Difference between revisions of "Chickenpox" - New World Encyclopedia

From New World Encyclopedia
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{{Claimed}}{{Contracted}}
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{{DiseaseDisorder infobox |
 
{{DiseaseDisorder infobox |
 
   Name        = Chickenpox |
 
   Name        = Chickenpox |
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   ICD10      = B01 |
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  Image      = Child with chickenpox.jpg |
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  Caption    = Child with varicella disease |
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   ICD10      = {{ICD10|B|01| |b|00}} |
 
   ICD9        = {{ICD9|052}} |
 
   ICD9        = {{ICD9|052}} |
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  DiseasesDB    = 29118 |
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  ICDO          = |
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  OMIM          = |
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  MedlinePlus    = 001592 |
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  eMedicineSubj  = ped |
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  eMedicineTopic = 2385 |
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  eMedicine_mult = {{eMedicine2|derm|74}}, {{eMedicine2|emerg|367}} |
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  MeshName      = Chickenpox |
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  MeshNumber    = C02.256.466.175 |
 
}}
 
}}
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'''Chickenpox''', also spelled '''chicken pox''', is the common name for ''Varicella zoster'', classically one of the childhood infectious diseases caught and survived by almost every child.
  
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'''Chickenpox''', also spelled '''chicken pox''', is the common name for ''Varicella simplex'', classically one of the childhood infectious diseases caught and survived by most children.
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Chickenpox is caused by the [[varicella-zoster virus]] (VZV), also known as human herpes virus 3 (HHV-3), one of the eight [[Herpesviridae|herpes viruses]] known to affect humans. It starts with [[conjunctival]] and [[catarrhal]] symptoms and then characteristic spots appearing in two or three waves, mainly on the body and head rather than the hands and becoming itchy raw [[pox]] (pocks), small open sores which heal mostly without scarring.
  
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Chickenpox is caused by the [[varicella-zoster virus]] (VZV), also known as human herpes virus 3 (HHV-3), one of the eight [[Herpesviridae | herpes viruses]] known to affect humans. It starts with conjunctival and catarrhal symptoms, moderate [[fever]] and then characteristic spots appearing in two or three waves, mainly on the body and head rather than the hands and becoming itchy raw [[pox]] (pocks), small open sores which heal mostly without scarring.
+
Chickenpox has a 10-14 day incubation period and is highly contagious through physical contact two days before symptoms appear. Following primary infection there is usually lifelong protective immunity from further episodes of chickenpox. Recurrent chickenpox, commonly known as [[shingles]], is fairly rare but more likely in people with compromised immune systems.
  
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==Effects==
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Chickenpox is rarely fatal (usually from varicella [[pneumonia]]), with pregnant women and those with a suppressed immune systems being more at risk. Pregnant women not known to be immune and who come into contact with chickenpox may need urgent treatment as the virus can cause serious problems for the baby. This is less of an issue after 20 weeks.
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[[Image:Child with chickenpox.jpg|right|250px|thumb|Child with varicella disease.]]
 
  
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Chickenpox has a two-week incubation period and is highly contagious by air transmission two days before symptoms appear.  Therefore, chickenpox spreads quickly through schools and other places of close contact.  Once someone has been infected with the disease, they usually develop protective immunity for life. It is fairly rare to get the chickenpox multiple times, but it is possible for people with irregular immune systems. As the disease is more severe if contracted by an adult, parents have been known to ensure their children become infected before adulthood.  
+
Later in life, viruses remaining dormant in the nerves can reactivate causing localised eruptions of [[shingles]]. This occurs particularly in people with compromised immune systems, such as the elderly, and perhaps even those suffering sunburn. Unlike chickenpox which normally fully settles, shingles may result in persisting [[post-herpetic neuralgia]] pain.
  
−
The disease can be fatal. Pregnant women and those with immune system depression are more at risk.  Death is usually from varicella [[pneumonia]]. In the US, 55 percent of chickenpox deaths were in the over-20 age group.  Pregnant women not known to be immune and who come into contact with chickenpox should contact their doctor immediately, as the virus can cause serious problems for the [[fetus]]. In the UK Varicella antibodies are measured as part of the routine of prenatal care, and by 2005 all NHS healthcare personnel had determined their immunity and been immunised if they were non-immune and have direct patient contact.  
+
==Signs and Symptoms==
 +
Chickenpox is a highly contagious disease that spreads from person to person by direct contact or through the air from an infected person's coughing or sneezing. Touching the fluid from a chickenpox blister can also spread the disease. A person with chickenpox is contagious from 1-2 days before the rash appears until all blisters have formed scabs. This may take 5-10 days.<!--
 +
  —><ref name="DermNet NZ">{{cite web | author=New Zealand Dermatological Society | title=Chickenpox (varicella) | url=http://www.dermnetnz.org/viral/varicella.html | date=14 Jan 2006 | accessdate=2006-08-18}}</ref>
 +
It takes from 10-21 days after contact with an infected person for someone to develop chickenpox.<!--
 +
  —><ref name="CDCP-diseaseFAQs">{{cite web | work=Varicella Disease (Chickenpox) | title=General questions about the disease | url=http://www.cdc.gov/nip/diseases/varicella/faqs-gen-disease.htm | date=December 2 2001 | publisher=CDCP | accessdate=2006-08-18}}</ref>
  
