Collin County Health Care Services has issued a health alert due to an increase in chickenpox (varicella) across the county. Chickenpox is an infection caused by varicella-zoster virus, leading to a fever and an itchy rash with spots all over the body.

Because it is highly contagious, chickenpox is a reportable condition in Texas and must be disclosed to the local health department. According to health officials, schools and childcare settings are high-risk environments for outbreaks. Prompt identification and exclusion of cases are critical to limiting transmission.

While chickenpox used to be a common illness in the United States, it has become much rarer due to the chickenpox vaccine which helps prevent the infection.

Cook Children’s Health Care System doctors know parents and caregivers may have questions about this, Laura Romano, D.O., a hospitalist at Cook Children’s and mom herself, addresses some concerns.

• I got chickenpox as a kid. Should I be concerned if my little one gets it?
  • One infection with chicken pox should give you lifelong immunity.
• How effective is the varicella vaccine?
  • Two doses give up to 98% protection and have decreased hospitalizations and death by over 97% since 1995!
• What if my little one only had one dose. What does that mean for them?
  • If your child has already had one dose of the chicken pox vaccine, they will most likely not need another one if they get an actual infection. Please talk with your pediatrician about this.
• What happens if someone is immunocompromised and is around someone who has varicella?
  • The most common complication is a skin infection caused by scratching at the lesions, which may require antibiotics to help treat. Other more serious complications include pneumonia, ataxia (difficulty walking), dehydration, or encephalitis (swelling of the brain). People who also have chicken pox are at risk for shingles later in life. Vaccination against chicken pox helps prevent against all these complications including the furture risk of shingles.
• What complications can arise from chickenpox?
  • The most common chickenpox complications are bacterial infections of the skin and soft tissues in children and pneumonia in adults.
• How do you treat chickenpox?
  • While there is not a single treatment for chicken pox, doctors focus on symptom relief. Doctors recommend Tylenol for fever, calamine lotion or oatmeal baths for itchiness. Lesions should go away in the 10-14 days. 

Symptoms of Chickenpox:

A mild fever may occur 1 to 2 days before rash onset, particularly in adults. In children, the rash is often the first sign of disease.

Seek immediate medical attention when your child:

• has trouble breathing
• has a severe headache
• is very drowsy or has trouble waking up
• has trouble looking at bright lights
• has trouble walking
• seems confused
• seems very ill
• has a stiff neck
• has a fever that lasts for more than 4 days
• has a bad cough
• has an area of rash that leaks pus (thick, yellowish fluid) or becomes red, warm, swollen, or sore
• is vomiting

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. 

Last week, a Plano CPS agent responded to a different type of call after a Facebook post inviting parents to bring their children over to be exposed to chickenpox was reported

What is a pox party?

Pox parties were more common prior to the introduction of the chickenpox vaccine in 1995. The general feeling was that, if your child was going to get chickenpox at some point anyway, you might as well get it out of the way. It seemed like a rite of passage that everyone should go through. Because most people survived chickenpox with a few days of itchy annoying rash, there are some that ask me if the vaccine is necessary. “Wouldn’t it be better for us to just get the disease?”

Why do we vaccinate for chickenpox?

Most children with chickenpox develop fever, sore throat and loss of appetite which is followed by the classic rash. I was taught that the rash was like “dew drops on a rose petal” because of the clear, fluid-filled bumps that form on a red base. The rash would then crust over with the crusts lasting one or two weeks before falling off.

It was a memorable disease but not dangerous for most. I happen to remember riding around in the floorboard of my dad’s gas truck (it was a different time for lots of reasons) while I was recuperating, not able to go to school because our local farmer’s couldn’t wait for my rash to heal to have gas for their tractors.

Unfortunately, not all children with chickenpox have a simple course. Here is a list of possible complications that can arise from chickenpox:

1. Skin infections-These could be simple and treated with antibiotics but also can be deeper and involve muscle or other tissues. This would be more dangerous now that we see more antibiotic resistant bacteria.

2. Neurologic complications-Infection of the tissue around the brain could lead to confusion and infection of a particular part of the brain lead to a loss of coordination, both complications lead to hospitalization.

3. Less frequent complications-Pneumonia and hepatitis (liver infection) can also occur but do so less commonly.

Prior to the vaccination, there were 11,000 hospitalizations and 100 deaths from varicella yearly. About three children out of 1000 infected required hospitalization. Since 1996, hospitalizations and deaths have fallen significantly (70 and 88 percent).

Is there anything wrong with having a pox party?

