Chicken Pox and Shingles
Chickenpox and shingles are both caused by varicella-zoster, a member of the herpes virus family (does NOT cause genital or oral herpes). Chickenpox is an uncomfortable, highly contagious and sometimes serious disease. The good news is that it's generally preventable through vaccination, and it’s very unusual to acquire more than once in immunocompetent persons. The bad news is the virus remains in your body and can later reactivate and become shingles.
Chickenpox is spread through the air by coughing or sneezing, through contact with nasopharyngeal secretions, and in cases of direct contact with the fluid from someone’s chickenpox lesions (a small blister like bump with a pink to red base found on the skin or scalp). The incubation period (time frame between initial exposure to an infection and the appearance of the first symptoms) can last from 10 to 21 days, with an average of 14-16 days most commonly noted. Chickenpox begins with slight fever and malaise, and possibly a sore throat and/or loss of appetite. After 1-2 days, a rash of red spots that typically begins on the chest or back is noted. The rash then appears in successive crops of varied stages of development across much of the body. Blisters may form on your scalp, in your nose, or any other place on your body; commonly to the trunk and extremities. The blisters burst and form scabs. These can leave permanent scars, especially if scratched. New blisters continue to form for 4-5 days with crusting of lesions noted within 6 days of formation. Itching often accompanies the rash.
Prevention and Treatment
The varicella vaccination is recommended for persons who have not had chicken pox to prevent getting chickenpox. For college students, the vaccine is administered in two injections, 4 to 8 weeks apart. Contact the IU Health Center Immunization and Allergy Clinic for more information and to set up an appointment if you feel you have not been adequately vaccinated in the past and have no history of chickenpox. Those who have no history of the illness, nor been vaccinated, and come in contact with an infectious person, should get the varicella vaccine within 72 hours of exposure. In instances of immunosuppression (history of underlying malignancy, HIV positive, long term steroid or immunosuppressive therapy, or solid organ transplantation) and contact with varicella, it is recommended to be seen by a health care provider;
Infected individuals become contagious 1-2 days before the rash appears and until ALL blisters have formed crusted scabs. Throughout this timeframe, the person with chickenpox should self-isolate from others by not attending classes or social events, and avoiding contact with roommates and significant others.
There is no cure for chicken pox. Treatment generally consists of supportive measures to alleviate fever malaise, sore throat and the annoyance of the rash. You should see a health care provider if you are pregnant, the fever lasts more than 4 days or is over 102F (38.9C), or if you become extremely ill or have other complications such as difficulty breathing, stiff neck, confusion or vomiting.
You can reduce the symptoms of chickenpox with these self-care treatments:
- Over-the-counter antihistamines (such as Benadryl) or colloidal oatmeal baths to relieve itching
- Tylenol or ibuprofen to reduce fever and pain; follow label instructions for use
- Avoid aspirin due to potential for Reye’s syndrome
If you've had chicken pox, the virus never leaves your body. It remains dormant in a nerve root near your spinal cord. For reasons we don't fully understand, it can be reactivated in some people by fatigue, stress, illness, immune system-suppressing drugs, radiation therapy, or other factors. Shingles, also known as Herpes Zoster, is most common in people over the age of 50, but anyone who has had chicken pox can get it. A person with shingles can cause chickenpox to anyone who has not already had chickenpox or the varicella vaccination. Contagion occurs through either direct or airborne contact with the virus that is shed from the skin lesions. You cannot, however, directly catch shingles from a shingles afflicted person. Anyone with active shingles is potentially contagious to others from time of onset skin lesions until scabbing and sloughing of lesions and re-epithelization occurs (typically at least a 2 week process).
- Pain along the nerve where the virus resides; most typically in thoracic and lumbar areas but can occur anywhere on body
- Itching and burning sensation to skin, and even possible weakness in nearby muscles
- Groups of small blisters in a generalized linear pattern, most often only to one side of the body (though occasionally crosses the midline)
- Pain may continue weeks, months or years after the rash heals (more often in the elderly or immunocompromised)
- Hypo or hyperpigmentation, and even scarring, may occur following resolution of skin lesions
For young healthy adults, treatment is generally supportive in nature. It is, however, strongly encouraged that you be seen by a health care provider as early in the course of suspected shingles as possible to more accurately diagnose the likelihood of shingles and more fully obtain an understanding of the potential consequences to both patient and their contacts. Use of antiviral medications are sometimes used in the first 72 hours to reduce pain and promote healing. Pain relievers and soothing soaks and lotions similar to those used for chicken pox can also help with partial relief of symptoms.
Prevention of Transmission: Keep rash covered. Wash hands frequently. Avoid contact with persons who have not had either Chickenpox or the Varicella vaccine, in particular pregnant women, premature or low birth weight infants, and immunocompromised individuals.
For more information, please visit the CDC website http://www.cdc.gov/chickenpox/index.html
Additional information on the topics of Chickenpox or Shingles is available at the UpToDate link on the Get Health Answers page of the Indiana University Health Center website www.healthcenter.inidana.edu