By: Capt. Monisha Malek, MD and Lt. Col. Megan Donahue, MD, FAAP
Chickenpox is a highly contagious disease caused by the varicella-zoster virus. It used to be one of the most common diseases of childhood, affecting almost all children before 9 years of age. A well-known symptom of chickenpox is a very itchy, blister-like
rash.
Symptoms of chickenpox usually are mild, but the infection can cause serious problems, especially for pregnant people, young children and people with conditions that affect their immune system.
Since the vaccine became available in 1995, infections have
gone down 97%. But it is still possible to get chickenpox, especially if your child falls behind on
immunizations.
Here's what to know about the chickenpox rash, symptoms and when your child should get the vaccine.
Chickenpox rash & other symptoms
Most children with chickenpox have symptoms of a rash and sometimes a mild
fever. The rash typically appears 10 to 21 days after exposure.
The chickenpox rash starts on the torso and scalp, often with redness around each blister, and may spread to the face, arms and legs. Children may have as many as 250 to 500 blisters. New blisters can show up as older blisters are starting to heal. Over time, the blisters become crusty (scab) before healing.
The rash can lead to problems such as:
Bacterial infection of the blisters that spreads to the bloodstream
Lung infection (pneumonia)
Infection in the brain (encephalitis)
Home care tips for chickenpox
Children with chickenpox should stay home from school or child care until every blister has scabbed or crusted over. Symptoms of itchy rash and mild fever usually get better within a week or so.
Here's how to help your child feel better while they are recovering from chickenpox.
If your child has a mild
fever, keep in mind that it can help the body fight an infection. Over-the-counter
acetaminophen can help relieve discomfort. Never give aspirin to a child with a fever, as it can cause a serious condition called
Reye syndrome.
Bathe your child with soap and water. Consider using daily oatmeal or baking soda baths (sold at your local drugstore or online) to
relieve discomfort and prevent bacterial skin infection.
Help stop the itch by applying ointment or lotion to the skin. Use products such as calamine lotion, body lotion or 0.25% menthol lotion. Ask your pediatrician about over-the-counter oral antihistamine such as
diphenhydramine.
Keep your child's
fingernails clean and neatly trimmed to prevent germs from getting into the rash and to avoid skin infections and scarring. Gloves or socks on their hands may help stop your child from scratching their skin.
How long is chickenpox contagious?
The contagious period begins 1 to 2 days before the first appearance of the rash and continues for another 5 to 7 days (and until all blisters have crusted over).
While your child is contagious, keep them away from others who have never had chickenpox or the chickenpox vaccine—especially young children, those with conditions that affect the immune system and pregnant people. Varicella-zoster infection during the first 20 weeks of pregnancy can lead to severe birth defects and problems for the fetus.
People can get chickenpox more than once, but it is rare. They can also spread it to others.
When to call your pediatrician
Most healthy children with chickenpox do not need to be seen by a pediatrician. However, contact your pediatrician for any of the following.
Your child has a high fever (temperature greater than 102°F or 38.9°C) or a fever that lasts for more than 4 days.
Your child is less than 1 year old, older than 12 years old, or immunocompromised and was exposed to chickenpox or has signs of chickenpox.
They have signs of a bacterial infection, such as part of the rash becoming extremely red, tender and warm, or symptoms that seem to be getting worse.
They have difficulty breathing, waking up or walking.
Medication to treat chickenpox
Your pediatrician can prescribe an antiviral medication called acyclovir that can reduce the symptoms of chickenpox. However, to work best, it must be given within 24 hours after the first signs of infection. This medicine is most often prescribed for teenagers and for children with
asthma or a skin condition called
eczema.
Vaccine to prevent chickenpox
The
chickenpox vaccine is recommended for all children who have not had the disease. Most people who get the vaccine are protected for life and won't get chickenpox.
Children receive two doses of chickenpox vaccine to ensure the broadest protection.
The first dose is given at 12 to 15 months of age.
The second dose is given between 4 and 6 years old. They can receive their second dose earlier if it has been at least three months since the first dose.
Children 13 years and older who have never had chickenpox or the vaccine should get two doses, spaced at least 28 days apart.
If you plan to become pregnant and have not had chickenpox or the vaccine, get the vaccine before pregnancy. Infants under age 12 months are too young to get the vaccine. They do get some immune protection during the first few months of life that is passed to them during pregnancy if their mother had chickenpox or had the vaccine.
Other benefits of the chickenpox vaccine
The chickenpox vaccine also lowers the risk of another painful rash, called
shingles, later in life. The virus that causes chickenpox also causes shingles. After a chickenpox infection, the virus remains in the body. People get shingles later in life when the virus reactivates. People with shingles can
spread the virus to others. Those who get infected will develop
chickenpox, not shingles.
Remember
Chickenpox spreads very easily. The infection can be serious, especially for young children. Most people who get both doses of the vaccine will not get chickenpox. Getting two doses is the best way to help protect your child and others.
More information
About Dr. Malek
Capt. Monisha Malek, MD, is a third-year pediatric resident at the San Antonio Uniformed Services Health Education Consortium (SAUSHEC). Her interests are in public health and preventable infectious diseases.
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About Dr. Donahue
Lt. Col. Megan Donahue, MD, FAAP, is board-certified in Pediatrics and Pediatric Infectious Diseases. She is the Division Chief for Pediatric Infectious Diseases at Brooke Army Medical Center and the Associate Program Director for the SAUSHEC Pediatrics Residency. Her interests are in medical education and tropical infectious diseases.
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The views expressed in this manuscript are those of the author(s) and do not necessarily reflect the official policy or position of the Defense Health Agency, the Department of Defense, nor any agencies under the U.S. Government.