Overview
Chickenpox is a highly contagious childhood disease caused by the varicella zoster virus (VZV). It progresses with itchy blisters and rashes throughout the body. Since its addition to the vaccination program in our country, cases have significantly decreased.
It is most common in children under age 10 and usually progresses mildly. It can be more severe in adults, pregnant women, and immunocompromised individuals.
Symptoms
Symptoms begin 10-21 days after exposure to the virus:
Early symptoms (1-2 days, before the rash):
- Fever (38-39 °C)
- Weakness, fatigue
- Loss of appetite
- Headache
- Sore throat
Rash phase:
- Red bumps starting on the face, body, spreading throughout the body
- Bumps quickly turn into fluid-filled blisters (vesicles)
- Number of vesicles can reach 250-500
- Blisters crust over
- Severe itching
- Rash everywhere including scalp, mouth, genital area
- Lesions at different stages (red spots, blisters, crusts all together)
- New rashes continue to appear for 5-10 days
- Crusts fall off within 1-2 weeks
Causes
The varicella zoster virus spreads through coughing, sneezing, direct contact, or blister fluid. Contagious period:
- Begins 1-2 days before the rash
- Continues until all blisters have crusted (5-7 days)
Risk Factors
- Being unvaccinated
- Not having had the disease
- Being an adult (severe course)
- Pregnancy
- Weakened immunity (HIV, chemotherapy, cortisone)
- Newborns (those born to mothers with active disease)
Complications
It usually resolves without complications in most children, but complications can occur:
Common complications:
- Bacterial skin infections (from scratching)
- Permanent scars
Serious complications:
- Pneumonia (especially in adults)
- Brain inflammation (encephalitis)
- Reye syndrome (if aspirin is given)
- Bacterial bloodstream infection (sepsis)
- Thrombocytopenia
- Congenital varicella syndrome (in the baby if infected during pregnancy)
- Shingles (may appear years later)
When to See a Doctor
- In case of an uncertain diagnosis
- Fever above 38.5 °C lasting more than 4 days
- Severe headache
- Confusion, change in consciousness
- Severe cough, shortness of breath
- Signs of infection in the rash (pus, redness, warmth)
- In immunocompromised patients in any case
- In pregnant women
- In babies under 12 months
- Neck stiffness
- Persistent vomiting
Diagnosis and Treatment
Diagnosis: Clinical appearance is usually sufficient. In suspicious cases, blister fluid testing can be done.
Treatment:
Supportive treatment is sufficient in most children:
- Plenty of fluids
- Rest
- Cool compress (for itching)
- Antihistamines for itching (cetirizine, loratadine)
- Calamine lotion
- Warm bath (with oatmeal)
- Keep nails short (to prevent scratch wounds)
- Paracetamol for fever (aspirin should not be used - Reye syndrome)
Antiviral therapy (when needed):
- Acyclovir: in those over 12, with chronic lung/skin disease, adults
- Should be started within the first 24-48 hours
- Intravenous in severe cases
Prevention
Vaccine (most effective):
- The chickenpox vaccine is given in 2 doses
- Added to routine vaccination schedule at 12 months in our country
- Adults can also be vaccinated
- Vaccinated individuals usually experience a mild course even if exposed
Other measures:
- Isolate the sick child (until all crusts fall off)
- Do not send to school or daycare
- Stay away from sick people
- If pregnant and not vaccinated/exposed, avoid contact with sick people
- Protect immunocompromised individuals
- Vaccine/immunoglobulin can be given within 5 days of exposure