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Chickenpox is a highly infectious disease, caused by the virus, Varicella Zoster. It mainly affects children under 10 years of age, where the risk of serious complications is not as high as in adults.
Chickenpox virus is spread through personal contact with an infected individual or through coughing and sneezing. It is possible to develop Chickenpox from contact with someone who has shingles. However, you cannot contract shingles directly from someone who is infected with Chickenpox.
The virus is most infectious 1-2 days before the rash occurs and for around 5 days after (or until the rash crusts over). 90% of household contacts of someone infected with Chickenpox will catch the infection if they have never had it before.
Signs and symptoms
Chickenpox has an incubation period of 3 weeks. This is the time taken from contracting the infection to developing the symptoms.
The classic symptom is a rash, which is very itchy and can be widespread affecting the face, chest, arms and legs. Sometimes, the blisters can occur inside the mouth. There is often fever and cold symptoms also. The symptoms tend to improve after 1 week.
The illness can vary from mild symptoms with a few spots to itchy rash covering the whole body, which can be very distressing, affecting sleep, school and work and causing scarring to the skin.
In children, complications of Chickenpox are rare, but include:
• Superimposed bacterial infection of the skin, which can be widespread
• Neurological complications such as encephalitis (inflammation of the brain) or meningitis (inflammation of the lining of the brain).
• Very rarely-inflammation of the kidney and arthritis.
Adults who catch Chickenpox are more likely to have a severe illness with complications, including:
Chickenpox in Pregnancy is a serious disease for the mother and especially the baby. Therefore, it is important to know before trying for pregnancy whether you have immunity to this illness and if not, vaccination may be appropriate to protect you.
There is no specific treatment for Chickenpox as most children will recover spontaneously. The mainstay of managing the infection includes pain medications, antihistamines and soothing skin lotions such as calamine. In severe infections, antiviral drugs can be used to modify the illness. It is important if you are working closely with children or in health care to check whether you have already had Chickenpox, as there is vaccination is available to protect you.
As the disease is very infectious, if you are vulnerable to severe infection or have never had Chickenpox, then vaccination should be considered.
The Chickenpox vaccine has been used routinely in the childhood immunisation programme in the United States since 1995 and is safe and effective prevention against Chickenpox infection. Many other countries also routinely provide the vaccination in their immunisation schedules.
The vaccine is live containing a weakened virus. Two doses of the vaccine provide 98% protection in children and 75% protection in adults against Chickenpox infection. In both groups, if breakthrough infection does occur, it is much milder and of a shorter duration than in those who have never been vaccinated.
The vaccine can be given to anyone over 12 months of age:
• to prevent development of Chickenpox infection in those who have never had it.
• to protect occupational groups, such as those working with children and health care workers who have never had Chickenpox infection.
• to prevent healthy susceptible contacts of immunocompromised patients from transmitting natural infection to them. For example, siblings of a leukaemic child, or a child whose parent is undergoing chemotherapy.
• to prevent development of Chickenpox infection in those who have never had the illness and have been in close contact with a person with Chickenpox. The vaccine must be given within 3 days to prevent infection from occurring.
|Age||Method of Administration||Dosing Schedule||Interval between doses||Booster dose requirement|
|12 months onwards||Intramuscular injection to the thigh or deltoid muscle depending on age||2 doses||4-8 weeks||None|
Post Exposure Prevention
To prevent infection from occurring in those who have never had chicken pox and have been exposed to infection (post exposure prevention): 2 doses of Chickenpox vaccine is required.
The first dose must be given within 3 days of the exposure to prevent the disease from developing. The first dose can be given 3-5 days from exposure to modify the severity of the disease.
After 5 days from exposure, there is no evidence that the vaccine will change the course of the infection and therefore, is not beneficial. The second dose should be given after 4 to 8 weeks.
The vaccine cannot be given to the following groups:
• Anyone with suppressed or weakened immune system caused by diseases such as leukaemia, lymphoma, severe HIV infection or due to drugs such as oral steroids, cancer therapies.
• In the presence of a illness with a high temperature (above 38.5 degrees Celsius)
• If there is a previous history of severe allergic reaction to Chickenpox vaccine or to any of the ingredients in the vaccine (see FAQ section)
• Anyone with active Tuberculosis
• Anyone with a uncontrolled neurological disorders, such as epilepsy not responding to medications.
• Pregnant women
The Chickenpox vaccine cannot be given to pregnant women under any circumstances.
If a pregnant women is not immune to Chickenpox and encounters the disease, they must see their NHS healthcare provider as soon as possible to start immunoglobulin treatment (passive antibodies against Chickenpox given via injection).
Pregnancy must be avoided during the vaccination course and for a further 1 month after the second dose has been received.
The Chickenpox vaccine can be given to breast feeding mothers. Studies have shown that the virus is not transmitted in breast milk to the infant
Common Side Effects
• Local reactions at the injection site-including pain, redness and swelling
• Chicken pox like rash-occurs in 10% of adults and 5% of children who receive the vaccine. The rash is either localised around the injection site or generalised. across the body. On average, there is usually around 5 spots.
• The vaccine virus can stay in the body for life and reactivate as shingles, but the risk of this occurring is substantially lower than with naturally occurring infection.
Risk of transmitting infection
There have been isolated cases where the vaccine virus has been transmitted from the vaccinated individual to non immune contacts. As a general rule, contact with any individual with normal immune system is not a concern as the vaccine virus is weakened and will easily be dealt with by the immune system. However, because of the potential serious complications of Chickenpox infection in certain groups, we advise that close contact is avoided for a period of 6 weeks after the administration of the first dose with the following individuals:
• Pregnant women who have never had Chickenpox infection.
• Newborn babies (those within 28 days of birth) of mothers who have never had Chickenpox infection
• Anyone with poor or suppressed immune system such as those receiving cancer treatments.
However, it is important to bear in mind that the risk of transmission has only occurred from those individuals who have developed the rash following vaccination and is extremely rare. This is opposed to the highly infectious nature of Chickenpox itself.
Interactions with Other Vaccines
Chickenpox can be safely given at the same time as:
• Diphtheria, tetanus, polio, pertussis vaccines
• Meningitis B vaccine
• All travel vaccines including yellow fever
Chickenpox and MMR vaccine Interactions
Chicken pox vaccine must be given either on the same day as the MMR vaccine or separated by interval of 4 weeks.
This is because the MMR vaccine causes an increased response to the Chickenpox vaccine, which means that breakthrough infection with Chickenpox is more likely if this interval is not respected. However, the data available shows that the breakthrough infection with Chickenpox in these cases tends to mild and not full blown severe Chickenpox infection. Where both vaccines have been given within 4 weeks of each other, it is advisable to consider a further dose of the vaccine given second.
So whether you would like to protect your child or yourself against chicken pox, please consult with our nurse at Glasgow Medical Rooms.
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