Before 1995, chickenpox was widespread in the U.S., causing millions of cases, thousands of hospitalizations, and numerous deaths annually. However, the introduction of routine vaccinations dramatically reduced its prevalence. Though manageable with home remedies and over-the-counter treatments, severe cases may still require medical attention and even resurface later in life as shingles. Understanding symptoms and seeking prompt treatment can improve outcomes for those affected.
Who's at risk of chickenpox?
Chickenpox is caused by the varicella-zoster virus (VZV) and mostly affects children under the age of 10. This highly contagious disease spreads easily with those in close contact. However, with the integration of chickenpox virus protection into routine childhood immunizations since 1995, its incidence has notably declined.
Chickenpox can be transmitted through direct contact with the rash or eye and nose secretions, but more often through inhaling air droplets from an infected person who may cough or sneeze.
While any unvaccinated individual can develop chickenpox infection, it is most commonly a childhood disease. Because it is highly contagious, it spreads rapidly in school settings. If one person has chickenpox, up to 90% of the people close to the infected person and who are not immune will likely become infected.
Adults who didn’t have chickenpox during childhood, those who didn’t receive the vaccine, or individuals working in childcare or schools are also more likely to get the infection. Most people develop life-long immunity after an infection, though rarely, one can get chickenpox more than once.
Thankfully, chickenpox usually produces mild, though very bothersome signs. Symptoms in non-vaccinated individuals usually last 4–7 days. Chickenpox symptoms may include:
- Low fever
- Tiredness (malaise)
- Loss of appetite
- Muscle pain
These signs often occur before the typical, notorious chickenpox rash onset. Though they may occur simultaneously, remember that some kids may have no pre-symptoms and suddenly develop the rash.
The chickenpox rash is extremely itchy, starts on the back, chest, and face, then spreads over the entire body.
The rash goes through three phases. First, small raised pink-reddish bumps develop. Second, these become small blisters filled with white milky fluid, finally crusting and scabbing over. A person with the infection may have all three phases simultaneously, but usually, the rash develops in various locations over time, so one often has multiple stages of ongoing healing.
Remember, open lesions spread infection. If you scratch open a sore, wash your hands with soap and water well for at least 20 seconds to prevent spreading infection.
Generally speaking, chickenpox causes mild, annoying symptoms that require one to stay home (because it is easily spread from person to person). We treat the irritating itch, prevent scratching, and provide supportive care. Most people recover without incident. However, in some cases, we can see complications, including:
- Extensive rash over the entire body
- Bacterial skin infections
- Inflammation of the brain
- Blood clotting issues
- Liver issues
- In rare instances, it can be fatal
While complications can arise in any individual, they are more common in those less than one year of age, pregnant women, and those who are immunocompromised.
If a woman becomes infected during early pregnancy, there is a risk that her baby may have low birth weight and changes affecting the lungs. If the mother catches chickenpox right before birth, the baby may develop a severe chickenpox infection.
Chickenpox is usually a clinical diagnosis, based on the characteristic rash, with skin lesions found in all three phases: bumps, blisters, and crusts. A history of being exposed to another person who has the rash is another clue.
There are specific lab tests available such as the Tzanck smear, fluid culture, and serologic testing, but these tests are rarely needed to confirm the diagnosis.
Thankfully, chickenpox treatment is often simple at-home care and managing symptoms to make a person more comfortable as the disease runs its course. Most cases of chickenpox are mild.
If your child gets chickenpox, in addition to making them comfortable as the disease runs its course, you want to keep them home. Keep those sick at home (or minimize exposure to others) until the sores have scabbed over, and you don't see new blisters arise. This usually takes about 5–7 days, but it could be up to 2 weeks for some.
6 home remedies for immediate relief
Most individuals do not need to seek medical care with chickenpox. Symptoms can easily be managed at home. Look at these seven home remedies for immediate (or close to) relief.
- Anti-itch, soothing lotions such as Calamine lotion (or other anti-itch topicals, even petroleum jelly can provide relief).