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Later in life, [[virus]]es remaining in the nerves can develop into the painful disease [[shingles]], particularly in people with compromised immune systems, such as the elderly, and perhaps even those suffering [[sunburn]]. Some of these will develop zoster-associated pain or post-herpetic neuralgia, described usually as "horrible" or "excruciating". A chickenpox [[vaccine]] has been available since [[1995]], and is now required in some countries for children to be admitted into elementary school. In addition, effective medications (e.g. [[aciclovir]]) are available to treat chickenpox in healthy and [[immunocompromised]] persons.
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The chickenpox lesions (blisters) start as a 2&ndash;4 mm red papule which develops an irregular outline (rose petal). A thin-walled, clear vesicle (dew drop) develops on top of the area of redness. This "dew drop on a rose petal" lesion is very characteristic for chickenpox. After about 8&ndash;12 hours the fluid in the vesicle gets cloudy and the vesicle breaks leaving a crust. The fluid is highly contagious, but once the lesion crusts over, it is not considered contagious. The crust usually falls off after 7 days sometimes leaving a crater-like scar. Although one lesion goes through this complete cycle in about 7 days, another hallmark of chickenpox is the fact that new lesions crop up every day for several days. Therefore, it may take about a week until new lesions stop appearing and existing lesions crust over. Children are not to be sent back to school until all lesions have crusted over.<!--
 +
  —><ref>{{cite web | author=Heather Brannon | title=Chicken Pox - Varicella Virus Infection | url=http://dermatology.about.com/cs/chickenpox/a/chickenpox.htm | date=December 25, 2005 | accessdate=2006-08-18}}</ref>
  
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Symptomatic treatment&mdash;[[calamine lotion]] to ease itching and [[paracetamol]] to reduce fever&mdash;is widely used.  Aspirin is contraindicated in children,  as it can lead to [[Reye's syndrome]].
+
Second infections with chickenpox occur in immunocompetent individuals, but are uncommon. Such second infections are rarely severe.  A soundly-based conjecture being carefully assessed in countries with low [[prevalence]] of chickenpox due to immunisation, low birth rates, and increased separation is that immunity has been reinforced by subclinical challenges and this is now less common.  This is more dangerous with [[shingles]].  There have been reported cases of repeat infections.<!--
 +
  —><ref>{{cite web | title=Definition of Chickenpox | url=http://www.medterms.com/script/main/art.asp?articlekey=2702 | publisher=MedicineNet.com | accessdate=2006-08-18}}</ref><!--Chickenpox is a rash caused by a virus. The chickenpox rash usually appears less than two weeks after exposure to the virus and begins as superficial spots. These spots quickly turn into small liquid-filled blisters that break open and crust over. New spots continue to appear for several days and may number in the hundreds. Itching may range from mild to intense.
 +
The course of chickenpox will vary with each child, but a child generally will be sick with chickenpox for about 4-7 days.  New blisters usually stop appearing by the 5th day, most are crusted by the 6th day, and most scabs are gone within 20 days after the rash begins. If complications set in, however, the recovery period may be even longer.
  
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==History==
 
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One history of medicine book claims [[Giovanni Filippo]] ([[1510]]&ndash;[[1580]]) of [[Palermo]] the first description of varicella (chickenpox).  Subsequently in the [[1600s]], an [[United Kingdom|English]] physician named Richard Morton described what he thought was a mild form of [[smallpox]] as "chicken pox."  Later, in [[1767]], a physician named [[William Heberden]], also from England, was the first physician to clearly demonstrate that chickenpox was different from smallpox.  However, it is believed the name chickenpox was commonly used in earlier centuries before doctors identified the disease.
 
  
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There are many explanations offered for the origin of the name chickenpox:
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These are the most common symptoms of chicken pox:
 +
o Mild fever. The fever varies between 101-o F to 105-o F and returns to normal when the blisters have disappeared.
 +
o backache
 +
o headache
 +
o sore throat
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o a rash (red spots)
 +
o blisters filled with fluid
  
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* the specks that appear looked as though the skin was picked by chickens,
+
  —><ref>{{cite web | author=American Academy of Pediatrics | title=Varicella Immunization | url=http://www.cispimmunize.org/fam/chpox/chpximm.html | publisher=CDCP | accessdate=2006-08-18}}</ref>Chickenpox is highly contagious and is spread through the air when infected people cough or sneeze, or through physical contact with fluid from lesions on the skin.  Zoster, also known as shingles, is a reactivation of chickenpox and may also be a source of the virus for susceptible children and adults. It is not necessary to have physical contact with the infected person for the disease to spread.  Those infected can spread chickenpox before they know they have the disease - even before any rash develops. In fact, people with chickenpox can infect others from about 2 days before the rash develops until all the sores have crusted over, usually 4-5 days after the rash starts.  
−
* the disease was named after [[Chickpea|chick pea]]s, from a supposed similarity in size of the seed to the lesions
 
−
* [[Samuel Johnson]] suggested that the disease was "no very great danger," thus a "chicken" version of the pox
 
−
* the term reflects a corruption of the Old English word, "giccin", which meant "itching"
 
−
 
 
−
As "pox" also means curse, in medieval times some believed it was a plague brought on to curse children by the use of black magic.
 
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During the medieval era, oatmeal was discovered to soothe the sores, and oatmeal baths are today still commonly given to relieve itching.
 
−
 
 
−
In 1998, Dr. Charles F. Grose and Dr. Richard Santos discovered a Mutant form of Chickenpox. This is phenotypic ally different from VZV 32, which is the wild type. The Mutant forms of viruses can often be attributed to contamination of the wild-type in nature. Mutant forms are becoming more frequent with time.
 
−
 
 
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==Infection==
 
−
Chickenpox is highly infectious and spreads from person to person by direct contact or through the air from an infected person’s coughing or sneezing. Touching the fluid from a chickenpox blister can also spread the disease. A person with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs. This may take between 5-10 days.[http://www.dermnetnz.org/viral/varicella.html] It takes from 10-21 days after contact with an infected person for someone to develop chickenpox.<!--
 
−
  —>[http://www.cdc.gov/nip/diseases/varicella/faqs-gen-disease.htm]
 
−
 
 
−
The chickenpox lesions (blisters) start as a 2-4 mm red papule which develops an irregular outline (rose petal). A thin-walled, clear vesicle (dew drop) develops on top of the area of redness. This "dew drop on a rose petal" lesion is very characteristic for chickenpox. After about 8-12 hours the fluid in the vesicle gets cloudy and the vesicle breaks leaving a crust. The fluid is highly contagious, but once the lesion crusts over, it is not considered contagious. The crust usually falls off after 7 days sometimes leaving a craterlike scar. Although one lesion goes through this complete cycle in about 7 days, another hallmark of chickenpox is the fact that new lesions crop up every day for several days. Therefore, it may take about a week until new lesions stop appearing and existing lesions crust over. Children are not sent back to school until all lesions have crusted over.<!--
 
