When it comes to most illnesses people do their best to protect themselves and their loved ones from infection. However, this is often not the case where the varicella zoster virus (VZV), or chicken pox, is concerned.
Dr Pete Vincent of Netcare Travel Clinics and Medicross Family Medical and Dental Centre, Tokai, explains that once a person has had this disease they are immune to it for the rest of their life. It is for this reason that many parents take exception to the rule of protecting their children from illness, allowing and even encouraging them to catch chicken pox so that they do not have to suffer from it as adults.
“Chicken pox is a highly infectious virus that is generally a mild disease in children but can have serious complications in infants, teenagers, adults and those with compromised immune systems,” says Dr Vincent.
“The death rate from VZV in children is low - below two in every 100 000, but in adults the likelihood of death grows by 15 times. Potentially serious complications that can occur with chicken pox include secondary bacterial infections of the skin lesions, viral pneumonia, cerebellar ataxia and acute encephalitis. Such illnesses also pose a threat to immunocompromised patients such as those with cancer or HIV/AIDS,” he adds.
“Although it is rare, severe complications can occur in seemingly healthy children too such as inflammation of the kidneys, liver, pancreas, testes and heart muscle as well as a number of other conditions. Chicken pox is particularly dangerous for pregnant women and can have a hugely negative impact on the health of both mother and baby.”
Named for its most characteristic symptom, chicken pox is infamous for the red skin lesions or spots that present on the skin of the infected, causing a considerable amount of itching and discomfort. These lesions can appear on isolated parts of the body including inside the mouth but are usually found on the face and torso. Chicken pox usually lasts from four to seven days and typically presents with one to two days of low-grade fever and headache before the skin lesions start appearing in three or more waves, resolving in scabs.
According to Dr Vincent this highly infectious virus is transmitted from person to person contact, inhalation of infected particles from skin lesions or from droplets coughed or sneezed into the air. The virus enters the body through the upper respiratory system. One remains infectious from before the rash breaks out until the last scab falls off.
Chicken pox infections peak in winter and early spring. In the tropics it tends to occur at older ages making adults more susceptible than in more temperate climates.
“Fever and headache with chicken pox is best treated with paracetamol or ibuprofen as the use of aspirin can cause Reye’s syndrome, a severe and often fatal metabolic disease, advises Dr Vincent. Interestingly, although no adverse events following the use of aspirin related products have occurred, after vaccination the manufacturers recommend that vaccine recipients avoid aspirin for six weeks after having the vaccine.
“Itching due to skin lesions can be treated with warm oatmeal baths and topical ointments such as Caladryl cream. Cool and wet compresses can also soothe itchy areas of the skin. Antihistamines can relieve itching as well. Ask your doctor to recommend the medication that is best suited to your needs.
“It is very important to keep nails trimmed short during the itching period to prevent deep scratching as even if you tell your child not to scratch or you yourself try not to, the temptation is inevitably too great. Scratching the lesions spreads infection and must be controlled. It can also lead to permanent scarring once the patient has recovered. If necessary put mittens on very little children to stop them from scratching,” he says.
In a small number of children and in many adult cases antibiotics may be required for the treatment of secondary conditions. Hospitalisation can be necessary in severe instances of infection. Fortunately anti viral medication is available which can be used in severe cases and in any patient that develops a cough.
“Parents will also find it helpful in the treatment of children to provide plenty of entertainment such as books, music, games, puzzles and DVDs as they often become bored with having to stay at home and indoors for days at a time,” recommends Dr Vincent.
Active encouragement of infection
Because chicken pox is in the majority of cases a mild illness in children yet a potentially dangerous illness in adults, many parents believe that it is beneficial to actively encourage infection. The most common way of doing this is by ensuring that their child mingles with another child who is known to have chicken pox.
However, some parents find it difficult to willingly allow their child to become ill. It is also argued that although rare, there can be instances where serious, life-threatening complications develop from chicken pox.
The Varicella-zoster virus vaccine is a live attenuated vaccine that was introduced in South Africa in March 2002. It is not yet considered one of the essential childhood vaccines such as the Measles Mumps Rubella (MMR) vaccine. The VZV vaccine can be administered at the same time as MMR. However, if they are not given at the same time then there must be at least a four-week gap between the two as they are both live vaccines.
The VZV vaccine can prevent chicken pox or lessen the severity of symptoms. It can be administered to exposed individuals greater than 12 months of age as soon as possible within 72 hours and possibly up to 120 hours after exposure. This can prevent or modify the disease.
Women known to be pregnant or attempting to become pregnant should not receive the vaccine. Pregnancy should be avoided for a month following varicella vaccination. Breastfeeding is not a contra indication to the vaccine.
Dr Vincent says that vaccinating against chicken pox is effective in 70 to 90% of cases. Where breakthrough infections do occur symptoms are mild in 80% of cases often presenting with no more than 50 skin lesions.
Relatives and close friends of individuals with compromised immune systems are advised to have the VZV vaccine if they are likely to come into contact with the disease, such as siblings of children undergoing chemotherapy. It is however not advisable for immunocompromised individuals themselves.
“Vaccination can be a worthwhile alternative for those healthy individuals who did not contract the disease as a child and who wish to prevent severe infection as an adult,” concludes Dr Vincent.
(Martina Nicholson Associates on behalf of Netcare Travel Clinics, July 2010)