Chickenpox

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Introduction

Chickenpox

Chickenpox is common and mostly affects children, although you can get it at any age. It usually gets better by itself within a week without needing to see a GP.

Check if it's chickenpox

Other symptoms

You might get symptoms before or after the spots, including:

  • a high temperature above 38C
  • aches and pains, and generally feeling unwell
  • loss of appetite

Chickenpox is very itchy and can make children feel miserable, even if they don't have many spots. Chickenpox is usually much worse in adults.

It's possible to get chickenpox more than once, although it's unusual.

If you're not sure it's chickenpox

Check other rashes in children.

Things you can do yourself

You'll need to stay away from school, nursery or work until you've stopped getting any new spots and for at least 5 days after the first spots appeared.

But you don't need to wait until all the spots have healed or crusted over before going back as the risk of spreading it to others is very small after 5 days.

Do

  • drink plenty of fluid (try ice lollies if your child isn't drinking) to avoid dehydration
  • take paracetamol to help with pain and discomfort
  • put socks on your child's hands at night to stop scratching
  • cut your child's nails
  • use cooling creams or gels from your pharmacy
  • speak to your pharmacist about using antihistamine medicine to help itching
  • bathe in cool water and pat the skin dry (don't rub)
  • dress in loose clothes
  • check with your airline if you're going on holiday - many airlines won't allow you to fly with chickenpox

Don't

  • use ibuprofen - it can make someone with chickenpox very ill
  • give aspirin to children under 16
  • be around pregnant women, newborn babies and people with a weakened immune system, as it can be dangerous for them

Speak to a GP if:

  • you're not sure it's chickenpox
  • the skin around the blisters is red, hot or painful (signs of infection)
  • your child is dehydrated
  • you're concerned about your child or they get worse

Tell the receptionist you think it's chickenpox before going in. They may recommend a special appointment time if other patients are at risk.

Ask for an urgent GP appointment if:

  • you're an adult and have chickenpox
  • you're pregnant and haven't had chickenpox before and you've been near someone with it
  • you have a weakened immune system and you've been near someone with chickenpox
  • you think your newborn baby has chickenpox

In these situations, your GP can prescribe medicine to prevent complications. You need to take it within 24 hours of the spots coming out.

It's easy to catch chickenpox

You can catch chickenpox by being in the same room as someone with it. It's also spread by touching clothes or bedding that has fluid from the blisters on it.

How long chickenpox is infectious for

Chickenpox is usually infectious from 2 days before the spots appeared until 5 days after they first appeared.

How soon you get symptoms after coming into contact with chickenpox

It takes 1 to 3 weeks from the time you were exposed to chickenpox for the spots to start appearing.

Chickenpox in pregnancy

It's rare to get chickenpox when you're pregnant and the chance of it causing complications is low.

If you do get chickenpox when you're pregnant, there's a small risk of your baby being very ill when it's born.

Speak to your GP if you haven't had chickenpox and you've been near someone with it.

The chickenpox vaccine

You can get the chickenpox vaccine on the NHS if there's a risk of harming someone with a weakened immune system.

For example, a child could be vaccinated if one of their parents was having chemotherapy.

You can pay for the vaccine at some private clinics or travel clinics. It costs between £120 and £200.

Shingles and chickenpox

You can't catch shingles from someone with chickenpox. You can catch chickenpox from someone with shingles if you haven't had chickenpox before.

When you get chickenpox, the virus stays in your body. It can be triggered again if your immune system is low and cause shingles.

This can be because of stress, certain conditions, or treatments like chemotherapy.


Symptoms

Symptoms

The main symptom of chickenpox is a red rash made up of spots or blisters.

It usually takes between 1 and 3 weeks for symptoms to appear after becoming infected (the incubation period).

Early symptoms

Sometimes other symptoms may start a day or two before the rash appears.

These can include:

  • feeling tired and generally unwell
  • a high temperature (fever) of 38C (100.4F) or over
  • feeling sick
  • headache
  • aching, painful muscles
  • loss of appetite

Not everyone has these symptoms. They tend to be more common and more severe in older children and adults with chickenpox.