−
  —>[http://dermatology.about.com/cs/chickenpox/a/chickenpox.htm]
 
−
 
 
−
 
 
−
Second infections with chickenpox occur in immunocompetent individuals, but are uncommon. Such second infections are rarely severe.  A soundly-based conjecture being carefully assessed in countries with low [[prevalence]] of chickenpox due to immunisation, low birth rates, and increased separation is that immunity has been reinforced by sub-clinical challenges and this is now less common. This is more dangerous with [[shingles]].  There have been reported cases of repeat infections.<!--
 
−
  —>[http://www.medterms.com/script/main/art.asp?articlekey=2702]<!--
 
−
  —>[http://www.cispimmunize.org/fam/chpox/chpximm.html]
 
  
 
===Congenital defects in babies===
 
===Congenital defects in babies===
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These may occur if the child's mother was exposed to VZV during pregnancy. Effects to the fetus may be minimal in nature but physical deformities range in severity from under developed toes and fingers, to severe anal and bladder malformation. Possible problems include:
+
These may occur if the child's mother was exposed to VZV during pregnancy. Effects on the fetus may be minimal in nature but physical deformities range in severity from under developed toes and fingers, to severe anal and bladder malformation. Possible problems include:
 
* Damage to brain: [[encephalitis]], [[microcephaly]], [[hydrocephaly]], [[aplasia]] of brain
 
* Damage to brain: [[encephalitis]], [[microcephaly]], [[hydrocephaly]], [[aplasia]] of brain
−
* Damage to the eye (optic stalk, optic cup, and lens vesicles), [[microphthalmia]], [[cataracts]], [[chorioretinitis]], [[optic atrophy]].  
+
* Damage to the eye (optic stalk, optic cap, and lens vesicles), [[microphthalmia]], [[cataracts]], [[chorioretinitis]], [[optic atrophy]].  
 
* Other neurological disorder: damage to cervical and lumbosacral [[spinal cord]], motor/sensory deficits, absent deep [[tendon reflex]]es, anisocoria/[[Horner's syndrome]]
 
* Other neurological disorder: damage to cervical and lumbosacral [[spinal cord]], motor/sensory deficits, absent deep [[tendon reflex]]es, anisocoria/[[Horner's syndrome]]
 
* Damage to body: [[hypoplasia]] of upper/lower extremities, anal and bladder [[sphincter]] dysfunction
 
* Damage to body: [[hypoplasia]] of upper/lower extremities, anal and bladder [[sphincter]] dysfunction
−
* Skin disorders: zig zag ([[cicatricial]]) skin lesions, [[hypopigmentation]]
+
* Skin disorders: ([[cicatricial]]) skin lesions, [[hypopigmentation]]
  
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==Vaccination==
+
==Prognosis and treatment==
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Japan was among the first countries to routinely vaccinate for chickenpox. Routine vaccination against varicella zoster virus is also performed in the [[United States]], and the incidence of chickenpox has been dramatically reduced there (from 4 million cases per year in the pre-vaccine era to approximately 400,000 cases per year as of 2005). In [[Europe]] most countries do not currently vaccinate against varicella, though the vaccine is gaining wider acceptance. Australia, Canada, and other countries have now adopted recommendations for routine immunization of children and susceptible adults against chickenpox. Other countries, such as Germany and The United Kingdom have targeted recommendations for the vaccine, e.g. for susceptible health care workers at risk of varicella exposure.
+
Chickenpox infection tends to be milder the younger a child is and symptomatic treatment, with  a little [[sodium bicarbonate]] in baths or [[antihistamine]] medication to ease itching,<ref>{{cite journal |author=Somekh E, Dalal I, Shohat T, Ginsberg''''' GM''''', Romano O |title=The burden of uncomplicated cases of chickenpox in Israel |journal=J. Infect. |volume=45 |issue=1 |pages=54-7 |year=2002 |pmid=12217733 |doi=}}</ref> and [[paracetamol]] (acetaminophen) to reduce fever, are widely used. Ibuprofen can also be used on advice of a doctor. There is no evidence to support the topical application of [[calamine lotion]], a topical barrier preparation containing zinc oxide in spite of its wide usage and excellent safety profile.<ref>{{cite journal |author=Tebruegge M, Kuruvilla M, Margarson I |title=Does the use of calamine or antihistamine provide symptomatic relief from pruritus in children with varicella zoster infection? |journal=Arch. Dis. Child. |volume=91 |issue=12 |pages=1035-6 |year=2006 |pmid=17119083 |doi=10.1136/adc.2006.105114 |url=http://adc.bmj.com/cgi/content/extract/91/12/1035 |format-Abstract}}</ref>.
−
   
 
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Chickenpox is most often a mild disease, especially for children. Prior to the introduction of vaccine, there were around 4,000,000 cases per year in the US, mostly children, with typically 100 or fewer deaths. Though mostly children caught it, the majority of deaths (by as much as 80%) were among adults. Additionally, chickenpox involved the hospitalization of about 10,000 people each year.<!--
 
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  —>[http://www.who.int/vaccines/en/varicella.shtml]
 
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During 2003 and the first half of 2004, the CDC reported eight deaths from varicella, six of whom were children or adolescents. These deaths and hospitalizations have substantially declined in the US due to vaccination,<!--
 
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  —><ref name="Seward2002">{{cite journal | author=Seward JF, Watson BM, Peterson CL, ''et al.'' | title=Varicella disease after introduction of varicella vaccine in the United States, 1995&ndash;2000 | year=2002 | journal=JAMA | volume=287 | issue=5 | pages=606&ndash;11 | id=PMID 11829699 | url=http://jama.ama-assn.org/cgi/content/full/287/5/606 | accessdate=2006-05-01 }}</ref><!--
 
