Chicken pox: course in children and adults, danger during pregnancy and vaccination in Tashkent

How it proceeds

The incubation period lasts from 10 to 21 days, so the sick person usually knows exactly where and when he encountered the infection - in a kindergarten group, in a classroom, or at home from an older child. In children, the disease often begins immediately with a rash; in adolescents and adults, it is preceded by fever, headache and fatigue by 1–2 days.

1. Сыпь появляется волнами, обычно 3–5 подсыпаний за несколько дней: сначала на лице и туловище, затем на конечностях, часто на волосистой части головы и во рту.
2. Каждый элемент проходит стадии: пятно, затем узелок, затем пузырёк с прозрачным содержимым, затем корочка.
3. Одновременно на коже видны элементы разного возраста — это ключевой признак, по которому ставят диагноз.
4. Основная жалоба — сильный зуд, из-за которого страдает сон и появляется соблазн расчёсывать пузырьки.
5. Корочки отпадают за 1–2 недели; рубцы остаются в основном там, где элементы были расчёсаны или инфицированы.

How many people are contagious?

Chickenpox is one of the most contagious infections in general: its ability to be transmitted is comparable to measles. This is important to understand when planning visits to relatives, visits to the clinic, and any events where pregnant women, infants, or people undergoing chemotherapy may be present.

• Contagiousness begins 1–2 days before the first bubbles appear, when a person still considers himself healthy
• Continues until all the elements are covered with crusts, usually 5–7 days from the onset of the rash
• Transmitted by airborne droplets, as well as by contact with the contents of bubbles
• The virus spreads over long distances indoors, through corridors and ventilation, hence the name of the disease
• Susceptibility in those who are unvaccinated and have not been ill is close to universal: the vast majority of contacts become ill
• A person with shingles can become a source of chickenpox for those who have not had it.

Why is it harder for adults?

With age, the immune response to the virus becomes more vigorous, and concomitant diseases and smoking add to the risks. The difference with childhood is not minor: adults require hospitalization more often and complications develop more often.

• Higher and prolonged temperature, severe intoxication
• Severe rash, often with a large number of elements and severe itching
• Chickenpox pneumonia is the most common serious complication in adults, especially in smokers.
• Damage to the nervous system: cerebellar ataxia with unsteadiness of gait, less often encephalitis
• Bacterial complications of the skin when scratching
• Higher chance of residual scarring

This is why adults and adolescents are usually prescribed an antiviral drug, and it should be started early - on the first day after the rash appears, when it actually shortens the duration of the rash and reduces the risk of complications. In a healthy child with a mild course, such therapy is usually not required.

Pregnancy and newborns

Most adult women had chickenpox as children and are protected. The danger concerns those who have not been sick and are not vaccinated, so the question of the presence of immunity is best decided before pregnancy.

1. Заражение в первой половине беременности связано с риском синдрома врождённой ветряной оспы у плода — редкого, но тяжёлого состояния с поражением кожи, конечностей, глаз и нервной системы.
2. Заболевание матери незадолго до родов и в первые дни после них наиболее опасно для новорождённого: у ребёнка не успевают сформироваться защитные антитела, и инфекция протекает крайне тяжело.
3. Ветряночная пневмония у самой беременной развивается чаще и протекает тяжелее, чем вне беременности.
4. При контакте непривитой беременной с больным нужно обратиться к врачу немедленно, не дожидаясь симптомов: существует профилактика специфическим иммуноглобулином, эффективная только в первые дни после контакта.
5. Планирование беременности — подходящий момент проверить наличие антител и при их отсутствии привиться, выдержав рекомендованный интервал до зачатия.

Care and treatment

There is no specific treatment for mild chickenpox in a child, and all help comes down to relieving itching, reducing fever and preventing scratches from becoming suppurated. It sounds modest, but it is the quality of care that determines whether scars will remain on the skin.

• The main task is to reduce itching and prevent scratching: short-cut nails, light cotton clothes, cool air in the room
• A cool shower without a washcloth is acceptable and relieves itching; You can’t rub your skin with a towel; it needs to be blotted
• Antipruritic drugs and antihistamines are prescribed by a doctor, taking into account age
• Antipyretic - paracetamol; They try not to use ibuprofen for chickenpox due to a possible connection with severe bacterial complications of the skin
• Acetylsalicylic acid is strictly contraindicated for children and adolescents - risk of Reye's syndrome
• Drink plenty of fluids, eat soft foods for mouth rashes
• Antibiotics are needed only for a confirmed bacterial complication of the skin

Scars after chickenpox form primarily where the blisters have been scratched or where a bacterial infection has occurred. Therefore, the fight against itching is not only a matter of comfort, but also the prevention of cosmetic defects.

Vaccination and shingles

Chickenpox is an infection that has a long-term continuation. Having been ill in childhood, a person receives not only immunity, but also a virus that remains in the nerve ganglia for life. This is a fundamental difference between surviving the disease and getting vaccinated, and it is worth considering when making a decision.

• The chickenpox vaccine prevents the disease, and in those vaccinated who do get sick, the course is usually mild, with a small number of elements and without fever
• It is especially important for adolescents and adults who were not sick in childhood, for women planning pregnancy and for people living near patients with reduced immunity
• There is emergency prevention: a vaccination given in the first days after contact can prevent the disease or significantly mitigate it
• After an infection, the virus persists for life in the nerve ganglia and, with a decrease in immunity, can be activated in the form of herpes zoster - a painful rash along the nerve.
• Shingles at a young age, especially common and recurrent, is a reason to be examined and exclude the causes of immunodeficiency