- Cool to lukewarm (not hot) soothing bath using colloidal oatmeal or baking soda (warm/hot water will make the itching worse). Do not use the oatmeal you eat, but use colloidal formulations, or it won't relieve the itch.
- Over-the-counter (OTC) antihistamine medications (e.g., Benadryl), which may help lessen the itchiness of the lesions.
- OTC pain reliever: Tylenol (acetaminophen), not ibuprofen or aspirin, should be used to manage fever, aches, and pains.
- Keep fingernails short of any individual who is sick with chickenpox to minimize trauma caused by scratching.
- Prevent scratching. Consider oven mitts, mittens, or gloves on the hands to lessen the risk of self-trauma from scratching.
When treating at home, be careful with what OTC medications you use. You need to avoid using certain medications. First, don't use aspirin as it can lead to Reye syndrome (a rare side effect causing swelling of the liver and brain). Second, don't use ibuprofen, which can cause bacterial infections or tissue damage.
When to seek medical care for chickenpox
Knowing when to seek medical care with chickenpox is important to prevent complications. While most cases of chickenpox resolve without medical professional intervention, there are a few instances where you should seek assistance.
Consider calling a healthcare provider if you have chickenpox and:
- Develop a fever for more than 4 days or higher than 102°F (38.9°C)
- Rash areas become very warm, sore, red, or leaking thick abnormally colored fluid
- Have confusion or trouble waking
- Feel your neck is stiff
- Develop difficulty walking
- Have problems breathing
- The rash starts to bleed or you are bruising
- Develop significant belly pain
Can I prevent chickenpox?
Chickenpox prevention is easily achieved through the successful vaccination programs established in children after 1995. It is widely available and used throughout the U.S. Chickenpox represents another successful vaccination campaign, helping minimize infections, unnecessary suffering, hospitalizations, and deaths.
Ensuring your child is vaccinated against chickenpox helps protect other children, those who are immunocompromised, those who may have chronic diseases and may be more susceptible, and your community as a whole. The chickenpox vaccine is recommended in the U.S. for children aged 12–15 months, with a second dose between ages 4 and 5 as part of the childhood vaccination series.
Older children and adults who never had chickenpox or did not receive the vaccine but are at risk are also good candidates for immunization. If exposed, individuals at high risk for complications from infection may speak with their healthcare provider about vaccination to help lessen the chance of becoming sick.
Who else should be vaccinated?
While ideally, everyone should receive chickenpox as part of their core childhood vaccines, for those children and adults who never received the vaccination or never developed a wild infection, some may be at higher risk and should consider being vaccinated. Talk to your healthcare provider if you think you are at high risk. Those who should consider vaccination include:
- Those in the healthcare field, especially those working with children and the immunocompromised
- Childcare workers
- Those working in nursing homes, assisted living facilities, and related locales
- People who care for the immunosuppressed (e.g., a family member with cancer or another illness)
- College students, especially those living in dorms, high-rises, group living situations
- Those who are incarcerated and staff at these facilities
- Military personnel
- Those who plan to become pregnant
- International travelers.
- People who live with kids (especially if the child is not vaccinated)
Those who should not be vaccinated include those on high doses of steroids or steroids at moderate doses for two weeks or longer, those being treated for active cancer (including radiation or chemotherapy), those on medications that suppress the immune system, and those who have recently received blood products (transfusion).
Shingles and chickenpox: what's the connection?
Is the clinical condition shingles from chickenpox? Yes. Shingles represents a late-stage reactivation of the chickenpox virus, usually affecting older adults (over 50). The virus remains dormant in the nerve cells and can reactivate later in life.
Shingles also causes a characteristic rash with blisters, usually as a single strip around one side of the torso. The affected area is painful and sensitive to touch and may be associated with numbness, tingling, or a burning sensation. Some people develop pain that persists long after recovering from shingles.