−
  —><ref name="Nguyen2005">{{cite journal | author=Nguyen HQ, Jumaan AO, Seward JF | title=Decline in mortality due to varicella after implementation of varicella vaccination in the United States | journal=N Engl J Med | year=2005 | volume=352 | pages=450&ndash;8 | id=PMID 15689583 | url=http://content.nejm.org/cgi/content/abstract/352/5/450 | accessdate=2006-05-01 }}</ref><!--
 
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—> though the rate of shingles infection has increased for the same reason. The vaccine has more recently been determined to be effective at preventing shingles (zoster) in persons 60 years of age and older, if administered regularly.<!--
 
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  —><ref name="Oxman2005">{{cite journal | author=Oxman MN, Levin MJ, Johnson GR, ''et al'' | title=A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults | journal=[[New England Journal of Medicine|N Engl J Med]] | year=2005 | volume=352 pages=2271&ndash;84 | id=PMID 15930418 }}</ref>
 
  
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The long-term duration of protection from varicella vaccine is unknown, but there are now persons vaccinated more than thirty years ago with no evidence of waning immunity, while others have become vulnerable in as few as 6 years. Assessments of duration of immunity are complicated in an environment where natural disease is still common, which typically leads to an overestimation of effectiveness, and we are only now entering an era in the US where the long-term efficacy of varicella vaccine can be accurately gauged.<!--
+
It is important to maintain good hygiene and daily cleaning of skin with warm water to avoid secondary bacterial infection.  [[Infection]] in otherwise healthy adults tends to be more severe and active; treatment with antiviral drugs (e.g. [[acyclovir]]) is generally advised. Patients of any age with depressed immune systems or extensive eczema are at risk of more severe disease and should also be treated with antiviral medication. In the U.S., 55 percent of chickenpox deaths are in the over-20 age group.
−
  —><ref name="Goldman2005">{{cite journal | author=Goldman GS | title=Universal varicella vaccination: efficacy trends and effect on herpes zoster | journal=Int J Toxicol| volume=24| issue=4 | year=2005 | pages=205&ndash;213 | id=PMID 16126614}}</ref>
 
  
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The vaccine is exceedingly safe: approximately 5% of children who receive the vaccine develop a fever or rash, but there have been no deaths yet (as of 1 May 2006) attributable to the vaccine despite more than 40 million doses being administered.<!--
+
==Vaccination==
−
   —><ref name="Wise2000">{{cite journal | author=Wise RP, Salive ME, Braun MM, ''et al.'' | title=Postlicensure safety surveillance for varicella vaccine | journal=JAMA | year=2000 | volume=284 | issue=10 | pages=1271&ndash;9 | id=PMID 10979114 }}</ref>
+
{{main|Varicella vaccine}}
−
Cases of vaccine-related chicken pox have been reported in patients with a weakened immune system,<!--
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A [[varicella vaccine]] has been available since 1995 to inoculate against the disease.  Some countries require the varicella vaccination or an exemption for [[matriculation]] in elementary school.  Protection is not lifelong and further vaccination is necessary five years after the initial immunization.<!--
−
  —><ref name="Wise2000"/><ref name="Quinlivan">{{cite journal | author=Quinlivan MA, Gershon AA, Nichols RA, La Russa P, Steinberg SP, Breuer J | title=Vaccine Oka Varicella-oster virus genotypes are monomorphic in single vesicles and polymorphic in respiratory tract secretions | year=2006 | journal=J Infect Dis | volume=193 | issue=7 | pages=927&ndash;30 | id=PMID 16518753 }}</ref><!--
+
   —><ref>{{cite journal | author=Chaves SS, Gargiullo P, Zhang JX, ''et al.'' | title=Loss of vaccine-induced immunity to varicella over time | journal=N Engl J Med | year=2007 | volume=356 | issue=11 | pages=1121&ndash;9 | id=PMID 17360990}}</ref>
−
—> but no deaths.
 
  
−
The literature contains several reports adverse reactions following varicella vaccination,<!--
+
In the UK, varicella antibodies are measured as part of the routine of prenatal care, and by 2005 all NHS healthcare personnel had determined their immunity and been immunised if they were non-immune and have direct patient contact. Population-based immunization against varicella is not otherwise practiced in the UK, because of lack of evidence of lasting efficacy or public health benefit.
−
  —><ref name="Ravkina1970">{{cite journal | author=Ravkina LI, Matsevich GR | title=Morphological changes in the central nervous system in post-vaccinal encephalomyelitis developing after chickenpox vaccination in children | journal=Zh Nevropatol Psikhiatr Im S S Korsakova | year=1970 | volume=70 | issue=10 | pages=1465&ndash;71 | id=PMID 4395233 }}</ref><ref name="Sunaga1995">{{cite journal | author=Sunaga Y, Hikima A, Ostuka T, Morikawa A | title=Acute cerebellar ataxia with abnormal MRI lesions after varicella vaccination | journal=Pediatr Neurol | year=1995 | volume=13 | issue=4 | pages=340&ndash;2 | id=PMID 8771172 }}</ref><!--
 
−
  —><ref name="Singer1999">{{cite journal | author=Singer S, Johnson CE, Mohr R, Holowecky C | title=Urticaria following varicella vaccine associated with gelatin allergy | journal=Vaccine | year=1995 | volume=17 | issue=4 | pages=327&ndash;9 | id=PMID 9987170}}</ref><!--
 
−
  —><ref name="Gerecitano1997">{{cite journal | author=Gerecitano J, Friedman-Kien A, Chazen GD | title=Allergic reaction to varicella vaccine | journal=Ann Intern Med | year=1997 | volume=126 | issue=10 | pages=833&ndash;4 | id=PMID 9148672}}</ref><!--
 
