chickenpox

and Sabine Schrör, medical journalist

Mareike Müller is a freelance writer in the medical department and assistant doctor for neurosurgery in Düsseldorf. She studied human medicine in Magdeburg and gained a lot of practical medical experience during her stays abroad on four different continents.

More about the experts

Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

Chickenpox (varicella) is a highly contagious viral disease that causes an itchy rash with blisters on the skin. Usually children and adolescents get chickenpox, but adults can also be affected. There is a risk of complications, especially during pregnancy and when the immune system is weakened. Read more about chickenpox infection and symptoms, duration of illness, treatment and prevention here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. P35B01

Brief overview

What is chickenpox? highly contagious viral infection, which is one of the childhood diseases, but can occur at any age - but only once in a lifetime.
Second disease: After a chickenpox infection, you are immune to the pathogen for life. However, this remains in the body for life and can become active again later - the person affected then develops shingles.
Infection: Often through droplet infection (inhalation of infectious droplets of secretion given off by the sick when coughing, sneezing or exhaling), sometimes by smear infection (contact with infectious liquid in the skin vesicles of the sick).
Symptoms: At first general symptoms such as malaise, headache and body aches, fatigue, occasionally fever. Then a typical rash with fluid-filled, itchy blisters (first on the torso and face, later also in other places).

Treatment: mainly treating the symptoms (e.g. skin care, antipruritic agents, pain relievers). In severe cases and if there is an increased risk of complications, add anti-viral drugs (antivirals).
Prognosis: Chickenpox usually heals without any problems. Complications such as additional bacterial skin infections, pneumonia, meninges or meningitis (encephalitis, meningitis) rarely occur. Varicella is often more severe in adults than in children.
Prevention: Mainly by means of a chickenpox vaccination. Those who are not vaccinated should avoid contact with sick people.

Chickenpox: contagion

Varicella-zoster viruses are responsible for a chickenpox infection. These are highly contagious herpes viruses that only occur in humans. The risk of chickenpox infection is particularly high in the winter and spring months. During this time, varicella infections increase.

The pathogens are usually transmitted by droplet or smear infection:

In the case of a droplet infection, tiny droplets of saliva containing the virus are released from infected persons through exhalation, speaking, sneezing or coughing and are then inhaled by healthy people.
The smear infection occurs through direct contact with the virus-containing liquid from the characteristic skin vesicles of the patient - for example when one touches the sick person with the hand and then unconsciously grabs the mouth or nose. As soon as the viruses get on the mucous membranes, they can easily penetrate inside the body.

There is a risk of infection as early as one or two days before the typical rash becomes visible! It only ends when all of the vesicles are encrusted. This is usually five to seven days after the first blisters appear.

Very rarely, varicella is transmitted from a pregnant woman to the unborn child via the placenta. Such a chickenpox infection in the womb can lead to what is known as fetal varicella syndrome. Chickenpox infection in newborns is also possible if the mother herself developed varicella shortly before or after the birth.

Shingles patients are also a source of infection: Shingles is the second disease that varicella viruses can trigger - even years after the chickenpox infection. Patients can pass the pathogen on to healthy people from the appearance of the rash until the blisters have crusted over completely (usually five to seven days after the rash begins). If they have not been vaccinated against varicella and have not yet had chickenpox, they can develop the disease as a result - chickenpox, not shingles. However, shingles patients are less contagious than chickenpox patients.

Chickenpox: incubation period

Chickenpox can show its first symptoms 8 to 28 days after infection. On average, this incubation period is 14 to 16 days. The disease only breaks out if you have never had chickenpox and are not vaccinated against it. After an infection, you are immune to the chickenpox virus for life.

Chickenpox - "Everyone should get vaccinated!"

Three questions for

Prof. Dr. Jörg Schelling,
Specialist in General Medicine
1
Why is chickenpox vaccination important?

Prof. Dr. Jörg Schelling
Chickenpox is contracted through the air in more than 90 percent of cases. So you can't protect yourself. Only a vaccination helps, if of course not 100 percent. Chickenpox is not a "harmless childhood disease" either. Often, especially in children, unsightly scars remain from scratching or a superinfection with bacteria occurs. And I do not wish any adult to get chickenpox!
2
What can happen without vaccination?

Prof. Dr. Jörg Schelling
Thank goodness, complications are relatively rare. The most common of these are bacterial superinfections mostly caused by staphylococci, cerebellar coordination disorders (ataxia) or so-called sepsis, i.e. a bacterial body-wide infection. In the worst case, chickenpox can be fatal without a vaccination; according to a Swiss study, this happens in one in 100,000 cases.
3
So that means: vaccination for everyone?