While shingles itself isn't contagious, adults with shingles can transmit the chickenpox virus to individuals who have never had the vaccine or natural inflection. Those with shingles can spread the chickenpox virus through their respiratory droplets loaded with the virus or through direct contact with blisters.
The only way to prevent the development of shingles in any individual is with the shingles vaccination. Those with natural chickenpox exposure have a higher risk of developing shingles. However, those who are vaccinated for chickenpox can also develop the disease, though it is usually much less severe.
Shingrix is the shingles vaccine, currently recommended for adults age 50 or older or for those 19 and over with immunosuppression and certain underlying criteria.
Chickenpox: a preventable disease
Chickenpox in the U.S. is an uncommon disease thanks to modern vaccination development and campaigns. While disease still occurs, symptoms are often mild, can be easily managed in most people with at-home remedies, and recovery is usually within 1–2 weeks. For those at high risk of disease complications, seek medical advice and care if you are exposed to or develop symptoms of chickenpox.
If you are 50 or over and have not yet received the shingles vaccine, discuss with your healthcare provider whether this is right for you. Finally, understanding the disease and how to prevent and treat it can help you lessen your family's risk of becoming sick.
Can you get chickenpox more than once?
Though rare, an individual could get sick with chickenpox more than once.
How can you clean and care for chickenpox blisters?
If you scratch open a sore, wash your hands with soap and water well for at least 20 seconds to prevent spreading infection. Cover lesions that are in exposed areas when feasible to minimize direct contact with others. Monitor the areas closely to ensure they are healing properly.
Can I go to work if my child has chickenpox?
If your child has chickenpox, consider your vaccination history before deciding whether to go to work. If you're vaccinated or previously had the disease, your risk is lower, but still maintain distance. Given the 2–3 week incubation period, consider staying home while your child is contagious to minimize spread.
When is chickenpox most contagious?
A person with chickenpox is contagious from 1–2 days before the rash appears until the last sore has scabbed over, typically taking 5–7 days to resolve. However, in some cases, the rash can persist for up to 14 days. As long as there are active skin lesions, the individual remains contagious.
Do you have to isolate with chickenpox?
Isolation is crucial with chickenpox, which spreads easily through virus aerosolization and skin contact. Stay home from school, work, or social events until fully recovered. Contagiousness lasts until blisters dry up, typically 5–7 days for some and longer for others.
Can people vaccinated against chickenpox get sick?
Breakthrough chickenpox (symptoms that develop in vaccinated individuals) does occur, though it is highly uncommon, and symptoms are usually milder and shorter-lived. Those vaccinated, however, may have lesions that do not crust over. They will be contagious for 24 hours after the final sore has developed.
Is shingles contagious?
No. Shingles isn't contagious. It is a reactivation of the chickenpox virus in your body, which can cause a rash, as with chickenpox, and nerve pain. However, those with an active shingles rash can spread chickenpox to others, so keep this in mind.
Chickenpox in the U.S. has declined since vaccination campaigns started in 1995. However, individuals may still get sick with fever, headache, body aches, and the typical rash.
Those with chickenpox remain contagious as long as any of the blisters still have fluid within them. Once they scab and dry out, an individual can no longer spread the disease.
Complications of chickenpox may include pneumonia, skin infections, brain infection (encephalitis), and liver disease, among others. Another issue is the reactivation of the virus in one's body when they are older, triggering shingles.
Though preventable by vaccination, shingles can cause painful (not itchy) skin lesions and nerve pain. This condition can last much longer than chickenpox. While active sores are present, those with shingles can spread the chickenpox virus to non-immune individuals.
- Centers for Disease Control and Prevention. Chickenpox transmission.
- Centers for Disease Control and Prevention. Chickenpox signs and symptoms.
- Medscape. Chickenpox clinical presentation.
- Medscape. Chickenpox guidelines.
- Centers for Disease Control and Prevention. Chickenpox prevention and treatment.
- American Academy of Dermatology Association (AAD). How to care for a child with chickenpox.