−
—><ref name="Sakaguchi1997">{{cite journal | author=Sakaguchi M, Yamanaka T, Ikeda K, Sano Y, Fujita H, Miura T, Inouye S | title=IgE-mediated systemic reactions to gelatin included in the varicella vaccine | journal=J Allergy Clin Immonol | year=1997 | volume=99 | issue=2 | pages=263&ndash;4 | id=PMID 9042057 }}</ref><!--
 
−
  —><ref name="Naruse1993">{{cite journal | author=Naruse H, Miwata H, Ozaki T, Asano Y, Namazue J, Yamanishi K | title=Varicella infection complicated with meningitis after immunization | journal=Acta Paediatr Jpn | year=1993 | volume=35 | issue=4 | pages=345&ndash;7 | id=PMID 8397466 }}</ref><!--
 
−
  —><ref name="Lee1986">{{cite journal | author=Lee SY, Komp DM, Andiman W | title=Thrombocytopenic Purpura following varicella-zoster vaccination | journal=Am J Pediatr Hematol Oncol | year=1986 | volume=8 | issue=1 | pages=78&ndash;80 | id=PMID 3013041 }}</ref><!--
 
−
  —><ref name="Wrensch2001">{{cite journal | author=Wrensch M, Weinberg A, Wiencke J, Miike R, Barger G, Kelsey K | title=Prevalence of antibodies to four herpesviruses among adults with glioma and controls | journal=Am J Epidem | year=2001 | volume=154 | issue=2 | pages=161&ndash;5 | id=PMID 11447050}}</ref><!--
 
−
  —><ref name="Naseri2003">{{cite journal | author=Naseri A, Good WV, Cunningham ET Jr | title=Herpes zoster virus sclerokeratitis and anterior uveitis in a child following varicella vaccination | journal=Am J Ophthalmol | year=2003 | volume=135 | issue=3 | pages=415&ndash;7 | id=PMID 12614776}}</ref><!--
 
−
  —><ref name="Esmaeli1999">{{cite journal | author=Esmaeli-Gutstein B, Winkelman JZ | title=Uveitis associated with varicella virus vaccine | journal=Am J Ophthalmol | year=1999 | volume=127 | issue=6 | pages=733&ndash;4 | id=PMID 10372892}}</ref><!--
 
−
  —><ref name="Schwab2004">{{cite journal | author=Schwab J, Ryan M | title=Varicella zoster virus meningitis in a previously immunized child | journal=Pediatrics | year=2004 | volume=114 | issue=2 | pages=e273&ndash;4 | id=PMID 15286270}}</ref><!--
 
−
  —><ref name="Bronstein2005">{{cite journal | author=Bronstein DE, Cotliar J, Votava-Smith JK, Powell MZ, Miller MJ, Cherry JD | title=Recurrent papular urticaria after varicella immunization in a 15-month-old girl | journal=Pediatr Infect Dis J | year=2005 | volume=24 | issue=3 | pages=269&ndash;70 | id=PMID 15750467}}</ref><!--
 
−
  —><ref name="Binder2005">{{cite journal | author=Binder NR, Holland GN, Hosea S, Silverberg ML | title=Herpes zoster ophthalmicus in an otherwise-healthy child | journal=J AAPOS | year=2005 | volume=9 | issue=6 | pages=597&ndash;8 | id=PMID 16414532}}</ref><!--
 
−
—> including vaccine-strain zoster in children and adults.<!--
 
−
  —><ref name="Matsubara1995">{{cite journal | author=Matsubara K, Nigami H, Harigaya H, Baba K | title=Herpes zoster in a normal child after varicella vaccination | journal=Acta Paediatr Jpn | year=1995 | volume=37 | issue=5 | pages=648&ndash;50 | id=PMID 8533598}}</ref><!--
 
−
  —><ref name="Hammerschlag1989">{{cite journal | author=Hammerschlag MR, Gershon AA, Steinberg SP, Clarke L, Gelb LD | title=Herpes zoster in an adult recipient of live attenuated varicella vaccine | journal=J Infect Dis | year=1989 | volume=160 | issue=3 | pages=535&ndash;7 | id=PMID 2547882 }}</ref>
 
−
A mean of 2,350 reports per year are attributed to varicella vaccine based on 20,004 cases reported to the Vaccine Adverse Event Reporting System (VAERS) database from May, 1995 through December, 2003.  Minor events are known to be under-reported reported to VAERS.
 
  
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== Controversy ==
+
==History==
−
Mortality due to primary varicella has declined significantly in countries which make wide use of the varicella vaccine.<!--
+
One history of medicine book credits [[Giovanni Filippo]] ([[1510]]&ndash;[[1580]]) of [[Palermo]] with the first description of varicella (chickenpox).  Subsequently in the [[1600s]], an [[United Kingdom|English]] physician named Richard Morton described what he thought  a mild form of [[smallpox]] as "chicken pox." Later, in [[1767]], a physician named [[William Heberden]], also from England, was the first physician to clearly demonstrate that chickenpox was different from smallpox.  However, it is believed the name chickenpox was commonly used in earlier centuries before doctors identified the disease.  
−
  —><ref name="Seward2002"/><!--
 
−
  —><ref name="Wise2000"/>
 
−
Zoster (shingles) occurs decades after varicella and unsurprisingly zoster incidence has not declined in multiple studies.  It is too early to observe the effect on [[postherpetic neuralgia]] (PHN).  
 
  
−
It has been claimed that shingles may increase after introduction of varicella vaccine.<!--
+
There are many explanations offered for the origin of the name ''chickenpox'':
−
  —><ref name="Yih2005">{{cite journal | author=Yih WK, Brooks DR, Lett SM, Jumaan AO, Zhang Z, Clements KM, Seward JF | title=The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccination coverage, 1998-2003 | journal=BMC Public Health | volume=5| issue=1 | year=2005 | pages=68-68 | id=PMID 15960856}}</ref><!--
 
−
  —>[http://www.herpesdoctor.com/node/506].
 
