Varicella (chickenpox) is an infection caused by the varicella-zoster virus (VZV).

The infection usually starts as a rash on the face that spreads to the rest of the body. The rash begins as red bumps that eventually become blisters. A child will often get 300 to 500 blisters during the infection, which crust over and fall off in one to two weeks. The virus can be spread in the fluid from the blisters or droplets from an infected person’s nose or throat. Varicella is generally a mild disease, but it is highly contagious and can be severe and even fatal in otherwise healthy children (less than 1 out of every 10,000 cases). Chickenpox can cause pneumonia (23 out of every 10,000 cases), and is an important risk factor for developing severe invasive “strep” (group A streptococcal disease), commonly referred to as “flesh-eating disease.” Treatment of this deep infection requires antibiotics and surgery to remove the infected tissue. Complications of varicella include bacterial infections (up to 5% of cases), decreased platelets, arthritis, hepatitis, and brain inflammation (1 in 10,000 cases), which may cause a failure of muscular coordination. Complications are more common among adolescents and adults, and in immunocompromised persons of all ages, than in children. The virus which causes chickenpox remains in the body for life and may reappear as shingles, particularly in the elderly. A woman who contracts chickenpox in early pregnancy can pass the virus to her fetus, causing abnormalities in 2% of cases. The fetus can develop scarring of the skin and affected limb(s), limb deformities (hypoplesia), eye damage, low birth weight, brain atrophy, and mental retardation. The virus sometimes leads to fetal demise or spontaneous abortion, while some infected fetuses die in infancy. A pregnant woman who has never had chickenpox, but has been exposed, should contact her physician immediately. Prior to the introduction of the varicella vaccine, there were 3 to 4 million cases of varicella in the United States each year. About 10,000 people were hospitalized with complications, and approximately 100 patients died. While only 5% of reported cases of varicella are in adults, adults account for 35% of the deaths from the disease. Although national figures demonstrating the decline in varicella are not yet available, smallerscale studies show that the vaccine is effective in reducing the number and severity of chickenpox cases. A number of studies have demonstrated that varicella-containing vaccines are effective in preventing disease in large populations of students. However, when chickenpox exposure occurs, breakthrough chickenpox (that is chickenpox lesions in an immunized person) can occur. Most children who are immunized but later develop chickenpox have mild disease, although some may have more typical illness with fever and many lesions. Breakthrough varicella can be contagious. As a consequence, in June 2006, the Centers for Disease Control and Prevention recommended a second dose of varicella-containing vaccine for all children.

Chickenpox vaccine is the best way to prevent chickenpox. Vaccination not only protects vaccinated persons, it also reduces the risk for exposure in the community for persons unable to be vaccinated because of illness or other conditions, including those who may be at greater risk for severe disease. While no vaccine is 100% effective in preventing disease, the chickenpox vaccine is very effective: about 8 to 9 of every 10 people who are vaccinated are completely protected from chickenpox. In addition, the vaccine almost always prevents against severe disease. If a vaccinated person does get

it is usually a very mild case lasting only a few days and involving fewer skin lesions (usually less than 50). and few other symptoms.chickenpox. . mild or no fever.

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