Prof. Dr. Jörg Schelling
Yes. I strongly recommend a vaccination for every child and every adolescent. Also for every woman of childbearing age who is not immune. Especially during pregnancy, chickenpox can have serious consequences for the pregnant woman and the unborn child. In case of doubt, patients can use a so-called titer determination to clarify with their family doctor whether they are immune.
Prof. Dr. Jörg Schelling,
Specialist in General Medicine
Founding director at the Institute for General Medicine at LMU Munich and member of the Bavarian state working group on vaccinations. As a vaccination expert, he trains general practitioners in vaccinating.

Protection against infection

Anyone who has not yet had a chickenpox infection and has not been vaccinated against it is considered unprotected against the chickenpox virus. The risk of infection is very high: In nine out of ten cases, unprotected people develop chickenpox after contact with patients. Unprotected people should therefore avoid contact with the sick. Especially if someone has varicella in the home environment, you should keep your distance as far as possible and not stay in the same room with the sick person for a long time. This is especially true for people with a weak immune system.

Otherwise, no special precautionary measures are generally necessary. Sometimes, however, a so-called post-exposure vaccination against chickenpox is advisable in consultation with the doctor: It can be used, for example, for pregnant women, immunocompromised people and newborns who have had contact with sick people and (possibly) became infected. "Contact" means here, for example, that those affected live in the same household as the sick or have stayed in the same room for at least an hour or have come very close to the patient ("face-to-face") ). You can get the active chickenpox vaccines within five days of such contact or up to three days after the typical rash appears. This can prevent an outbreak of the disease or weaken its course.

Instead of the active vaccination, finished antibodies against varicella can also be administered as a post-exposure vaccination. This passive vaccination should, if possible, take place within three days (up to a maximum of ten days) after the possible infection.

When hospital patients have chickenpox, they are isolated from other patients. This should prevent the infectious disease from spreading. The same goal is pursued when an outbreak of disease occurs in community facilities such as schools and kindergartens: Everyone who has chickenpox must stay at home for the time being. The others sometimes receive a vaccination against varicella as a precautionary measure if they are unprotected (locking vaccination). Sick people are only allowed to visit the facilities again after a week, when the risk of infection has largely been averted. A medical certificate is not required for this.

Chickenpox is notifiable. Doctors must provide the health department with the names of all patients who are suspected of having chickenpox or who have actually broken out. Death from chickenpox must also be reported.

Chickenpox vaccination

The Standing Vaccination Commission (STIKO) recommends vaccination against chickenpox for all children aged 11 months and over. Young people who have not yet had chickenpox and have not been vaccinated against it should get the vaccination. The same applies to adults if they belong to one of the following risk groups:

Women who want to have children and have no antibodies against chickenpox in their blood

Patients before starting therapy that weakens the immune system (e.g. before an organ transplant) if no antibodies against chickenpox are detectable in the blood

Occupational groups at an increased risk of infection (such as medical staff and preschool teachers) if they have never had chickenpox and are not vaccinated against it or if no chickenpox antibodies are detectable in the blood
People with severe atopic dermatitis if they have never had chickenpox and are not vaccinated against it or if no chickenpox antibodies are detectable in the blood

Read more about vaccination against varicella in the article Chickenpox - Vaccination.

Chickenpox: symptoms

In the first two days, chickenpox only shows general symptoms such as feeling sick, a slight fever and fatigue. The typical rash does not develop until later, from the third to fifth day of the illness:

Small red spots form, which develop into blisters filled with clear liquid within a few hours. You are very itchy. After a day or two they dry up with crust formation. New blisters can form over a period of three to five days. This creates a complexion with vesicles in various stages of development, which is also known as the starry sky.

The number of vesicles varies from patient to patient. Usually it is between 250 and 500. Small children usually show fewer blisters than adults.

The rash begins on the torso and face and then spreads to arms and legs, and later to the scalp, oral mucosa and genitals. The rash is often accompanied by a fever of up to 39 degrees.

Permanent scars after the illness can be reminiscent of the typical symptoms of chickenpox (skin vesicles). These arise when the vesicles are also infected with bacteria and then become inflamed (bacterial superinfection). Scratching the itchy blisters can also leave scars.

This is how chickenpox spreads over the body

The chickenpox first shows up on the face and trunk. They later spread over the rest of the body.

