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Home Health Disease Health Chickenpox
About Chickenpox

Chickenpox is a highly contagious disease caused by primary infection with varicella zoster virus (VZV).It usually starts with a vesicular skin rash mainly on the body and head rather than on the limbs. The rash develops into itchy, raw pockmarks, which mostly heal without scarring. On examination, the observer typically finds skin lesions at various stages of healing and also ulcers in the oral cavity and tonsil areas. The disease is most commonly observed in children.

Chickenpox is an airborne disease which spreads easily through coughing or sneezing by ill individuals or through direct contact with secretions from the rash. A person with chickenpox is infectious one to two days before the rash appears. They remain contagious until all lesions have crusted over (this takes approximately six days).

Chickenpox has been observed in other primates, including chimpanzees and gorillas.

Diagnosis

The diagnosis of varicella is primarily clinical, with typical early "prodromal" symptoms, and then the characteristic rash and oral-cavity sores. Confirmation of the diagnosis can be sought through either examination of the fluid within the vesicles of the rash, or by testing blood for evidence of an acute immunologic response.

Vesicular fluid can be examined with a Tzanck smear, or better by testing for direct fluorescent antibody. The fluid can also be "cultured", whereby attempts are made to grow the virus from a fluid sample. Blood tests can be used to identify a response to acute infection (IgM) or previous infection and subsequent immunity (IgG)

Pathophysiology

Exposure to VZV in a healthy child initiates the production of host immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA) antibodies; IgG antibodies persist for life and confer immunity. Cell-mediated immune responses are also important in limiting the scope and the duration of primary varicella infection. After primary infection, VZV is hypothesized to spread from mucosal and epidermal lesions to local sensory nerves. VZV then remains latent in the dorsal ganglion cells of the sensory nerves. Reactivation of VZV results in the clinically distinct syndrome of herpes zoster (i.e., shingles), postherpetic neuralgia and sometimes Ramsay Hunt syndrome type II

Prevention

The spread of chickenpox can be prevented by isolating affected individuals. Contagion is by exposure to respiratory droplets, or direct contact with lesions, within a period lasting from three days prior to the onset of the rash, to four days after the onset of the rash.The chickenpox virus is susceptible to disinfectants, notably chlorine bleach (i.e., sodium hypochlorite). Also, like all enveloped viruses, it is sensitive to desiccation, heat and detergents.

Vaccine

A varicella vaccine was first developed by Michiaki Takahashi in 1974 derived from the Oka strain. It has been available in the US since 1995 to inoculate against the disease. Some countries require the varicella vaccination or an exemption before entering elementary school. Protection from one dose is not lifelong and a second dose is necessary five years after the initial immunization,which is currently part of the routine immunization schedule in the US.The chickenpox vaccine is not part of the routine childhood vaccination schedule in the UK. In the UK, the vaccine is currently only offered to people who are particularly vulnerable to chickenpox. A vaccinated person is likely to have a milder case of chickenpox if infected

Prognosis

The duration of the visible blistering caused by varicella zoster virus varies in children usually from 4 to 7 days, and the appearance of new blisters begins to subside after the 5th day. Chickenpox infection is milder in young children, and symptomatic treatment, with sodium bicarbonate baths or antihistamine medication may ease itching, it is recommended to keep new infants from birth till 6 months of age away from an infected person for 10 to 21 days as their immune systems are not developed enough to handle the stress it can bring on.

Epidemiology

Primary varicella occurs in all countries worldwide. Varicella has a prevalence that is stable from generation to generation. As of 2010 it caused about 6,800 deaths, down from 11,200 in 1990.

In temperate countries, chickenpox is primarily a disease of children, with most cases occurring during the winter and spring, most likely due to school contact. It is one of the classic diseases of childhood, with the highest prevalence in the 4–10 year old age group. Like rubella, it is uncommon in preschool children. Varicella is highly communicable, with an infection rate of 90% in close contacts. In temperate countries, most people become infected before adulthood, and 10% of young adults remain susceptible.

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