Humza Khizer

Learn how to comfort and care for a child with chickenpox with Meri Sehat. Prioritize soothing measures for a quicker recovery.

Chickenpox – How To Make Your Child Feel Better?

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Medilink Consultant clinic

Saad Ullah Siddiqui

Yes, Adults Can Also Get Chickenpox!

Introduction

Chickenpox, also called varicella, is largely a childhood illness accounting for less than 5% of cases in adults.<a href="#accordion">[1]</a>&nbsp;With more than 60% of Pakistan&#39;s population ranging from 15-64 years of age, it&#39;s important to know about the disease&#39;s impact on adults.<a href="#accordion">[2]</a>&nbsp;Although the true incidence of the disease in Pakistan remains unknown, previous chickenpox outbreaks seem to have mostly affected adults.

In 2017, an outbreak in Faisalabad, Pakistan resulted in more than 300 chickenpox cases and dozens of deaths due to complications.<a href="#accordion">[3]</a>&nbsp;A majority of the cases and deaths occurred in adults. Moreover, the recent outbreak in Islamabad and Rawalpindi also caused a more severe infection in the adult population.<a href="#accordion">[4]</a>&nbsp; 
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Understanding Adult Chickenpox

The highly contagious viral illness is caused by the varicella-zoster virus (VZV). It typically presents with a fever, headache, and malaise. Soon after, an itchy rash begins to develop on the face and trunk. The rash initially starts off as a small red bump and then develops into blisters that may leak. Eventually, the blisters crust, scab, and fall off. During the infection, your body will be covered in vesicles at various stages, and new lesions may appear every few days. Adults usually have a larger, and greater, number of lesions. The rash may take 7-14 days to completely disappear. A person is considered contagious 2 days prior to the rash until all the blisters have crusted over.&nbsp;

Although chickenpox mostly causes a mild illness, however in adults, pregnant women, and immunocompromised individuals, the disease can present with serious complications. In pregnant women, varicella can result in low birth weight, and abnormalities of the brain, eyes, and limbs. Whereas viral pneumonia is the most common complication in adults.<a href="#accordion">[1]</a>&nbsp;Moreover, the risk of death is eight times higher in adults than in children.<a href="#accordion">[5]</a>

In most adults and immunocompromised individuals, doctors may prescribe antiviral therapy with acyclovir. It is highly effective at preventing complications, especially if given within 24 hours of rash.<a href="#accordion">[6]</a> 
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Once you recover, it might seem like you&#39;ve gotten rid of the virus for good, but the truth is that the varicella-zoster virus never really goes away. Instead, it goes and lies dormant in the neural ganglia. And if you&#39;re the unlucky 10-20%, then the virus will reactivate to cause herpes zoster or shingles.<a href="#accordion">[7]</a>

<a href="https://www.merisehat.pk/article/what-are-shingles">Shingles</a> is most common in those aged 50 years and above, and immunocompromised individuals. The painful viral illness presents with a burning, vesicular rash that appears as a band, confined to a single dermatome. Other than the rash, people also complain of fever, chills, and headaches. Unlike chickenpox, shingles are not contagious. However, VZV can be transmitted to others. In these people, the virus may cause chickenpox if they have never been infected, but not shingles.&nbsp;

Treatment involves antiviral drugs such as acyclovir, calamine lotion for the rash, and pain relievers. 
&nbsp;&nbsp;

The varicella vaccine remains the best protection against chickenpox. A two-dose regimen is considered 94% effective at preventing infection<a href="#accordion">[1]</a>. Adults who have never had chickenpox, or have never received a chickenpox vaccine, should get one or two doses of the vaccine depending on their doctor&#39;s advice. 
&nbsp;

However, certain groups of people cannot receive the vaccine due to adverse reactions. These include:

<ul>
</ul>

<ul>
	<li>Pregnant women</li>
	<li>People with an immunocompromising disease such as HIV, or those undergoing immunosuppressive therapy</li>
	<li>People undergoing chemotherapy or radiation</li>
	<li>Those with a moderate or severe illness</li>
	<li>History of allergy to any ingredient of the chickenpox vaccine</li>
	<li>People who have recently received a blood transfusion</li>
</ul>