−
There is yet no evidence this has occurred, and it might occur in the absence of immunisation due to a general decrease in childhood infection for other reasons.<!--
 
−
  —><ref name="Brisson2002">{{cite journal | author=Brisson M, Gay NJ, Edmunds WJ, Andrews NJ | title=Exposure to varicella boosts immunity to Herpes-zoster: implications for mass vaccination against varicella | journal=Vaccine | year=2002 | volume=20 | pages=2500&ndash;7 | id=PMID 12057605 | doi=10.1016/S0264-410X(02)00180-9}}</ref>
 
  
−
Vaccination is common in the United States. 41 of the 50 states require immunization for children attending government-run schools.  The vaccination is not routine in the United Kingdom.  Debate continues in the UK on the time when it will be desirable to adopt routine chickenpox vaccination, and in the US opinions that it should be dropped, individually, or [[anti-vaccinationist|along with ''all'' immunizations]], are also voiced.  
+
* [[Samuel Johnson]] suggested that the disease was "no very great danger", thus a "chicken" version of the pox;
 +
* the specks that appear looked as though the skin was pecked by chickens;
 +
* the disease was named after [[Chickpea|chick pea]]s, from a supposed similarity in size of the seed to the lesions;
 +
* the term reflects a corruption of the Old English word ''giccin'', which meant ''itching''.
  
−
===Duration of immunity===
+
As "pox" also means curse, in medieval times some believed it was a plague brought on to curse children by the use of black magic.
−
Some vaccinated children have been found to lose their protective antibody in as little as five to eight years; however, according to the [[World Health Organization]]: "After observation of study populations for periods of up to 20 years in Japan and 10 years in the United States, more than 90% of immunocompetent persons who were vaccinated as children were still protected from varicella."<!--
 
−
  —>[http://www.who.int/vaccines/en/varicella.shtml]
 
−
As time goes on, boosters may be determined to be necessary, and introduced.  Persons infected after vaccine experience milder cases of chicken pox.<!--
 
−
  —>[http://www.cdc.gov/nip/vaccine/varicella/faqs-gen-vaccine.htm]
 
−
 
 
−
Catching wild chickenpox as a child has been thought to commonly result in lifelong immunity, indeed parents have deliberately ensured this in the past with "pox parties" (and similarly for some other diseases such as [[rubella]].  See below.)  Historically, exposure of adults to contagious children has boosted their immunity, reducing the risk of shingles.<!--
 
−
  —>[http://www.herpesdoctor.com/node/506]
 
−
Second episodes of chickenpox have been rare, but occur and probably more frequently in the UK latterly{{citation needed}}<!--it is an impresion, a clinical impression, but it needs checking and counting and not quoting AKM —> and definitely more frequently in the vaccine group. In one study, 30% of children had lost the antibody after five years, and 8% had already caught "wild" chickenpox in that five year period.<!--
 
−
  —>[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=121373]
 
−
 
 
−
<!-- immunocompromise is a different topic really —>
 
−
The CDC and corresponding national organisations are carefully observing the failure rate which may be high compared with other modern vaccines - large outbreaks of chickenpox having occurred at schools which required their children to be vaccinated.<!--
 
−
  —>[http://www.wfsb.com/Global/story.asp?S=1025686]<!--
 
−
  —>[http://pediatrics.aappublications.org/cgi/content/abstract/113/3/455]<!--
 
−
  —>[http://www.al.com/news/huntsvilletimes/index.ssf?/base/news/113464189674151.xml&coll=1]<!--
 
−
  —>[http://www.wpmi.com/news/state/story.aspx?content_id=90C8BF3E-0658-408B-80A8-E4854B229B45]<!--
 
−
  —>[http://health.yahoo.com/ency/healthwise/hw208205].
 
−
 
 
−
===Immunocompromise===
 
−
The mortality rate in immunocompromised patients with disseminated herpes zoster is 5-15%, with most deaths from pneumonia. Vaccines, unfortunately are less effective among these high-risk patients, as well as being more dangerous because it is an attenuated live virus (see last footnote), but clearly immunisation before immunocompromise would be desirable.
 
−
 
 
−
==Pox parties==
 
−
A "pox party" is a party held by parents for the purpose of infecting their children with childhood diseases. Similar ideas have applied to other diseases, e.g. [[measles]], but are now discouraged by doctors and health services. The rationale behind such parties is that guests exposed to the [[varicella]] virus will contract the disease and develop strong and persistent [[Immune system|immunity]], at an age before disaster is likely particularly from chickenpox or [[rubella]]. Such parties are now less common in mainstream communities. They are essentially a revival of primitive, pre-vaccination attempts at inoculation.
 
−
 
 
−
The first reference to such a practice is the [http://www.library.ucla.edu/libraries/biomed/smallpox/wortleyletter.html letter] of [[Mary Wortley Montagu|Lady Montagu]] to [[Sarah Chiswell]] describing the parties people in Istanbul made for the purpose of [[variolation]] - an effective technique for gaining immunity to [[smallpox]], which she imported to England.
 
  
−
Pox parties have been portrayed in TV cartoons, including [[South Park]] ("[[Chickenpox (South Park)|Chickenpox]]") and [[The Simpsons]] ("[[Milhouse of Sand and Fog]]").
+
From ancient times, [[neem]] has been used by [[India|Indians]] to alleviate the external symptoms of itching and to minimise scarring.  Neem baths (neem leaves and a dash of [[turmeric]] powder in water) are commonly given for the duration.
  
