TAKE TO DEVELOP (Incubation period).
Chickenpox usually takes from 13-17 days to develop after
contact with someone who has it.
KEEPING CHILDREN AWAY FROM SCHOOL/CHILD CARE
A child should be kept at home for 5 days after the first
spots appear, or until all blisters are dry if this takes
longer. Some scabs will still be there but as long as they
are dry this does not mean the child needs to be kept out
of school, or away from others.
HEALTH PROBLEMS FROM CHICKENPOX
For most children chickenpox is a mild illness, however some
can have spots over the whole body, including in the mouth
and in the genital area. They may have encephalitis (infection
of the brain). They may be quite unwell from this, but will
usually recover fully.
The spots are very itchy, and scratching can cause a bacterial
infection (the same as impetigo, or school sores). An infected
spot is more likely to leave a scar. (Note: the spots are
very itchy. Expecting children not to scratch is usually too
much to ask of them).
Adults usually have a more severe illness, and a few get pneumonia,
some will die from the infection (this is rare).
Chickenpox can be a fatal illness for people who have immune
problems (eg with HIV/AIDS, treatment for severe asthma or
cancer.) All these people need to be seen by a doctor urgently
if they are in contact with chickenpox. There is a treatment
which will protect them from the severe effects of the infection
if they get the treatment soon after coming in contact with
it.
CHICKENPOX IN PREGNANCY & NEWBORN BABIES
If a pregnant woman gets chickenpox during the first half
of a pregnancy, there is a small risk that the unborn baby
may be affected (less than 2%). Some of the effects include
scarring, and birth defects.
If a woman gets chickenpox from 5 days before delivery to
2 days after delivery, it is estimated that there is up to
30% risk that the baby will develop a severe infection. Many
of these babies will die from the infection.
Pregnant women should see their doctor if they have been in
contact with chickenpox and are not certain that they have
had chickenpox.
WHAT PARENTS CAN DO
There is no specific treatment which affects how bad the chickenpox
is or how long it lasts (unless the person has another severe
health problem).
Give the child plenty of drinks and give paracetamol if needed
for fever and pain. Aspirin should not be used because it
has been linked to a very serious illness (Reyes Syndrome)
when given during a chickenpox illness.
If blisters are in the mouth don’t give food or drinks
that have a lot of acid or salt. (Orange juice, salty or spicy
foods.)
Try a soothing mouth washes (if mouth sores are as problem.
Soothing lotions, such as calamine lotion, or special oils
(lavender or tea tree oil) that reduce itch can be used. These
oils can be added to cool baths. Sodium bicarbonate (baking
soda) in the bath can also help soothe the itching.
Anti-histamine medicines (diphenhydramine i.e. Benadryl cough
syrup) can help with the itch, and have the added benefit
of sedation for any distressed child.
IMMUNISATION
Although the varicella vaccine is recommended for all children
and adolescents who have not yet had the disease, it is not
part of the standard vaccination schedule in Australia. Basically
what this means is that if you want the vaccine, you have
to pay for it (at least in Australia any way), and unfortunately
this particular vaccine is quite expensive.
This immunisation can be given after 12 months.
Children under the age of 12 years need one injection of the
varicella vaccine. Adolescents and adults need two injections
1 to 2 months apart.
Immunisation is recommended for adolescents (12 years and
older) and adults who have not had chickenpox, especially
those who work in high risk situations (such as child care,
teaching and health care), non-immune women before pregnancy
and non-immune family members of people with immune system
disorders.
The vaccine should not be given during pregnancy, however
no problems have occurred yet when women have been given the
vaccine accidentally while pregnant.
EFFECTS FROM IMMUNISATION
Side effects are uncommon in healthy people.
About 20% of children and adults will get some soreness at
the site of the injection, 5% or less will get some fever
and less than 5% will get a rash.
Some people may still catch chickenpox from an infected person
after immunisation (not all people get fully protected), but
the illness will be milder than if no immunisation had been
given.
Until next edition, stay healthy, stay happy and stay young!
Kim Patra is a qualified Registered Nurse / Midwife, and
mother of three, who has been living and working in Bali for
past 15 years. She has assisted many traveller (... and others)
either as a flying medical escort or just a voice on the end
of the phone! Kim is happy to discuss any health concerns
that your may have. Her e-mail contact is info@chcbali.com
