Chickenpox

What is chickenpox?

Chickenpox is an acute infectious rash disease caused by the varicella-zoster virus. It is one of the most common contagious diseases in childhood and is characterized by fever and a typical itchy, blister-like rash on the skin. Recovery usually results in lasting immunity. However, the virus remains in the body in a latent ("dormant") state and can reactivate years later in the form of another condition—herpes zoster (shingles).

What are the symptoms, and how can we recognize it?

The illness most often begins with:

• fever
• fatigue
• headache
• loss of appetite

This is followed by the characteristic, intensely itchy rash. It goes through several stages:

• small red spots
• raised bumps
• blisters filled with clear fluid
• crusts

It is typical for chickenpox that different stages of the rash can be observed on the skin at the same time. The rash usually starts on the face, scalp, and torso, then spreads over the entire body.

How does the infection spread, is there seasonality, and which age groups are most at risk?

Chickenpox is a highly contagious infection. It is transmitted:

• via airborne droplets (coughing and sneezing)
• through direct contact with skin blisters

The contagious period begins 1–2 days before the rash appears and lasts until all blisters have crusted over. The incubation period is 10–21 days.

The disease is more common in late winter and spring. It most frequently affects children between the ages of 2 and 10, especially those attending daycare centers and schools.

How does the disease progress?

In most cases, chickenpox is mild in healthy children.

The rash appears in successive "waves" over 3–5 days, and the total duration of the illness is usually 7–10 days. Each blister gradually dries out and forms a crust. The itching can be very intense and is often the primary source of discomfort for the child.

In some cases, the course of the disease is severe and accompanied by complications. Children with weakened immune systems and adults are at a higher risk of severe illness. Pregnant women can also experience severe symptoms, which poses risks to the baby, such as malformations or neonatal chickenpox.

What is the treatment?

In most cases, treatment is symptomatic, as the disease is self-limiting.

The main measures include:

• fever-reducing medications
• anti-itch treatments
• adequate fluid intake
• maintaining good skin hygiene

It is important not to use aspirin in children, as it can cause a rare but serious complication known as Reye's syndrome.

For children at risk of complications or those with a more severe course of the disease, we prescribe antiviral treatment.

What are the most common mistakes parents make?

The most common mistakes are:

• scratching the blisters, which increases the risk of scarring and bacterial infection
• using inappropriate medications without a doctor's recommendation
• failure to follow quarantine
• insufficient fluid intake

It is important to keep the child's nails trimmed short to reduce the risk of scratching.

What are the possible complications?

In rare cases, the following may occur:

• bacterial skin infection
• pneumonia
• inflammation of the brain (encephalitis)
• dehydration
• sepsis

Is there any prevention?

Yes. There is an effective chickenpox vaccine that is well-known to pediatricians.

The vaccine is proven to be effective and significantly reduces the risk of infection. If a vaccinated child does contract the virus, the illness is usually much milder.

Tips from Dr. Malinova - how can we help the child?

The most important thing is to ensure the child's comfort and peace:

1. Ensure rest and plenty of fluids.
2. Monitor the temperature and use an appropriate antipyretic if needed.
3. Maintain good skin hygiene.
4. Trim the nails to avoid scratching.
5. Seek medical attention if you experience a high fever, severe fatigue, or signs of complications.

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Author: Dr. Vasilka Malinova, Pediatrician and Pediatric Nephrologist, First Children's Consultative Clinic, Sofia

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