Chickenpox in children is one of the most contagious viral diseases, which is especially common among children. A child attending a kindergarten or school will almost inevitably encounter chickenpox. Do adults really have a hard time with chickenpox? What is better – to get sick or to get vaccinated? We asked infectious disease specialist Daria Panieva to put together a crash course on the disease.
Chickenpox in Children (Information for Parents), Pregnant Women and Other Adults
At what age do people most often get chickenpox?
It depends on the population in question. There are countries where chickenpox vaccination is included in the national vaccination calendar and most people are vaccinated. And there are those where it is not. In the first case, the incidence is generally low, including among children. In the second, both children and adults get sick, but most often older preschoolers.
The virus circulates on a massive scale and almost all children have time to encounter it before school.
For whom is chickenpox dangerous?
For everyone who is at risk. When we say that children tolerate chickenpox easier, we mean those who are over one year old. Starting from adolescence, it is more severe and the risk of complications is higher. Pregnant women , people with chronic diseases and weakened immune systems, including cancer patients or those taking immunosuppressive drugs as indicated, are also at risk for complications.
What are these complications?
For example, chickenpox pneumonia. This is the most common complication in pregnant women who fall ill, especially in the third trimester. The chickenpox virus is not considered extremely dangerous for pregnancy. If the disease develops in the first trimester, the risk of damage to the fetus is very low (0.4–2.0%). But if a woman falls ill 5 days before delivery or within 7 days after, then the child is also at risk for congenital chickenpox, which is severe in newborns.
What will be the treatment for a patient at risk?
Doctors prescribe him acyclovir or valacyclovir. Drugs with these active ingredients are effective against herpes viruses, which include the chickenpox virus. Acyclovir is prescribed to all teenagers and adults to prevent severe cases of the disease.
Pregnant women are given specific chickenpox immunoglobulin as an emergency preventive measure, since they cannot be vaccinated with it. But, unfortunately, it is not always available. Therefore, when planning a pregnancy, if you have doubts about whether you have been ill or not, it is better to clarify whether you have antibodies to the virus. And if there are no antibodies, then get vaccinated. This is the most reasonable option.
How do they find out?
To detect immunity to the chickenpox in children, you need to give blood for antibodies to this virus. The result will be known in a few days. Of course, any analysis can be false positive or false negative. This one is no exception, but the probability of a false result is low.
Chickenpox rash and fever
How to distinguish chickenpox rashes from others?
Chickenpox rashes usually appear simultaneously with a rise in temperature. Each rash element goes through several stages — a spot, a raised spot, a blister, a crust. The rash is accompanied by itching and covers not only the skin, but also the mucous membranes. Self-diagnosis is still not worth it, as there are other diseases that can have similar manifestations.
What to apply to chickenpox in children? The question for parents who see the characteristic rash and want to alleviate the child’s condition is no less acute…
The most common complication of chickenpox in children is the addition of a bacterial skin infection. If a child scratches the rash, a wound surface is formed, to which an infection can easily attach. It would not be entirely true to say that there is no need to treat it with anything. Another thing is that the dyes we are so accustomed to are not used all over the world. The same “brilliant green”.
There, preference is given to such drugs as, for example, “Calamine” lotion, which reduces itching. And the less it is, the less scratching and the risk of secondary infection. Our old lady “brilliant green” has no evidence base, because it appeared and was widely introduced into practice long before the term “evidence-based medicine” appeared. And yet, there are some advantages to using it,
When you treat with dye, you do not miss rashes. It is known that chickenpox in children is considered contagious for 5 days after the appearance of the last element of the rash. When we treat with dyes, we can track the appearance of new ones. From the point of view of danger to others, it is important, but for the patient, the main thing is to reduce discomfort and itching and prevent the addition of a bacterial infection. Therefore, local treatment should not be ignored.
Does it make sense to use antihistamines to reduce itching?
It is acceptable, but there are no official recommendations. It is believed that local remedies are sufficient. There are very different foreign and domestic recommendations regarding bathing. In our country, bathing is completely prohibited, while abroad, on the contrary, they say that cool water relieves itching.
What do you recommend?
I recommend bathing in cool water under the shower, without rubbing with a towel, but only blotting the skin.
Is it possible to go for a walk when you have chickenpox?
Yes, if the patient feels well enough to go for a walk. But, of course, only walk away from other people. No playgrounds or crowded streets.