−
==See also==
+
During the medieval era, [[oatmeal]] was discovered to soothe the sores, and oatmeal baths are today still commonly given to relieve itching.
−
* [[Cowpox]]
 
−
* [[List of diseases]]
 
−
* [[List of vaccine-related topics]]
 
−
* [[Monkeypox]]
 
−
* [[Shingles]]
 
−
* [[Smallpox]]
 
−
* [[Vaccination schedule]]
 
−
* [[Vaccine controversy]]
 
  
 
==References==
 
==References==
−
    * Bernstein, Henry. Who Discovered Chickenpox?. Pediatrics Questions and Answers. Family Education Network. Retrieved on 2005-10-16.
+
* {{cite web | author=Bernstein, Henry | url=http://www.familyeducation.com/experts/advice/0,1183,25-26758,00.html | title=Who Discovered Chickenpox? | work=Pediatrics Questions and Answers | publisher=Family Education Network | accessdate=2005-10-16}}
−
    * Chickenpox (Varicella) Vaccine. Immunization Action Coalition: (October 2005). Retrieved on 2006-06-12.
+
* {{cite web | title=Chickenpox (Varicella) Vaccine | url=http://www.vaccineinformation.org/varicel/qandavax.asp | month=October | year=2005 | publisher=Immunization Action Coalition | accessdate=2006-06-12}}
−
    * U.S. Census Bureau. Countries Ranked by Population: 2006. International Data Base. Retrieved on 2005-10-16.
+
* {{cite web | author= U.S. Census Bureau | authorlink=United States Census Bureau | title=Countries Ranked by Popn: 2006 | url=http://www.census.gov/cgi-bin/ipc/idbrank.pl | work = International Data Base | accessdate=2005-10-16}}
−
    * Centers for Disease Control and Prevention (CDC) (2005). "Varicella-related deaths—United States, January 2003-June 2004." (PDF). MMWR Morb Mortal Wkly Rep 54 (11): 272-4. PMID 15788992.
+
* {{cite journal | author=Centers for Disease Control and Prevention (CDC) | authorlink=Centers for Disease Control and Prevention  | title=Varicella-related deaths—United States, January 2003-June 2004. | journal=MMWR Morb Mortal Wkly Rep | volume=54 | issue=11 | pages=272-4 | year=2005 | id=PMID 15788992 | url=http://www.cdc.gov/mmwr/PDF/wk/mm5411.pdf | format=PDF}}
−
    * Thomas S, Wheeler J, Hall A (2002). "Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study." (PDF). Lancet 360 (9334): 678-82. PMID 12241874.
+
* {{cite journal | author=Thomas S, Wheeler J, Hall A | title=Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study. | journal=Lancet | volume=360 | issue=9334 | pages=678-82 | year=2002 | id=PMID 12241874 | url=http://image.thelancet.com/extras/01art6088web.pdf | format=PDF}}
 +
* {{cite journal | author=Jeff Aronson | title=When I Use a Word...Chickenpox | journal=BMJ | volume=321 | issue=7262 | page=682 | year=2000 |  url=http://www.bmj.com/cgi/content/full/321/7262/682 | format=web}}
  
 
==Notes==
 
==Notes==
Line 159: Line 99:
  
 
==External links==
 
==External links==
−
* [http://www.cdc.gov/nip/diseases/varicella/default.htm CDC.gov] - 'Varicella Disease (Chickenpox): Varicella, although a common disease, can be dangerous and even deadly' [[Center for Disease Control]]
+
{{commonscat|Chickenpox}}
−
 
+
* {{cite web | title=Varicella Disease (Chickenpox): Varicella, although a common disease, can be dangerous and even deadly. | url=http://www.cdc.gov/vaccines/vpd-vac/varicella/default.htm | date=May 26, 2005 | publisher=[[Centers for Disease Control and Prevention|CDC]]}}
−
 
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*[http://www.assortedinformation.com/chickenpox How to tell you Have Chickenpox]
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{{credit|60988107}}
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{{Viral diseases}}
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[[Category:Life science]]
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{{credit|146373449}}
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[[Category:Life sciences]]
 

Revision as of 10:44, 2 August 2007


Chickenpox
Child with chickenpox.jpg

Child with varicella disease
ICD-10 B01
ICD-O:
ICD-9 052
OMIM [1]
MedlinePlus 001592
eMedicine ped/2385
DiseasesDB 29118

Chickenpox, also spelled chicken pox, is the common name for Varicella zoster, classically one of the childhood infectious diseases caught and survived by almost every child.

Chickenpox is caused by the varicella-zoster virus (VZV), also known as human herpes virus 3 (HHV-3), one of the eight herpes viruses known to affect humans. It starts with conjunctival and catarrhal symptoms and then characteristic spots appearing in two or three waves, mainly on the body and head rather than the hands and becoming itchy raw pox (pocks), small open sores which heal mostly without scarring.

Chickenpox has a 10-14 day incubation period and is highly contagious through physical contact two days before symptoms appear. Following primary infection there is usually lifelong protective immunity from further episodes of chickenpox. Recurrent chickenpox, commonly known as shingles, is fairly rare but more likely in people with compromised immune systems.

Chickenpox is rarely fatal (usually from varicella pneumonia), with pregnant women and those with a suppressed immune systems being more at risk. Pregnant women not known to be immune and who come into contact with chickenpox may need urgent treatment as the virus can cause serious problems for the baby. This is less of an issue after 20 weeks.

Later in life, viruses remaining dormant in the nerves can reactivate causing localised eruptions of shingles. This occurs particularly in people with compromised immune systems, such as the elderly, and perhaps even those suffering sunburn. Unlike chickenpox which normally fully settles, shingles may result in persisting post-herpetic neuralgia pain.

