SUBJECTS AT RISK OF COMPLICATIONS: elderly people, immunosuppressed people (AIDS, anticancer therapy, organ transplants, etc.), carriers of chronic kidney and respiratory diseases or under treatment with high-dose corticosteroids.
Figure: rash associated with chickenpox; note the presence of vesicles in different stages of development (starry sky appearance)
Vesicle Infection
The most common complications of chickenpox include those related to bacterial superinfection of the vesicles, usually caused by Staphylococcus aureus or beta hemolytic streptococcus.
Among these infectious forms, the most severe are abscesses, infectious cellulitis and necrotizing fasciitis, in general.
Neurological complications, such as meningo-encephalitis and facial nerve paralysis, are quite frequent.
On the other hand, complications are rather rare in children:
- haematological (thrombocytopenia, autoimmune haemolytic anemia);
- lung (pneumonia)
- gastrointestinal (appendicitis, peritonitis)
- hepatic (acute liver failure);
- kidney (acute glomerulus nephritis).
- osteoarticular (osteomyelitis, reactive arthritis);
- cardiological (myocarditis and pericarditis).
Complications in Pregnancy
The appearance of chickenpox in the first 20 weeks of pregnancy is associated with an estimated risk of fetal malformations in 2%. When present, damage can affect the eyes, central nervous system, or limbs, which appear underdeveloped.
If chickenpox affects the pregnant woman in the week preceding the birth, it can cause a serious form of neonatal chickenpox, which seriously endangers the life of the newborn (mortality in 30% of cases).
To learn more: chickenpox in pregnancy.
Shingles
Anyone who has had chickenpox in the past is free from any kind of contagion. However, some surviving viruses take refuge in the nerve ganglia, sheltered from the antibodies that circulate in the blood.
Even after long years, the small viral population can take advantage of an immune deficiency and reactivate, causing a disease known as Herpes zoster or St. Anthony's Fire.
Older people, those who take corticosteroids for long periods and immunosuppressed individuals (such as those affected by the HIV virus) are more susceptible to getting sick.
About 90-95% of people become ill with chickenpox in the course of their life and it is estimated that 10-20% of them are subsequently affected by the fire of Sant "Antonio. This disease can be accompanied by important complications, such as Postherpetic neuralgia, a condition in which the pain caused by the rash remains for months or years after the lesion has disappeared. For further information see the "article dedicated to the fire of Sant" Antonio.
Care and treatment
If the diagnosis is made within the first 2-3 days of infection, chickenpox can be treated with antiviral drugs or antibodies that attenuate its manifestations. Especially in children, however, people prefer to let it go, limiting themselves to monitoring their evolution and attenuating their symptoms.
In severe, progressive forms, such as in immunocompromised patients or in newborns, hospitalization is required.
Palliative Treatments
Antihistamines are effective in calming itching and the temptation to scratch; for the same reason, the child's nails are shortened and made to wear cotton gloves.
Even frequent baths, the application of talcum powder and a massage with refreshing lotions can give relief. In any case, it is important to give free rein to the vesicles, avoiding touching them or worse still breaking them; such behavior is in fact associated with an increased risk of scarring, infectious complications and contagion.
Antipyretics, such as paracetamol, are indicated in case of fever; avoid administration of acetylsalicylic acid.
Diet
In the presence of chickenpox it is recommended to take soft and easy to chew foods (avoid those too acidic, fatty, hot and spicy), in order not to irritate an oral mucosa already tested by the possible presence of ulcers.
Finally, rest completes the picture of the measures to be taken in the presence of common chickenpox.
Medicines
For further information: Medicines for the treatment of chickenpox
An antiviral drug (aciclovir, valaciclovir or famciclovir) is common for those at risk.
Within 4 days, preferably 3, from exposure to the virus (in family, school or hospital settings), even before the symptoms of chickenpox arise, the intramuscular administration of specific immunoglobulins is effective in attenuating its severity.
In the presence of complications, the doctor may intervene with specific treatments. Antibiotics, for example, are indicated in the treatment of pneumonia and skin infections, while encephalitis is generally treated with antivirals.
People affected by chickenpox must absolutely avoid aspirin and other acetylsalicylic acid-based drugs (especially in children), since their intake during the disease predisposes to Reye's syndrome.
In the presence of feverish increases, it is possible to take paracetamol.
Vaccination
For some years now, an effective anti-varicella vaccine has been available, which guarantees immunity in 90% of the children to whom it is administered.
Vaccination involves the administration of two subcutaneous doses three months apart: the first dose is administered between 12 and 15 months, the second dose is recommended in children between 4 and 6 years.
The varicella vaccine can be combined with the vaccine against measles, rubella and mumps during childhood (see for example ProQuad ®).
In any case, if it proves insufficient to prevent the onset of the disease, it will still manifest itself in a more attenuated form.
Furthermore, the vaccine, if administered within 72 hours of infection or at the latest within 5 days, can protect or make the disease lighter.
Who is it suitable for?
Vaccination is recommended for adults and adolescents who have never had chickenpox, especially in the presence of a high risk of contracting it (healthcare staff, teachers, babysitters and women of childbearing age to prevent fetal infection).
The vaccine is contraindicated for immunosuppressed individuals, pregnant women and anyone who has had an anaphylactic reaction to the first dose or to any component of the vaccine (neomycin, gelatin).
What changes from 2017
With the decree law on vaccination prevention for minors from zero to 16 years, approved on 28/07/2017, vaccination against chickenpox has become mandatory.
This specific vaccination can be carried out with a single injection together with 3 other vaccination covers (the so-called quadrivalent MPRV vaccination, which includes vaccines: anti-measles, anti-rubella, anti-mumps, anti-varicella).
- The "obligation to vaccinate against chickenpox is in force, in the context of the 10 mandatory vaccinations, only for those born after 2017.
We remind you that compulsory vaccinations are a requirement for admission to nursery schools and preschools (for children from 0 to 6 years old) and that the violation of the vaccination obligation entails the application of significant financial penalties.
For more information on mandatory vaccines in children see this article.
Side effects
The varicella vaccine contains the live but attenuated virus, which retains the ability to stimulate the production of antibodies, but not the ability to cause disease.
The vaccine was shown to be safe and associated with a low number of adverse reactions. Side effects are usually mild and include redness, pain, swelling, febrile seizures and, rarely, small blisters at the injection site.
If a person does not remember having had chickenpox or not, a simple blood test is able, by looking for specific antibodies, to dispel any doubts.
Other articles on "Chickenpox: Care and Vaccination"
- Chickenpox
- Medicines for the treatment of chickenpox
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