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Chickenpox (varicella) is a common illness
that causes an itchy rash and red spots or blisters (pox) all over the body. It
is most common in children. But most people will get chickenpox at some point
in their lives if they haven't had the chickenpox vaccine.
Chickenpox can cause
problems for pregnant women, newborns, teens and adults, and people who have
immune system problems that make it hard for the body
to fight infection. Chickenpox usually isn't a serious health problem in healthy children. But a child with chickenpox needs to stay home from school. And you may need to miss work in order to care for your child.
After you have had chickenpox, you aren't
likely to get it again. But the virus stays in your body long after you get
over the illness. If the virus becomes active again, it can cause a painful
viral infection called
Chickenpox is caused by the varicella-zoster virus. It can spread easily.
You can get it from an infected person who sneezes, coughs, or shares food or
drinks. You can also get it if you touch the fluid from a chickenpox
A person who has chickenpox can spread the virus even
before he or she has any symptoms. Chickenpox is most easily spread from 2 to 3
days before the rash appears until all the blisters have crusted over.
You are at risk for chickenpox if you have never had the illness and haven't had the chickenpox vaccine. If someone you live with gets chickenpox, your
risk is even higher because of the close contact.
The first symptoms of
chickenpox usually develop about 14 to 16 days after
contact with a person infected with the virus. Most people feel sick and have a fever, a decreased appetite,
a headache, a cough, and a sore throat. The
itchy chickenpox rash usually appears about 1 or 2 days
after the first symptoms start.
chickenpox red spot appears, it usually takes about 1 or 2 days for the spot to
go through all its stages. This includes blistering, bursting, drying, and
crusting over. New red spots will appear every day for up to 5 to 7
It usually takes about 10 days after the
first symptoms before all blisters have crusted over. This is when the person with chickenpox can return to day care, school, or work.
Your doctor will ask
you about your symptoms and will examine you. This usually gives your doctor
enough information to find out if you have chickenpox.
A healthy child with chickenpox symptoms may not need to visit a doctor. You may be
able to describe your child's symptoms to the doctor over the phone.
Teenagers, adults, pregnant women, and people with
health problems need to see a doctor for chickenpox. This is especially
important for pregnant women, since chickenpox during early pregnancy can cause
Most healthy children and
adults need only home treatment for chickenpox. Home treatment includes resting
and taking medicines to reduce fever and itching. You also can soak in oatmeal
baths to help with itching.
People with long-term diseases or
other health problems may need more treatment for chickenpox. They may need
immunoglobulin treatment (IG) or antiviral medicine.
Your doctor can give you these soon after you are exposed to the virus to help
you feel better sooner.
You can prevent chickenpox with the
chickenpox vaccine. Children get the chickenpox vaccine as part of their routine immunizations.
have been around a person who has the virus and you have not had chickenpox or
the vaccine, you still may be able to prevent the illness. Get a shot of
chickenpox antibodies (immunoglobulin) or the vaccine right away.
Learning about chickenpox:
Taking care of yourself:
Health Tools help you make wise health decisions or take action to improve your health.
The varicella-zoster virus, one of
the herpes viruses, causes
chickenpox infection. The same virus that causes
chickenpox also causes
The chickenpox virus can spread
easily from one person to another. It most often spreads through the
respiratory tract, such as mucous membranes of the mouth and nose. You also can
get chickenpox through the air from an infected person's sneezing or coughing.
Less often, chickenpox is spread when fluid from a chickenpox blister gets on
In rare cases, a person can get chickenpox from the fluid of shingles
The first symptoms of chickenpox
The first symptoms are usually mild in children, but they
can be severe in teens and adults. These symptoms may continue throughout the
About 1 or 2 days after the first symptoms of chickenpox
appear, an itchy
About 14 to 16 days after
contact with a person infected with the virus, the first symptoms of
chickenpox usually develop. Most people feel sick and have a fever, a decreased appetite,
a headache, a cough, and a sore throat.
Chickenpox is most contagious from 2 to 3 days before the
rash appears until all the blisters have crusted over.
The chickenpox rash usually appears on the upper body about 1
or 2 days after the first symptoms start. The trunk usually is most affected,
and the arms and legs the least. The rash also may spread to the scalp, face, nose,
and mouth. In rare cases, it spreads into the eyelid lining (conjunctiva), into
the clear covering over the eye (cornea), inside the throat, or into the
It takes about 1 or 2 days for a chickenpox red spot
(macule) to go through all its stages:
Skin infection is the most common complication for children under age 5.
Skin infection can form after the rash is scratched. Scratching allows bacteria
from the skin or under the fingernails to get into a chickenpox blister. The infection can become serious if it isn't treated. An infected blister also may
leave a scar.
people also are at increased risk of more serious problems from chickenpox. This higher-risk group includes newborns,
teenagers, adults—especially pregnant women—and those who have weak immune systems.