Signs and Symptoms

Chickenpox is a highly contagious disease that spreads from person to person by direct contact or through the air from an infected person's coughing or sneezing. Touching the fluid from a chickenpox blister can also spread the disease. A person with chickenpox is contagious from 1-2 days before the rash appears until all blisters have formed scabs. This may take 5-10 days.[1] It takes from 10-21 days after contact with an infected person for someone to develop chickenpox.[2]

The chickenpox lesions (blisters) start as a 2–4 mm red papule which develops an irregular outline (rose petal). A thin-walled, clear vesicle (dew drop) develops on top of the area of redness. This "dew drop on a rose petal" lesion is very characteristic for chickenpox. After about 8–12 hours the fluid in the vesicle gets cloudy and the vesicle breaks leaving a crust. The fluid is highly contagious, but once the lesion crusts over, it is not considered contagious. The crust usually falls off after 7 days sometimes leaving a crater-like scar. Although one lesion goes through this complete cycle in about 7 days, another hallmark of chickenpox is the fact that new lesions crop up every day for several days. Therefore, it may take about a week until new lesions stop appearing and existing lesions crust over. Children are not to be sent back to school until all lesions have crusted over.[3]

Second infections with chickenpox occur in immunocompetent individuals, but are uncommon. Such second infections are rarely severe. A soundly-based conjecture being carefully assessed in countries with low prevalence of chickenpox due to immunisation, low birth rates, and increased separation is that immunity has been reinforced by subclinical challenges and this is now less common. This is more dangerous with shingles. There have been reported cases of repeat infections.[4][5]Chickenpox is highly contagious and is spread through the air when infected people cough or sneeze, or through physical contact with fluid from lesions on the skin. Zoster, also known as shingles, is a reactivation of chickenpox and may also be a source of the virus for susceptible children and adults. It is not necessary to have physical contact with the infected person for the disease to spread. Those infected can spread chickenpox before they know they have the disease - even before any rash develops. In fact, people with chickenpox can infect others from about 2 days before the rash develops until all the sores have crusted over, usually 4-5 days after the rash starts.

Congenital defects in babies

These may occur if the child's mother was exposed to VZV during pregnancy. Effects on the fetus may be minimal in nature but physical deformities range in severity from under developed toes and fingers, to severe anal and bladder malformation. Possible problems include:

  • Damage to brain: encephalitis, microcephaly, hydrocephaly, aplasia of brain
  • Damage to the eye (optic stalk, optic cap, and lens vesicles), microphthalmia, cataracts, chorioretinitis, optic atrophy.
  • Other neurological disorder: damage to cervical and lumbosacral spinal cord, motor/sensory deficits, absent deep tendon reflexes, anisocoria/Horner's syndrome
  • Damage to body: hypoplasia of upper/lower extremities, anal and bladder sphincter dysfunction
  • Skin disorders: (cicatricial) skin lesions, hypopigmentation

Prognosis and treatment

Chickenpox infection tends to be milder the younger a child is and symptomatic treatment, with a little sodium bicarbonate in baths or antihistamine medication to ease itching,[6] and paracetamol (acetaminophen) to reduce fever, are widely used. Ibuprofen can also be used on advice of a doctor. There is no evidence to support the topical application of calamine lotion, a topical barrier preparation containing zinc oxide in spite of its wide usage and excellent safety profile.[7].

It is important to maintain good hygiene and daily cleaning of skin with warm water to avoid secondary bacterial infection. Infection in otherwise healthy adults tends to be more severe and active; treatment with antiviral drugs (e.g. acyclovir) is generally advised. Patients of any age with depressed immune systems or extensive eczema are at risk of more severe disease and should also be treated with antiviral medication. In the U.S., 55 percent of chickenpox deaths are in the over-20 age group.

Vaccination

A varicella vaccine has been available since 1995 to inoculate against the disease. Some countries require the varicella vaccination or an exemption for matriculation in elementary school. Protection is not lifelong and further vaccination is necessary five years after the initial immunization.[8]

In the UK, varicella antibodies are measured as part of the routine of prenatal care, and by 2005 all NHS healthcare personnel had determined their immunity and been immunised if they were non-immune and have direct patient contact. Population-based immunization against varicella is not otherwise practiced in the UK, because of lack of evidence of lasting efficacy or public health benefit.

History

One history of medicine book credits Giovanni Filippo (1510–1580) of Palermo with the first description of varicella (chickenpox). Subsequently in the 1600s, an English physician named Richard Morton described what he thought a mild form of smallpox as "chicken pox." Later, in 1767, a physician named William Heberden, also from England, was the first physician to clearly demonstrate that chickenpox was different from smallpox. However, it is believed the name chickenpox was commonly used in earlier centuries before doctors identified the disease.

There are many explanations offered for the origin of the name chickenpox:

  • Samuel Johnson suggested that the disease was "no very great danger", thus a "chicken" version of the pox;
  • the specks that appear looked as though the skin was pecked by chickens;
  • the disease was named after chick peas, from a supposed similarity in size of the seed to the lesions;
  • the term reflects a corruption of the Old English word giccin, which meant itching.

As "pox" also means curse, in medieval times some believed it was a plague brought on to curse children by the use of black magic.

From ancient times, neem has been used by Indians to alleviate the external symptoms of itching and to minimise scarring. Neem baths (neem leaves and a dash of turmeric powder in water) are commonly given for the duration.

During the medieval era, oatmeal was discovered to soothe the sores, and oatmeal baths are today still commonly given to relieve itching.

References
ISBN links support NWE through referral fees

Notes

  1. ↑ New Zealand Dermatological Society (14 Jan 2006). Chickenpox (varicella). Retrieved 2006-08-18.
  2. ↑ General questions about the disease. Varicella Disease (Chickenpox). CDCP (December 2 2001). Retrieved 2006-08-18.
  3. ↑ Heather Brannon (December 25, 2005). Chicken Pox - Varicella Virus Infection. Retrieved 2006-08-18.
  4. ↑ Definition of Chickenpox. MedicineNet.com. Retrieved 2006-08-18.
  5. ↑ American Academy of Pediatrics. Varicella Immunization. CDCP. Retrieved 2006-08-18.
  6. ↑ Somekh E, Dalal I, Shohat T, Ginsberg GM, Romano O (2002). The burden of uncomplicated cases of chickenpox in Israel. J. Infect. 45 (1): 54-7.
  7. ↑ Tebruegge M, Kuruvilla M, Margarson I (2006). Does the use of calamine or antihistamine provide symptomatic relief from pruritus in children with varicella zoster infection?. Arch. Dis. Child. 91 (12): 1035-6.
  8. ↑ Chaves SS, Gargiullo P, Zhang JX, et al. (2007). Loss of vaccine-induced immunity to varicella over time. N Engl J Med 356 (11): 1121–9. PMID 17360990.

External links

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