Should I bring down the temperature or not?
It is necessary if you feel unwell and it is high — above 38. But nowhere in the world is aspirin used for this purpose, as there is a risk of developing Reye’s syndrome (acute liver failure and encephalopathy — ed.). And it is not advisable to use ibuprofen-based products — studies have been conducted that have shown a link between its use in chickenpox and the development of bacterial complications. Therefore, it is better to use paracetamol-based products.
Lately, you can often read the opposite — that paracetamol can cause serious complications.
This is pure speculation. Any medicine is essentially poison. When using drugs, you should always remember about possible reactions to overdoses. This is in the instructions, as are the side effects. In the US, paracetamol overdose is the leading cause of acute liver failure. In order to reduce the risks of uncontrolled use and violation of the dosage regimen, information campaigns are being carried out, manufacturers are required to indicate in large letters on the packaging.
If the drug contains paracetamol, and drugs are also removed from over-the-counter shelves so that when issuing the drug, the pharmacist once again explains the dosage regimen. But there is no talk about paracetamol being dangerous and should not be taken. When used appropriately and in compliance with the dosage regimen, this drug is not dangerous. You just need to use it appropriately.
Chickenpox vaccination for children: is it better to get vaccinated than to get sick?
There is an opinion that it is better to have chickenpox as a child than to get vaccinated.
An infectious disease is a process that is difficult to control. We cannot predict in each specific case how a person will tolerate the disease. Indeed,chickenpox in children is most often tolerated easily and without any consequences. The person will recover and will have lifelong immunity. At the same time, chickenpox can be complicated. There are risk groups that are susceptible to a more severe course of the disease. And in fact, complications can also occur in those who are not included in it. In addition, do not forget about shingles.
What is this?
The chickenpox virus does not disappear from the body after the disease, but settles in the nerve nodes and “lives” there in a dormant mode, without causing any pathological processes. But only until the immunity to the virus is sufficient to contain it. When the level of specific antibodies drops critically, the virus reactivates, which manifests itself as another disease called shingles. Most often, this is the lot of the elderly or people with immunodeficiency states. Chickenpox in children is always a risk of getting shingles in adulthood, regardless of how mild it was.
So this is, in essence, a relapse of chickenpox?
Yes, you could say so. But the symptoms are completely different. The main thing that worries about herpes zoster is that the nerve damage causes severe pain. The pain can be unbearable and last for a long time. In addition, unlike chickenpox, herpes zoster can recur repeatedly. Vaccination significantly reduces the risk of developing shingles.
Is immunity after vaccination lifelong?
We cannot judge unequivocally how long the immunity provided by the vaccine lasts. The data varies from 10–20 years to lifelong immunity. Revaccination is not recommended, but upon reaching the age of 50–55, everyone who has had chickenpox or has been vaccinated against it is also recommended to receive the shingles vaccine. This is a vaccine against the same virus, but it differs in composition and principle of action and is recognized to remind the immune system of what it has previously encountered in order to stimulate immunity.
Chickenpox Parties, Recurring Chickenpox, and “Dangerous” Antipyretics
Let’s be clear: can a person who has had or been vaccinated against chickenpox become infected with it again?
It happens. An infectious disease is always a fight between the immune system and the pathogen. The one whose weapon is stronger wins. Antibodies are produced in response to the vaccine and the previous infection. It may happen that a child has come into contact with someone sick with chickenpox, received a very large dose of the virus, and the antibodies that he has are not enough. And then he can get sick again. But, of course, the disease will be very mild, with isolated elements of a rash. Any vaccinated person gets sick easier.
Is it possible to get chickenpox and not notice it?
Asymptomatic progression of the disease is possible. It may be that a person is sure that he has not had chickenpox, but in fact he had it in a mild form. In this case, to be sure, you can give blood for antibodies. I have already talked about this above.
How do you feel about such a phenomenon as “chickenpox parties”, when people go to visit “for chickenpox”?
They have been in fashion in the US for a long time. Our compatriots still popularize them. But you can’t throw such a party in the US now, because vaccination is on the national calendar and no one really gets sick. When there are no preventive measures, this can still be justified somehow. And if there is no opportunity to get vaccinated, then you can go to visit “for chickenpox”. But when we have access to the vaccine, then chickenpox parties are on the level of absurdity.
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