People who have had chickenpox but at older than 50 years of age, may also be recommended a vaccine for shingles. However, the vaccine is mostly contraindicated in immunosuppressed individuals. Therefore, it is best to consult with your doctor and discuss all your options. 
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Conclusion

It is quite evident that adults are at a higher risk of severe infection and complications of chickenpox. However, there is a lack of awareness among the general population of the disease&#39;s impact. There is a need for the implementation of vaccination programs for adults and immunocompromised individuals to prevent life-threatening complications. 
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Key Points

<ul>
</ul>

<ul>
	<li>Chickenpox is a highly contagious viral illness that causes a more severe infection in adults.</li>
	<li>Complications such as pneumonia, bleeding problems, encephalitis, and sepsis are more common among adults and immunocompromised individuals.</li>
	<li>After recovery, the varicella-zoster virus goes and lies dormant in the person&#39;s neural ganglia. Weakened immunity and old age can often trigger its re-activation, resulting in the painful shingles infection.&nbsp;</li>
	<li>The chickenpox vaccine can be administered to adults who have never had chickenpox or received a chickenpox vaccine. In those aged 50 years and above with a history of chickenpox, doctors may also recommend the shingles vaccine.</li>
</ul>

[1] WHO, 2014. Varicella and herpes zoster vaccination position paper., Geneva: s.n.

[2] United Nations Population Fund, 2022. World Population Dashboard Pakistan. [Online].

[3] Yousaf, M. Z. et al., 2018. Deadly outbreak of chickenpox at district Faisalabad, Pakistan: possible causes, and preventive way forward. Molecular Biology Reports.

[4] The Express Tribune, 2022. Infectious diseases break out in twin cities. [Online].

[5] Cohen, J. I., Brunell, P. A., Straus, S. E. & Krause, P. R., 1999. Recent Advances in Varicella-Zoster Virus Infection. Annals of Internal Medicine.

[6] Bhatti, M. A., Manglani, C. B. & Khan, M. A., 2004. Fatal Case of Chickenpox in an Adult: a case report. Journal of the Pakistan Medical Association, 54(2).

[7] WHO, n.d. Varicella. [Online].

Nimrah H. Sattar

As a parent, there is nothing more distressing than a sick child. Especially, if your child is suffering from the highly contagious <a href="https://www.merisehat.pk/disease/chicken-pox">chickenpox</a>. 
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Understanding Ways To Care For Children With Chicken Pox

Caused by the varicella-zoster virus, chickenpox often presents with itchy bumps and blisters all over the body. Prior to the rash, children may complain of a fever, headache, and malaise. It can take about 10-21 days, after exposure to an infected person, for the rash to develop. One is considered contagious 2 days before the rash until all the blisters have scabbed over. So, if you have an infected child, the chances of a sibling catching the infection is extremely high. Although most cases are self-limiting and cause a mild illness, immunocompromised children can develop complications such as secondary bacterial infections, dehydration, and scars. 
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In Pakistan, chickenpox outbreaks in the past have occurred between March and May.<a href="#accordion">[1]</a>&nbsp;Recently, an outbreak of chickenpox, measles, and gastroenteritis was reported among both children and adults in Rawalpindi and Islamabad.<a href="#accordion">[2]</a>

Approximately 90% of global chickenpox cases occur in children.<a href="#accordion">[3]</a>&nbsp;Due to the mildness of the disease, doctors mostly recommend letting the disease run its course. However, that doesn&#39;t mean you can&#39;t ease some of your child&#39;s symptoms. Here are a few practices that can help make your child feel more comfortable as they recover from the viral illness. 
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The itchy rash is probably the most infuriating aspect of the illness. Especially if you&#39;re a child with little self-control and are constantly told not to scratch. As a parent, you can take the following steps to ease your child&#39;s discomfort:

