Fort Worth, Texas,
14:50 PM

Chicken pox: Why we vaccinate

A Cook Children's nurse practitioner talks varicella

Let’s get real and talk about varicella (chickenpox). I feel like varicella is a severely underestimated virus. Most people our age had a mild version of chickenpox as a child, I had it at age 10, and that was that. We weren’t educated about the complications and risks associated with the virus. When one kid had chickenpox, we all went over for a pox party and tried to get it! How crazy is that?

I want to go over some general information about the varicella virus and discuss complications that can arise. Chickenpox is highly contagious. When one individual in a household had it, there is a 90 percent infection rate for those in the same household who have not previously had it or been immunized. It is spread through droplets (think body secretions – runny nose, sneezing, coughing) and direct contact of lesions on skin when in the ruptured vesicular stage. This virus has a really long incubation period, which means there is a long period between the time you are exposed and the time you develop symptoms. The average time is 14 to 16 days! Just when you think you are out of the woods, you can develop symptoms!

Varicella generally starts with 1 to 2 days of fever, fatigue, sore throat, and loss of appetite, followed by a rash. The rash starts as tiny red bumps to the face, spreading to the torso and then extremities. There are three stages of a chickenpox rash: maculopapules, vesicles, and crusts. The maculopapular rash appears as tiny red bumps from pinpoint to pea sized. Vesicles are typically pea sized and are fluid filled (blister like) on an red skin base. One description I like is “dew on a rose pedal” appearance. After several days the vesicles will rupture and leave crusts. The crusts usually resolve in 1 to 2 weeks and can leave areas of lighter colored skin that will eventually disappear. As I mentioned before, it will usually start on the face and move down to the torso and then extremities. There will be several “crops” of new papules, which allows there to be rashes in different stages of healing. Start to finish, chickenpox can last anywhere from 7-14 days. I missed 10 days of school when I had it! You are contagious 48 hours prior to rash appearance (usually when fever starts) until all lesions have crusted over.

But if chickenpox is so mild, why do we bother with vaccinating? Varicella can have severe complications that can cause as little as discomfort or as much as death. The most common complication is secondary bacterial infections. Here is a list of a few:

1. Soft tissue or skin infections: It’s hard not to scratch when you’re itchy, especially if you’re a child! This can lead to secondary skin infections. The common culprit is strep, a common bacteria that lives on your skin. There are even cases of flesh eating bacteria post chickenpox!

2. Encephalitis: Before vaccinations, this neurological issue accounted for 20 percent of hospitalizations and 50 percent of the deaths related to varicella. Encephalitis is swelling of the brain that can happen after or with a virus. It causes delirium, stroke like symptoms, and seizures.

3. Pneumonia: This is a common complications with lots of viral illnesses, and possibly one of the most feared. The mortality rate with varicella pneumonia is estimated between 10-30 percent. Typically you develop high fever, after initial fever has resolved, and cough.4. Hepatitis: This is a liver condition that can occur in our patients who contract chickenpox and already have a low immune system. Kiddos with cancer or who have had organ transplants are at highest risk.

In my prior work in the ED, I have unfortunately witnessed all of these complications with the exception of hepatitis. Complications can affect any age, regardless of current health. I have seen some previously healthy children develop encephalitis and have permanent neurological and seizure disorders after!

With the development of the varicella vaccine in 1995, chickenpox cases decreased 90 percent! The American Academy of Pediatrics and the Centers for Disease Control recommend two doses of the varicella vaccine at 12 months and 4 years.

As always, if you have questions, please call the office. I am happy to discuss things with you. Our goal is to keep your kiddos happy and healthy while avoiding potentially fatal outcomes from preventable diseases!

Tara, NP

About the author

Tara Haraldson is a nurse practitioner at Cook Children's Willow Park office. To make an appointment for back-to-school vaccines, contact your Cook Children's pediatrician. To find a pediatrician near you, click the following link

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