Chicken Pox


     Chicken Pox is a viral infection caused by the varicella-zoster virus, a type of
herpes virus. It is contracted by contact with actual lesions or by respiratory
secretions and there is a 10-21 day incubation period during which your child is
developing the illness but does not show any symptoms and is not contagious
(until the very last 1 or 2 days before the pox appear.). Once the vesicles show
up there are likely to be many more on the way for between 3 and 7 more days and
your child is contagious throughout this whole period until there are no new
lesions for at least 24 hours and the old lesions are dry or scabbed. This virus
is unusual in several ways, one way being that it settles into areas of the
nervous system and then potentially can reactivate as a localized painful rash
that follows a nerve path. This is known as herpes zoster (also referred to as

Shingles) and it is spread to anyone who has never had chicken pox only by
direct contact with the lesions (not by the respiratory route like the original
chicken pox infection). Zoster often occurs in elderly or run down or immune
compromised people and is not the result of exposure to a child with chicken pox
- it is a reactivation of one's own previous chicken pox infection, usually from
as far back as childhood. This becomes important to families when young children
with chicken pox are scheduled to visit grandparents and parents are concerned
that their elderly parents will "catch" pox from the grandchildren.

Chicken pox can be acquired any time during the year but is most prevalent in
winter and spring. 90-95% of Americans get chicken pox in childhood and often
from their own siblings. For unclear reasons, chicken pox is less common in
tropical climates and many adult immigrants are not protected from this
infection. Infection in adults is typically more severe and can be life
threatening. Almost all exposed children will develop a rash, described as
"dewdrops on rosebuds", although some children have so few lesions
that they may go unnoticed. Many children have a prodrome (sick period before
the actual obvious illness appears) that included fever, malaise, headache, poor
appetite, and mild abdominal pain. These symptoms may continue for 2-4 days
after the rash first appears. Usually the vesicles start on the face and scalp,
moving next to the trunk and then on to the extremities. They arrive in clumps
so that there are clusters of lesions in various stages around the body. The
average number of lesions is about 300 but as few as 10 and as many as 1500
lesions have been counted on one child! They begin as itchy raised red bumps
that soon become blister like with fluid inside and then "pop" or ooze
and then crust over. Second cases in the home are usually worse than the
original case and children with skin conditions such as excema are also prone to
worse outbreaks. The lesions can appear anywhere including the mouth, the vagina
, the anus, the eyes, and although painful, it rarely has serious outcome. The
healing lesions are hypopigmented for many weeks but pox rarely scar except when
badly gouged and infected secondarily with bacteria in the fingernails of the
"scratcher". An immune globulin called VZIG (varicella-zoster immune
globulin) is available for protection of immune compromised children, pregnant
women, and newborn infants exposed to maternal varicella right before or after

Chicken Pox is a viral infection caused by the varicella-zoster virus, a type of
herpes virus. It is contracted by contact with actual lesions or by respiratory
secretions and there is a 10-21 day incubation period during which your child is
developing the illness but does not show any symptoms and is not contagious
(until the very last 1 or 2 days before the pox appear.). Once the vesicles show
up there are likely to be many more on the way for between 3 and 7 more days and
your child is contagious throughout this whole period until there are no new
lesions for at least 24 hours and the old lesions are dry or scabbed. This virus
is unusual in several ways, one way being that it settles into areas of the
nervous system and then potentially can reactivate as a localized painful rash
that follows a nerve path. This is known as herpes zoster (also referred to as

Shingles) and it is spread to anyone who has never had chicken pox only by
direct contact with the lesions (not by the respiratory route like the original
chicken pox infection). Zoster often occurs in elderly or run down or immune
compromised people and is not the result of exposure to a child with chicken pox
- it is a reactivation of one's own previous chicken pox infection, usually from
as far back as childhood. This becomes important to families when young children
with chicken pox are scheduled to visit grandparents and parents are concerned
that their elderly parents will "catch" pox from the grandchildren.

Most children with chicken pox are at least mildly uncomfortable from the itchy
nature of the pox. Using soothing lotions and cool baths is helpful as is
keeping the fingernails short and antihistamines available for the worst nights.

Many over the counter bath solutions claim to help dry the pox and certainly
make the itching milder but be careful to only gently pat dry the rash so as not
to irritate the skin or spread virus particles to others. Keeping cool and clean
is very helpful for the comfort and safety of the child with pox. Keeping
entertained is another matter and some families have combined their sick
children to keep each other company. The risk of increasing the exposure for
other siblings and for spreading secondary bacterial infection between the
children make this a poor idea in general. Besides, sick children need to rest
and be encouraged to drink more fluids instead of becoming more active during
the illness. Staying out of doors and away from sun exposure also decreases the
chance of severe itching and scarring. Most children are back in school in a
week or so and have many fellow students to compare notes with. This is a very
common and usually manageable childhood illness.