<ul>
</ul>

<ul>
	<li>Apply calamine lotion on the itchy spots, but not on the face or near the eyes.</li>
	<li>Give cool or lukewarm baths with oatmeal bath products or baking soda. You can repeat this 3-4 times a day and it will help soother your child&#39;s itch.</li>
	<li>Soaps should be avoided as they can dry the skin and worsen the itch.</li>
	<li>In case of genital sores, ask a doctor for pain-relieving ointments.</li>
	<li>If the itching continues to worsen, ask your doctor for a safe antihistamine.</li>
	<li>To prevent the child from scratching at night, put mittens or gloves on their hands.&nbsp;</li>
	<li>Trim your child&#39;s fingernails to reduce the chances of infection. 
	&nbsp;</li>
</ul>

Chickenpox can often cause blisters in the mouth and throat which makes it painful for the child to eat or drink. Combined with the loss of appetite, it can become extremely difficult to ensure that he or she is getting enough nutrients to stay healthy. Therefore, a soft diet is usually preferred. It is important to keep the child hydrated and avoid salty or spicy foods. Instead, stick to popsicles, milkshakes, and cold drinks. 
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Many doctors prescribe acetaminophen for mild fever. However, always consult a doctor before administering any medicine to your child. Moreover, never give aspirin to children with chickenpox. The use of aspirin can lead to a life-threatening illness called Reye syndrome. It can cause vomiting, tiredness, diarrhea, confusion, and eventually decreased level of consciousness. Seek emergency medical help if you&#39;ve administered aspirin and your child starts showing any of the mentioned symptoms. 
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The above remedies will help ease symptoms of chickenpox. However, in some cases, the illness may continue to worsen. If your child develops any of the following signs or symptoms, contact a doctor immediately:

<ul>
</ul>

<ul>
	<li>Fever of 102 or more and lasting for more than 4 days</li>
	<li>Trouble breathing</li>
	<li>The rash is red, swollen, and warm or blisters start draining pus</li>
	<li>Vision problems</li>
	<li>Confusion, trouble walking 
	&nbsp;</li>
</ul>

Vaccination is a key step in preventing the spread of infectious diseases. According to a U.S. study, the chickenpox vaccine has helped cause a drastic decline in chickenpox cases among children less than 10 years of age.<a href="#accordion">[4]</a>&nbsp;The live vaccine is either administered as a single dose or a two-dose regimen. A two-dose regimen offers 95% protection against severe infection.<a href="#accordion">[1]</a>&nbsp;In Pakistan, the chickenpox vaccine is either given separately or in combination with the mumps, rubella, and measles (MMR) vaccine. However, it is not part of the country&#39;s &#39;Expanded Programme of Immunization&#39; (EPI) program which provides routine immunizations to children aged 0-15 months.&nbsp;

If your child has not received his or her vaccine, book an appointment and get them vaccinated to prevent any severe infections or complications.&nbsp;Since chickenpox is highly contagious, in case of infection, it is important that the child stays home until all the blisters have been scabbed. Moreover, the school should be informed of your child&#39;s illness so they can take steps to prevent an outbreak.&nbsp; 
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<ul>
</ul>

<ul>
	<li>Chickenpox is a highly contagious disease that most commonly affects children. It presents with fever, headache, malaise, and itchy blisters all over the body.</li>
	<li>It is advised to not let children scratch the rash as it can become infected and lead to skin infections. Instead, calamine lotions, allergy medicine, and lukewarm baths are recommended.</li>
	<li>Since painful sores can make it difficult to eat, popsicles, cold shakes, and a soft diet can help your child maintain their health as they recover.</li>
	<li>Due to the risk of Reye syndrome, aspirin should never be given to a child with chickenpox. Always conduct a doctor before giving any fever medicine. Acetaminophen is usually the safer option for children.</li>
	<li>If your child has never had chickenpox, the varicella vaccine can help reduce their chances of catching the infection.</li>
</ul>

[1] Yousaf, M. Z. et al., 2018. Deadly outbreak of chickenpox at district Faisalabad, Pakistan: possible causes, and preventive way forward. Molecular Biology Reports.

[2] The Express Tribune, 2022. Infectious diseases break out in twin cities. [Online].

[3] WHO, 2014. Varicella and herpes zoster vaccination position paper., Geneva: s.n.

[4] Schmid, D. S. & Jumaan, A. O., 2010. Impact of Varicella Vaccine on Varicella-Zoster Virus Dynamics. Clinical Microbiology Reviews, 23(1), pp. 201-217.