Chickenpox rash

The chickenpox rash develops in 3 main stages.

1) Spots

The rash starts off as small, raised red spots.

The spots often first appear on the face or trunk before spreading to other parts of the body.

There may just be a few spots or there may be hundreds covering most of the body.

Sometimes spots can appear on the palms of the hands, the soles of the feet, inside the ears or mouth, or around the bottom or genitals.

2) Blisters

During the following hours or the next day, the spots develop a fluid-filled blister on top.

The blisters may be very itchy, but it's important not to scratch them.

Scratching could spread the infection to others and increases the chances of complications, such as a more serious skin infection.

3) Scabs and crusts

Over the next few days, the fluid in the blisters turns cloudy and the blisters begin to dry out and scab over.

New spots may keep appearing for a few days after the rash begins, so there may be a mix of spots, blisters and scabs at the same time.

Chickenpox is usually contagious until 5 days after the rash started.

The scabby crusts will fall off by themselves over the next week or two.


Treatment

Treatment

Chickenpox is usually mild and can be treated at home. Most people feel better within a week or so.

There's no cure, but the treatments below can help relieve the symptoms while the body fights the infection.

It's also important to take steps to prevent chickenpox spreading, such as staying off work or school until you've stopped getting any new spots and for at least 5 days after the first spots appeared.

Painkillers

Use paracetamol to relieve pain and discomfort.

Paracetamol is safe for most people to take - including pregnant women and children over 2 months of age. Special liquid versions are available for young children and babies.

Don't use anti-inflammatory painkillers, such as ibuprofen, as they can sometimes make people with chickenpox very ill. Never give aspirin to a child under 16 as it can be dangerous for them.

Always read the packet or leaflet that comes with the medicine to check if it's suitable and how much to take. Speak to a pharmacist or your GP if you're unsure.

Prevent itching and scratching

Chickenpox can be very itchy, but it's important not to scratch the spots as it can increase the chances of the skin becoming infected with bacteria and could result in scarring.

It can help to:

  • keep nails short and clean
  • tap or pat the skin instead of scratching it
  • wear cotton gloves at night (or socks over hands)
  • bathe in cool or lukewarm water - dab or pat the skin dry afterwards, rather than rubbing it
  • wear loose, smooth cotton clothing

You can also buy calamine lotion, moisturising creams, cooling gels or an antihistamine medicine called chlorpheniramine to help reduce itching and soothe the skin.

Food and drink

It's important to drink plenty of fluids to avoid dehydration.

Water is better than sugary, fizzy or acidic drinks - particularly if you or your child has chickenpox spots in the mouth.

Sugar-free ice lollies are also a good way of getting fluids into children and can help soothe a sore mouth.

Avoid sharp, hard, salty or spicy foods that may make the mouth sore. Soft, cool foods are best, such as soup that's been left to cool down.

If you breastfeed or bottle feed your baby, continue to give them feeds regularly.

Stronger treatments from a doctor

Antiviral medication or a treatment called immunoglobulin may be recommended if you're at risk of developing severe chickenpox.

Those at risk include:

  • pregnant women
  • adults, especially those who smoke
  • newborn babies under 4 weeks old
  • people with a weakened immune system (the body's defence system), such as people with HIV, those taking high doses of steroid medication, and those having chemotherapy

Antiviral medication

An antiviral medicine called aciclovir may be recommended if you're at risk of severe chickenpox and you already have symptoms.

It ideally needs to be started within 24 hours of the rash appearing. It doesn't cure chickenpox, but makes the symptoms less severe.

It's normally taken as tablets 5 times a day for 7 days.

Immunoglobulin

Immunoglobulin is a treatment given by injection that can help prevent severe chickenpox if you've been exposed to someone with the infection but don't have any symptoms yet.

It's sometimes given to pregnant women, people with a weakened immune system and newborn babies who've been exposed to the chickenpox virus and haven't had the infection before.