As best as I can tell (I am not a lawyer), there is nothing illegal about throwing a pox party. One thing is clear, sending lollipops through the mail (even pox parties want to be the next Uber) to infect others is. There is also a picture that has been shared around the internet which reportedly quotes the mom from the Plano area pox party as saying, “I had to open my husband’s shingles blister and swab their mouths.” I have a feeling most of those out there who would throw or go to a pox party would consider this a little much.

Should CPS have been called?

I have to say when I first read this story; I thought that the call to CPS was a little overboard. CPS is busy as it is. Investigating pox parties is probably not the best use of their time. I have served on local CPS boards and the things that we talked about needed the full attention of a staff that was already stretched thin.

Secondly, the likelihood of serious harm resulting from contracting chickenpox is overall pretty low. Should CPS be called for every parenting infraction that minutely increases the risk of harm to children? No. That would mean I should report every family that turns their child’s car seat around at 21 months or that allows their baby to sleep on their stomachs. While I disagree with those decisions, I choose to educate as best as I can but don’t log on and report them to CPS.

My only pause in this case came from what I admit is a slippery slope argument but stick with me for just a second. What if one of these children ended up seriously harmed as a result of contracting chickenpox at this party?

Seeing children suffer from vaccine preventable diseases (pertussis is the most common which admittedly occurs in both vaccinated and unvaccinated babies) is hard. If I saw a child suffering from a complication of chickenpox only to discover that the child had contracted chickenpox intentionally at a pox party, this would be even harder.

How can we prevent against chickenpox?

The most effective and best way is through vaccination. Vaccination at age 1 and 4 years protects against 90 percent of chickenpox disease and 99 percent against severe disease. Rarely, children can get chickenpox after they have been vaccinated but the cases seem to be milder.

Get to know Justin Smith, M.D.

Justin Smith, M.D., is a pediatrician in Trophy Club  and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. Dr. Smith is an experienced keynote speaker for a variety of topics including pediatric/parenting topics, healthcare social media and physician leadership. If you are interested in having Dr. Smith present to your conference or meeting, please contact him at thedocsmitty@cookchildrens.org.

He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” open now. Click to learn more. To make an appointment, call 817-347-8100.

Breaking news concerning the weirdest week in celebrity-infectious disease history:

Peyton Manning helped lead the Broncos to victory despite suffering from a flu-like illness.

Sidney Crosby and multiple other National Hockey League stars have been diagnosed with mumps.

Angelina Jolie missed press events for the release of Unbroken, a movie which she directed, because she was diagnosed with chicken pox.

Maybe it is not breaking news. In fact, I’m pretty confident that they will all recover without any issues. Most people with any of these three diseases do.

We so rarely see mumps and chicken pox that we often forget how people used to suffer severe consequences from these diseases.

Here’s a quick reminder of some of the problems people can have as a result of these infections:

Flu

We have talked a lot about flu and flu vaccination in the past few weeks. Most children with the flu will have fever, cough, congestion and body aches,but will recover without incident in three to five days.

What do we need to watch for?

The most common problems with flu are dehydration and wheezing or difficulty breathing (especially in children with asthma).

A couple of more rare complications:

Pneumonia - Children can have viral pneumonia or a “secondary” bacterial pneumonia after the flu. (Secondary means that it comes after and as a result of having the flu. Think of it like the flu made the lungs weaker and more likely to get a different kind of infection.)

Nervous system involvement - These are rare but can involve confusion (caused by encephalitis-which is inflammation of the lining of the brain) and weakness (Guillain-Barré syndrome).

Mumps

Most children with mumps have low grade fever, fatigue, headache and muscle soreness. These symptoms are followed quickly by the most characteristic sign of mumps which is swelling of a gland in the cheek, called the parotid gland. The infection is typically more severe in adults than children.

What do we need to watch for?

Orchitis - This is a mumps infection involving the testicles. It is the most common complication in adolescent and adult males and can lead to sterility. A similar infection can occur in girls in the ovaries but is less common.

Nervous system involvement-Infected persons can have meningitis which causes fever, headache and neck pain. In addition, prior to vaccination mumps was one of the most common causes of deafness in children.

Chicken Pox

Because most of us had chicken pox and only suffered fever and the characteristic red, itchy rash, it is sometimes difficult to understand why we are vaccinating against the virus. Fortunately, that is the case for most children who contract the disease.

What do we need to watch for?

Skin infections - Because staph skin infections are so common now (and often resistant to some antibiotics), I am glad that we have a vaccine to prevent chicken pox. Any open sore, especially one that children are scratching is prone to infection.

Best advice is to stay away from athletes and celebrities this holiday season.

Ultimately, just remember that these diseases can be serious even though these celebrities should be just fine.