The varicella pathogens remain in the body after the chickenpox has healed, namely in an inactive state. But you can "wake up" again years later. Then shingles (zoster) develops. So this can only occur in people who have had chickenpox at some point.

Chickenpox: examinations and diagnosis

If chickenpox is suspected, the doctor first takes the medical history (anamnesis): For example, he asks about the exact complaints and how long they have existed. This is followed by a physical exam. The characteristic skin rash usually allows the doctor to recognize a chickenpox infection at first glance.

Special examinations are only necessary in special cases if chickenpox is suspected. This applies, for example, to patients with a weakened immune system, because the disease is often untypical for them. Further examinations are also recommended in people with diseases of the central nervous system or pneumonia, as well as in pregnant women and newborns. They are used to directly or indirectly detect chickenpox:

In the case of direct detection, one looks for the genetic material of the virus in the vesicle fluid, the cerebrospinal fluid (liquor), the lung secretions or the patient's blood. In order to directly detect chickenpox in unborn babies, a sample of the placenta (chorionic villus sampling), the amniotic fluid (amniotic fluid test) or the child's blood (umbilical cord puncture) is examined for varicella genetic material.

In the case of indirect detection, one looks for antibodies against varicella in the patient's blood or cerebrospinal fluid.

The indirect varicella detection (antibody test) is also suitable to determine whether someone has already had chickenpox or whether the vaccination against it was effective.

Chickenpox: treatment

If the chickenpox is uncomplicated, only the symptoms are treated, especially the itching. In this way you can prevent the blisters from becoming inflamed by scratching them. The following methods have proven effective:

Stay in a cool environment, because heat and sweat increase the itching
Trim fingernails to avoid scratching the blisters
daily bathing
Antipruritic agents for topical application on the skin (lotions, gels, powders, mostly with active ingredients such as tannins, zinc or polidocanol)

Experts advise against taking antipruritic drugs (antihistamines). Its effectiveness in chickenpox has not been adequately studied.

If necessary, fever and pain relievers such as paracetamol or ibuprofen can be given for fever and body aches.

Acetylsalicylic acid (ASA) also helps against fever and pain, but must not be used in children and adolescents (or at most on the express instruction of the doctor). The drug can trigger the rare but life-threatening Reye's syndrome!

In severe cases, the chickenpox pathogen can be treated directly with special drugs that inhibit the virus from multiplying. These antivirals (virustatics) include, for example, the active ingredient acyclovir. You can shorten the duration of chickenpox illness. These drugs have proven themselves especially in patients with weakened immune systems.

Chickenpox: disease course and prognosis

In otherwise healthy patients, the disease usually proceeds without complications and heals without scars. However, in very rare cases, chickenpox can cause complications:

additional bacterial inflammation of the blisters (bacterial superinfection)
Pneumonia caused by the varicella virus (varicella pneumonia)
Complications in the area of the central nervous system such as balance disorders, inflammation of the brain (encephalitis) or meningitis (meningitis)
Complications in the area of the heart, kidneys, joints or cornea such as inflammation of the heart muscle (myocarditis), inflammation of the kidneys (nephritis), joint inflammation (arthritis), corneal damage

Chickenpox: pregnancy and childbirth

If a pregnant woman gets chickenpox within the first six months of pregnancy, the child can also get sick. Doctors then speak of the fetal varicella syndrome: The unborn child can develop skin changes (such as ulcers, scars) and damage to the eyes. There is also a risk of skeletal malformations as well as diseases and malformations of the nervous system. For example, a loss of brain tissue (brain atrophy), paralysis and convulsions are possible consequences of prenatal infection with chickenpox. Babies in the womb can even die from the disease.

Neonatal chickenpox infection occurs in newborns whose mother has varicella between five days before and two days after they are born. It is very difficult because the immune system of the little ones is not yet fully developed. Up to 30 percent of all affected babies die.

Chickenpox in adults

Adults can also get chickenpox if they are not vaccinated and have not had the disease. At this age, childhood illness is often more severe than at a young age. Adults are also more likely to develop complications as the disease progresses.

A very serious and feared complication is pneumonia caused by chickenpox (varicella pneumonia). Up to 20 percent of all adult patients get it. Pregnant women are particularly at risk. Pneumonia usually starts three to five days after the chickenpox infection breaks out.

Unprotected adults with an increased risk of severe disease and complications should therefore get vaccinated against chickenpox. These people at risk include, for example, women who want to have children who do not have antibodies against varicella.

Read more about the course and prevention of varicella infection in adulthood in the article Chickenpox in adults.