My wife has an older sister and, as luck would have it, she got the worst of the childhood illnesses, while my wife sailed through these events. Chickenpox was just such an event. My wife had a slight fever and two or three spots on her back while her sister suffered terribly. The lesions were horrific, forming blisters in her eyes and down her throat, and causing her fingernails to fall off. She also developed a secondary bacterial infection that progressed into pneumonia. It sounds like something out of a horror story, yet this was a reality for many children prior to the varicella vaccine.
I have heard many grandparents in my practice tell me about the chickenpox parties or getting sick children to bath with their siblings so that the kids could get chickenpox over and done with. I get it! December holidays with the whole family confined for weeks at a time was not much fun back in the day. Today, however, we do have alternatives and you need to be informed about what this illness is and what the consequences are so that you can protect your baby.
What is chickenpox?
Let’s start with a definition. Chickenpox is an infection caused by the varicella-zoster virus. It is characterised by fever and blisters all over the body, and is highly contagious to those who have not had the illness nor have not been vaccinated against it.
The disease is generally mild in healthy children. In severe cases, the rash can cover the entire body, and lesions may form in the throat, eyes, mucous membranes of the urethra, anus and vagina.
Once the child has recovered from chickenpox, the virus may remain in the body (inactive or latent), usually in the nervous system. Later in life, the virus can be reactivated and the person will suffer a very painful illness known as shingles.
What are the symptoms of chickenpox?
The difficult thing about chickenpox is that an individual is contagious to others two to three days before the rash appears. If your child has been exposed to chickenpox, then it can take between 10 and 21 days before the rash appears. Once the rash appears it can last anything between five to 10 days for the illness to pass. Now you can understand why granny was keen to get the process over and done with!
The other signs and symptoms are:
- Severe itching
- Loss of appetite
- Tiredness and a general feeling of being unwell (malaise)
Once the chickenpox rash appears, it goes through three phases:
- Raised pink or red bumps (papules), which break out over several days;
- Small fluid-filled blisters (vesicles), which form in about one day and then break and leak;
- Crusts and scabs, which cover the broken blisters and take several more days to heal.
The blisters usually appear on the head or chest first and then spread to the rest of the body. New bumps usually continue to appear for a number of days, so you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time. Chickenpox is contagious until all broken blisters have crusted over.
The Centres for Disease Control and Prevention estimates that the vaccine protects 98% of children who get the correct dose. If they do get the illness, then the severity of the disease is lessened.
What are some complications associated with the chickenpox virus?
For most children, chickenpox is a mild illness. They will feel very miserable as a result of the itchy, painful blisters and fevers, but this will all be over in five to 10 days. However, there can be other complications as a result of this illness and this is why parents need to be informed.
These complications include:
- Bacterial infections of the skin, soft tissues, bones, joints or bloodstream (sepsis)
- Inflammation of the brain (encephalitis)
- Toxic shock syndrome
- Reye’s syndrome in children and teenagers who take aspirin during chickenpox
Who is at risk for such complications?
In children these would include:
- Newborns and infants whose mothers never had chickenpox or the vaccine;
- Children with asthma or those with a lowered immune system.
Teenagers and adults are far more likely to suffer severe consequences from chickenpox especially:
- Pregnant women who haven’t had chickenpox.
- People who smoke.
- People whose immune systems are weakened by medication, such as chemotherapy, or by a disease, such as cancer or HIV.
- People who are taking steroid medications for another disease or condition, such as asthma.
When to see your doctor?
I would recommend that if your child has been exposed to chickenpox or if you suspect they may have chickenpox, then a visit to the doctor is in order. There are other illnesses that cause blisters, like coxsackie, so getting a diagnosis is important. If your child is younger than six months then it is vital that you consult with your doctor.
Please call ahead and warn your doctor’s receptionists if you suspect chickenpox. I prefer for these children to be isolated from others in my waiting room. Once the diagnosis is made, please stay in contact with your doctor if any of these symptoms occur:
- The blisters spread to the eyes.
- The fever is around 39 degree Celsius and you are struggling to get it under control.
- If your child develops a cough, has a stiff neck, feels dizzy or disorientated, struggles to breathe or starts vomiting.
But what can the doctor do?
For the most part, your doctor will just make the diagnosis and advise on how best to control the fever and how to help your child deal with the pain of the blisters. In certain cases, your doctor may prescribe an antiviral medication.
Is the vaccine safe, and what if a woman is pregnant?
I am aware of the ongoing resistance towards vaccinations, but I can honestly say this is an illness that children shouldn’t have to suffer. Even if it is only a week and no other complications arise, your child will suffer from fevers, run the risk of scarring and have a very uncomfortable time.
“…you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time. Chickenpox is contagious until all broken blisters have crusted over.”
The Centres for Disease Control and Prevention estimates that the vaccine protects 98% of children who get the correct dose. If they do get the illness, then the severity of the disease is lessened. The vaccine itself is well tolerated and in a recent article put out by the Mayo Clinic, it confirms that the vaccine is safe and very effective. This research and the risk of complications arising from chickenpox makes me an advocate for prevention through vaccination. Children don’t need to suffer and we certainly don’t want our aged to suffer the torment of shingles.
The vaccine has not been approved for pregnant woman, so it is crucial that women consult with their doctors before they fall pregnant to ensure they’ve had the necessary vaccines or are immune to the illnesses. Chickenpox in pregnancy is not to be taken lightly. If it is contracted in the first trimester, there is a risk that the baby is born with shortened limbs and low birth weight. If the mom gets chickenpox a few days before or after birth, the baby runs a significant risk of getting seriously ill.
This article was written for BabyYumYum by our partner paediatrician, Dr Maraschin.