Although you become
immune to the chickenpox virus after you have had
chickenpox, the virus will still be in your body. The virus can later cause
shingles (herpes zoster), usually when you are an
older adult. About 1 in 5 people who have chickenpox will later get
shingles.1 The shingles vaccine can help prevent shingles or make shingles less painful.
You are at risk for
chickenpox if you have not had chickenpox or the
vaccine and you:
After you have had chickenpox or the vaccine, you become
immune to the virus. It is possible that you may have
a slight reaction after reexposure, such as a few spots and a slight fever. But
you aren't likely to get chickenpox more than once.
Call your doctor right away if you or your child with
Call for an appointment with your doctor if:
If you are a teen or adult, are pregnant, or have a weak immune system, it's important to see your doctor as soon as you think you've been exposed to the chickenpox virus. Your doctor may want to give you a medicine that helps protect you from the virus.
A healthy child with chickenpox symptoms may not need to visit a doctor. You may be able to describe your child's symptoms to the doctor over the phone. Then your child won't have to leave the house and risk spreading the virus to others. But it is important to check with your doctor to find out if he or she wants to see your child.
If you go to a doctor's office, ask if you need to
take any precautions when you arrive to avoid spreading the infection. For
example, office staff may take you directly to an exam room when you arrive, rather than have you wait in the lobby.
following health professionals can diagnose and treat chickenpox:
If severe complications develop, you may be
referred to a specialist. For example, you may see a
pulmonologist for lung problems.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Chickenpox usually can be diagnosed based on how the
chickenpox rash looks. For a healthy child, describing the
rash over the phone to a doctor (rather than visiting the office)
may be all you need to do.
Anyone who is over age 12, or pregnant, or has a weak immune system needs to be checked by a doctor as soon as you suspect chickenpox. When given right away, treatment can help prevent serious complications. For more information, see When to Call a Doctor.
At the doctor's office, your doctor will ask you about your symptoms and will examine you. This usually gives your doctor enough information to find out if you have chickenpox.
woman who has had chickenpox early in her pregnancy may want to have her
fetus checked for birth defects. This can be done with
fetal ultrasound during the second trimester.
If you have never had chickenpox or the chickenpox vaccine(What is a PDF document?), you have no immunity against the virus. This means that the virus can make you sick—you can get chickenpox.
If you need to make sure you're immune to the chickenpox virus, a viral test can tell you. It makes sense to get a viral test if you aren't sure you're immune and you:
Treatment for chickenpox depends on your age, your health, how long it's been since you were exposed to the virus, and your symptoms.
The chickenpox, or varicella, virus spreads easily from person to person. If you have never had chickenpox or the chickenpox vaccine(What is a PDF document?), you have no immunity against the virus. This means that the virus can make you sick.
If you or your child is not immune, you can prevent chickenpox by getting the vaccine. It is recommended for:
For women who aren't immune, chickenpox and pregnancy can be a dangerous combination. Getting the vaccine when not pregnant prevents complications of chickenpox during pregnancy. Talk to your doctor about the right timing for the vaccine.
You can help
prevent chickenpox by avoiding close contact with people infected with the
virus. This is even more important if you have a
weak immune system. But the virus can spread from
an infected person even before symptoms develop.
If you have been in contact with a person who has chickenpox and aren't sure if you are immune, a shot of the vaccine may prevent you from having the illness. Or it may make the illness milder.
If you can't have the chickenpox vaccine (for example, during pregnancy) a shot of antibodies (immunoglobulin) or an antiviral medicine may help delay or prevent the chickenpox.
For more information, see Medications.
Before the chickenpox vaccine was available, families often had the virus for weeks at a time as it sickened one person, then the next. To "get it over with," some parents intentionally exposed their children to a child with chickenpox.
Now that the vaccine can protect against the virus, parents have a safer option than exposing their children to chickenpox. Do not expose a child to the chickenpox virus. Even young
children can have serious (though rare) complications from the infection,
Most healthy children, teens, and
chickenpox need only home treatment. But
all teens and adults with chickenpox need to see a doctor. When given right away, treatment can help prevent serious complications.
If you have chickenpox, you don't need to stay in bed. But it's best to
stay quiet and rest. Over-the-counter medicines can help relieve symptoms such as
fever and itching.
Before you give medicine to your sick child, check with your
child's doctor. Because of their small size, children are more sensitive than
adults to the effects of some medicines. Use a measuring spoon or medicine cup
to give liquid medicine to a child. Don't guess the amount or use a regular
The chickenpox rash itches. Do everything you can to control the itch and avoid scratching. Scratching the blisters may
cause a skin infection, or scars may form after the blisters heal.
