VZV is spread from person to person in 3 main ways: through tiny droplets expelled into the air by coughing or sneezing; through contact with saliva or mucus draining from the nose of an infected person; and through direct contact with the fluid from the blisters that are part of the skin rash of Chickenpox. The individual lesions of the rash look like a small (1-4 mm) bump or small blister (“vesicle”) surrounded by a flat pink or red area of skin only a couple of mm wider than the vesicle. These can be on the scalp or skin. The incubation period (the time 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 being the most common. Chickenpox begins with slight fever and feeling of malaise (fatigue and ill feeling), and possibly a sore throat and/or loss of appetite. After 1-2 days, the first red spots of the rash appear, usually beginning on the chest or back. The rash then spreads over much of the body, appearing in successive patches, so that there may be lesions in different stages of development across much of the body. The vesicles may form on the scalp, in the nose, or any other place on the body, although they are most commonly on the chest, back, abdomen, and the arms and legs. Over a few days, the blisters burst leaving a small open sore, which then dries up and forms a scab. New patches of blisters may continue to form for 4-5 days with a dry crust forming on each lesion within 6 days of formation. The individual lesions often itch, and may be painful. They can leave permanent scars as they heal, especially if scratched.
Prevention and Treatment
The varicella vaccination is recommended for persons who have not had Chickenpox to prevent getting the disease. It is usually given in early childhood, with the first dose given as an injection (a “shot”) at 12-15 months of age, and a second (“booster”) dose given at 4-6 years of age. For adults who have not had the illness or the vaccine in childhood, it is given in two doses 4-8 weeks apart. Two doses of the vaccine, properly administered, are about 90% effective in preventing an exposed person from getting the illness. Because the crowded living and classroom conditions on a college campus are ideal for spread of the illness from one person to another, all college students or other adults on campus who have not had the illness or been vaccinated in the past should be vaccinated.
Contact the Health Center Immunization and Allergy Clinic for more information and to set up an appointment if you are not sure you been adequately vaccinated in the past and have no history of Chickenpox. If you have no history of the illness, and have not been vaccinated, and you are exposed to a person with the illness, you should get the first dose of varicella vaccine within 72 hours of exposure. People with suppressed immune systems (history of cancer, HIV infection, long-term steroid medications or immunosuppressive therapy, or solid organ transplantation on antirejection medicines) who are exposed to a person with Chickenpox should see a health care provider as soon as possible. Infected individuals become contagious (can spread the illness to others) 1-2 days before the rash appears and continue to be infectious until ALL blisters have formed crusted scabs. Throughout this time, 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 Chickenpox although treatment with specific oral antiviral medications can decrease the severity and duration of symptoms if started in the first 24-48 hours after the onset of symptoms. Other treatment generally consists of supportive measures to reduce the discomfort of the fever, malaise, sore throat and the annoyance of the rash. You should see a health care provider if you suspect you have Chickenpox, especially 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 containing medicines (like Excedrin, Alka-Seltzer) due to potential for them to cause Reye’s syndrome, a serious condition that involves brain and liver swelling and can be fatal. Reye’s syndrome is rare, but it is much more common when people infected with chickenpox or influenza viruses take aspirin.