Chickenpox in Adults and Teenagers

What are the symptoms of chickenpox?

Symptoms are usually more severe in adults than in children. You can expect to have a few uncomfortable days.

Fever (temperature), aches and headache often start a day or so before a rash appears.
Rash. Spots appear in crops. The spots develop into small blisters and are itchy. They can be anywhere on the body and sometimes also in the mouth. Several crops may develop over several days. Some people are covered in spots, others have only a few.
Dry cough, sore throat, and feeling sick are common.

The fever and generally feeling unwell can last several days. The blisters gradually dry up and scab. They slowly fade over a week or so, but may take 2-3 weeks to go completely. A dry cough may persist for a while after all the other symptoms have gone.

What is the treatment for chickenpox?

Symptomatic treatments

Treatments that may ease symptoms whilst your immune system deals with the virus include the following:

Have plenty to drink to avoid dehydration.
Take paracetamol or ibuprofen to ease fever, headaches, and aches and pains.
Calamine lotion put on the spots may ease itching.
Antihistamine tablets taken at bedtime may help you to sleep if itch is a problem at night. You can buy these at pharmacies, or get them on prescription.

Antiviral medication

Antiviral drugs such as acyclovir can limit the severity of chickenpox. These drugs do not kill the virus, but stop the virus from multiplying. Adults with chickenpox may be advised to take an antiviral drug – but only if the drug can be started within 24 hours of the rash first developing. If it is started after this time it is not likely to have much of an effect. So, if started on time, an antiviral drug may help to reduce the severity of the illness.

Antiviral medication is especially useful in situations where chickenpox can be more serious. For example, for people who have a poor immune system, newborn babies, and for pregnant women. (Note: antiviral medication is not normally advised for healthy children who develop chickenpox.)

Are there any complications?

The spots do not usually scar unless they are badly scratched.
In some cases, some spots become infected with bacteria. If this occurs the surrounding skin becomes red and sore. Antibiotics may then be needed.
Inflammation of the lung (pneumonia) is a rare complication affecting about 1 in 100 adults with chickenpox.
Inflammation of the brain (encephalitis) is a very rare complication.
Vary rarely, other serious complications develop. For example: myocarditis (inflammation of heart muscle), glomerulonephritis (kidney inflammation), appendicitis, hepatitis (inflammation of the liver), pancreatitis (inflammation of the pancreas), Henoch–Schönlein purpura (a condition that affects kidneys), orchitis (inflammation of the testes), arthritis, and inflammation of various parts of the eye.

Therefore, although serious complications are rare, it is best to be vigilant. See a doctor if you develop any worrying symptoms that you are unsure about such as:

Breathing problems.
Weakness.
Drowsiness.
Convulsions.
Pains or headaches which become worse despite paracetamol or ibuprofen.
Being unable to take fluids due to a severe rash in the mouth.
A very severe rash or a rash which bruises or bleeds into the skin (‘hemorrhagic rash’).
Becoming generally more and more unwell.

In general, complications are uncommon. However, some people have a higher risk of developing complications from chickenpox. Anyone in the following groups should see a doctor urgently if they have symptoms of chickenpox:

Pregnant women.
People with a poor immune system. For example, people with leukemia, with HIV/AIDS, taking steroid medication or chemotherapy.
People with heart or lung disease.
People with severe skin conditions.
Very young babies – especially those less than a month old (neonates).

Shingles

Shingles is caused by the same virus that causes chickenpox and so is like a complication of chickenpox. Anyone who has had chickenpox in the past may develop shingles. Shingles is an infection of a nerve and the area of skin supplied by the nerve. It causes a rash and pain in a ‘band’ along the affected nerve. About 1 in 5 people have shingles at some time in their life. It can occur at any age, but it is most common in people over the age of 50.

The reason why shingles may occur is because the virus does not completely go after you have chickenpox. Some virus particles remain inactive in the nerve roots next to your spinal cord. They do no harm there, and cause no symptoms. For reasons that are not clear, the virus may begin to multiply again (reactivate). This is often years later. The ‘re-activated’ virus travels along the nerve to the skin to cause shingles. See leaflet called ‘Shingles’ for details.

Chickenpox and pregnancy

If you are pregnant and have not had chickenpox (or been immunized) and come into contact with a person with chickenpox – see your doctor urgently. Chickenpox can be more serious if you develop chickenpox whilst pregnant. However, a treatment with a product called ‘immunoglobulin’ may prevent chickenpox from developing. See separate leaflet that deals with this in more detail called ‘Chickenpox Contact and Pregnancy.’

Is chickenpox infectious?

A person with chickenpox is very infectious. The virus spreads in the air from person to person. For example, if you have not already had chickenpox, you stand a good chance of catching it if:

you are in the same room as someone with chickenpox for more than 15 minutes, or
you have any ‘face to face’ contact with someone with chickenpox, such as a conversation.

It takes 11-20 days to develop symptoms after catching the virus (the ‘incubation period’).

Protecting others

A person with chickenpox is infectious from two days before the rash first appears until all the spots have crusted over (commonly about 5-6 days after the onset of the illness). You can usually return to work after this time if you feel well enough. Whilst you are infectious, keep away from people who have an increased chance of having a severe illness if they get chickenpox. These people are listed above under ‘complications’.

Healthy people who have not had chickenpox may also want to avoid catching it. So, friends and family who have not had chickenpox may wish avoid you whilst you are infectious. However, most adults and many children have already had chickenpox, and so are immune.

Note: people with chickenpox should not travel by air until six days after the last spot appeared.

Are you a healthcare worker?

Healthcare workers come into contact with people with poor immune systems, pregnant women and newborn babies. They should be aware that if they catch chickenpox, they can be infectious for two days before a rash or illness appears, and be a risk to patients. So, if you are a healthcare worker and come into contact with someone who has chickenpox (or who develops it within the next two days), then:

If you have been immunized against chickenpox, or have definitely had chickenpox in the past, you are likely to be immune. You should continue working, but contact your occupational health department if you feel unwell or develop a rash.
If you are uncertain about whether you have had chickenpox or been immunized, you should have a test to see if you are immune. If you are not immune you should:
- Avoid contact with high-risk patients for 8–21 days after contact with chickenpox.
- Report to occupational health before patient contact if you feel unwell or develop a fever or rash.
- Get immunized against the varicella zoster virus (chickenpox virus).

Is there a vaccine against chickenpox?

Yes, there is an effective vaccine that protects against the virus that causes chickenpox. It has become part of the routine childhood immunization programme in certain countries such as USA, Canada and Australia.

Currently, there are no plans to make immunization against chickenpox routine for children in the UK. In the UK, the vaccine is offered by the NHS to certain special groups. For example, to healthcare workers who are not immune to chickenpox. Also, to people who are not immune to chickenpox and who are in close contact with people with a poor immune system. For example, brothers and sisters of children who are on chemotherapy.

References

Chickenpox, Clinical Knowledge Summaries (January 2008)
Heininger U, Seward JF; Varicella. Lancet. 2006 Oct 14;368(9544):1365-76. [abstract]
Immunisation against infectious disease – ‘The Green Book’, Department of Health (various dates)
Guidelines on Chickenpox – (Varicella), Health Protection Agency (2008)

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