You can take
control itching, such as taking oatmeal baths, applying cool compresses, and
antihistamines. Check with your child's
doctor before giving your child antihistamines.
Fever is your body's normal response to infection. A
higher-than-normal temperature kills bacteria and viruses that cause illness.
Fever medicines stop this natural process, so use one only when fever is causing discomfort.
You can help
relieve a fever with over-the-counter medicine. Follow the package instructions carefully. If you give medicine to your baby, follow your doctor's advice about what amount to give. (Do not give aspirin to people younger than 20, because of the risk of
Reye syndrome, a rare but serious problem).
Call your doctor if you or your child has a fever that lasts longer than 24 hours.
For more information, see Fever, Age 11 and Younger or Fever, Age 12 and Older.
If you or your
child has chickenpox, don't return to work, school, or day care until after all
blisters have crusted over, usually about 10 days after the first symptoms
start. To help
prevent spreading chickenpox, stay away from people
who aren't immune.
Medicines for chickenpox can:
If you (or your child) are not immune to chickenpox and have been exposed to the virus, call your doctor. The right medicine depends on your health, age, how long it's been since you were exposed to the virus, and your symptoms.
chickenpox, most people can get the
chickenpox vaccine(What is a PDF document?). To fully protect you, two doses are needed before you're exposed to the virus.
Some people can't get the chickenpox vaccine. They include women who are pregnant and people who have ever had a serious
allergic reaction to gelatin or the drug neomycin.
have symptoms of chickenpox, you can take
over-the-counter medicines to help relieve discomfort.
Check with your child's doctor before giving medicine to your child.
The American Academy of Pediatrics (AAP) offers a
variety of educational materials about parenting,
general growth and development, immunizations, safety, disease prevention, and more. AAP guidelines for various conditions and links to other
organizations are also available.
This CDC website has information about vaccines and the diseases that can
be prevented by immunization. It includes the recommended
immunization schedules for children, teens, and adults. You can also find
information about vaccine side effects and safety, school and state
requirements, and immunization records. Interactive schedules are also
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The March of Dimes tries to improve the health of babies
by preventing birth defects, premature birth, and early death. March of Dimes
supports research, community services, education, and advocacy to save babies'
lives. The organization's website has information on premature birth, birth
defects, birth defects testing, pregnancy, and prenatal care.
This U.S. Department of Health and Human Services website has vaccine information from many federal agencies. A Spanish version of the website is available at http://es.vaccines.gov.
CitationsGershon AA (2009). Varicella-zoster virus. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 2, pp. 2077–2088. Philadelphia: Saunders Elsevier.American Academy of Pediatrics (2009). Varicella-zoster infections. In LK Pickering et al., eds., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed., pp. 714–727. Elk Grove Village, IL: American Academy of Pediatrics.Other Works ConsultedBreuer J, Fifer H (2011). Chickenpox, search date June 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.Centers for Disease Control and Prevention (2006). A new product (VariZIG™) for postexposure prophylaxis of varicella available under an investigational new drug application expanded access protocol. MMWR, 55(8): 209–210. Also available online: http://www.cdc.gov/mmwr/PDF/wk/mm5508.pdf.Centers for Disease Control and Prevention (2007). Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 56(RR-4): 1–48. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr5604.pdf.Gershon AA, et al. (2008). Varicella vaccine. In SA Plotkin et al., eds., Vaccines, 5th ed., pp. 915–958. Philadelphia: Saunders Elsevier.Habif TP (2010). Varicella section of Warts, herpes simplex, and other viral infections. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 5th ed., pp. 474–478. Edinburgh: Mosby Elsevier.Habif TP, et al. (2011). Varicella (chicken pox)
section of Viral infections. In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 230–234. Edinburgh: Saunders.Hambleton S (2011). Varicella-zoster virus infections. In CD Rudolph et al., eds., Rudolph’s Pediatrics, 22nd ed., pp. 1160–1164. New York: McGraw-Hill.Hirsch MS (2007). Herpesvirus infections. In DC Dale, DD Federman, eds., ACP Medicine, section 7, chap. 26. New York: WebMD.Strauss SE, et al. (2008). Varicella and herpes zoster. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 2, pp. 1885–1898. New York: McGraw-Hill.Whitley RJ (2010). Varicella-zoster virus. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 2, pp. 1963–1969. Philadelphia: Churchill Livingstone Elsevier.Wolff K, Johnson RA (2009). Varicella zoster virus infections. In Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 831–836. New York: McGraw-Hill.
October 13, 2011
John Pope, MD - Pediatrics & Thomas Emmett Francoeur, MD, MDCM, CSPQ, FRCPC - Pediatrics
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