Antibodies
Antibodies are your body's natural defence against any foreign antigens that enter your blood. An antibody is a protein that is produced by the body to neutralise or destroy disease-carrying organisms and toxins.
Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.

Complications

Complications

Chickenpox is usually mild and passes without causing any serious problems, particularly in children.

But sometimes complications can occur.

These are more common in:

  • pregnant women
  • adults, especially those who smoke
  • newborn babies under four weeks old
  • people with a weakened immune system (the body's defence system), such as people with HIV, those taking high doses of steroid medication and those having chemotherapy

Some of the main risks associated with chickenpox are outlined below.

Skin infections

The most common complication of chickenpox is the skin becoming infected with bacteria. This is more likely to happen if you or your child scratches your spots.

The skin may be infected if it becomes:

  • red
  • swollen
  • painful and tender

Contact your GP if you think your or your child's blisters have become infected. You may need antibiotics to treat the infection.

Lung infections

Occasionally, the chickenpox virus can spread to the lungs and cause pneumonia.

This is more common in adults (particularly those who smoke), pregnant women and people with weakened immune systems.

Symptoms of pneumonia can include:

Contact your GP as soon as possible if you think you or your child may have developed pneumonia. You may need to be treated in hospital.

Infections of the brain or nerves

In rare cases, chickenpox can lead to more serious infections of the brain and spinal cord in children, people with weakened immune systems and pregnant women.

This can cause:

  • a lack of energy
  • drowsiness
  • confusion
  • seizures (fits)
  • vomiting
  • severe headaches
  • stiff neck
  • behavioural changes
  • problems with walking, balance or speech

Seek medical advice as soon as possible if you or your child develops any of these symptoms after having chickenpox. Treatment in hospital will usually be needed.

Pregnancy problems

If you become infected with chickenpox for the first time while you're pregnant, there is a small risk of potentially serious complications affecting your baby.

The risks depend on when you pick up the infection.

  • Infection during the first 28 weeks can result in a rare but serious condition called congenital varicella syndrome, which may cause shortened limbs, vision problems (such as cataracts), brain damage and scarring.
  • Infection during weeks 28 to 37 can mean your baby is at risk of developing shingles at some point after they're born.
  • Infection a week before to a week after birth can mean your baby is a risk of a severe and potentially life-threatening chickenpox infection.

Contact your GP as soon as possible if you're pregnant or have given birth recently and you think you have chickenpox or have been exposed to someone with the infection.

Your GP can do a blood test to check if you're already immune to the infection and can arrange for you to have stronger treatments to prevent a severe infection.

Prevention

Prevention

Chickenpox is highly contagious and can make some people very ill, so it's important to try to avoid spreading it to others.

Some of the things you can do are outlined below.

Stay away from school or work

If you or your child has chickenpox, stay away from nursery, school or work until you've stopped getting any new spots and for at least 5 days after the first spots appeared.

But you don't need to wait until all the spots have healed or crusted over before going back as the risk of spreading it to others is very small after 5 days.

Avoid contact with people at risk

Certain people are at a higher risk of becoming seriously ill if they become infected with chickenpox.

These include:

  • pregnant women
  • newborn babies
  • people with a weakened immune system (the body's defence system), such as people with HIV, those taking high doses of steroid medication and those having chemotherapy

If possible, try to avoid contact with people from these groups until the blisters have scabbed over and you're no longer contagious.

Clean and wash regularly

Chickenpox can be spread through contact with objects that have been contaminated with the virus, such as toys, bedding or clothing.

If someone in your house has chickenpox, you can help stop it spreading by cleaning any objects or surfaces with a disinfectant and making sure that any infected clothing or bedding is washed regularly.

Check before travelling on a plane

If you or your child has chickenpox, you may not be allowed to fly until all the blisters have dried and scabbed over.

It's a good idea to inform the airline of your situation and check whether they have a policy about when they allow people with chickenpox to fly.

It's also important to let your travel insurer know if you or your child has chickenpox.

You need to make sure that you'll be covered if you have to delay or cancel your holiday, or extend your stay until your child's well enough to fly home.

Chemotherapy
Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.
Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.