Chickenpox in adults: what is there to know?


The chickenpox is not just child ‘s play . Although it is an infectious disease -produced by the varicella-zoster virus (of the herpesvirus family) – that usually appears in childhood, 9.9% of chickenpox cases are between 15 and 44 years old , and 1, 1% are older than that age, according to the studies consulted. 

Carmen Sánchez Peinador , member of the Infectious Diseases Working Group of the Spanish Society of General and Family Physicians (SEMG) , explains that “chickenpox is a highly contagious disease. The virus spreads easily from sick people to those who have never had chickenpox or were never vaccinated. The contagion occurs by close contact with someone who has chickenpox, either by direct contact with the virus (for example, through skin lesions) or through airborne droplets, infected aerosol particles ”. 

Specifically, the family doctor points out that people with chickenpox are contagious from one or two days before the rash appears until a scab has formed on all the disease lesions . Vaccinees who contract the disease may have lesions without crusting. These people are considered contagious until 24 hours have passed without new lesions.

Pilar Camacho Conde , pediatrician at IHP Alcalá de Guadaíra (Seville), delves into this idea, commenting that the spread of chickenpox is direct from person to person due to skin lesions or Flügge droplets (small drops of saliva) , and can occur from 48 hours before the rash is evident.

In the characteristic varicella rash, says Camacho Conde, the coexistence of lesions in all stages stands out (that is, all the evolutionary forms of the lesions coincide and this is what is known as the ‘starry sky’). There macules (spots), papules (red bumps or pink), vesicles (blisters) small , containing clear liquid surrounded by a hyperemic halo scabs then just resecting and shedding. It is a pruritic rash (causes itching), which can affect any part of the body (more on the scalp than on the soles of the feet and palms of the hands), including the oral mucosa (which is known as enanthema) . Leaves permanent scars by itself or by superinfection by scratching the lesions.

Can chickenpox in adults be more serious than in children? 

“The age group most frequently affected is 1 to 10 years old. When it occurs in older children or adults, although it is less common, it is usually more serious and with more frequent complications, ”warns Camacho Conde.

According to Sánchez Peinador, “ chickenpox in adults and immunocompromised children (with leukemia , lymphoma or infected by the human immunodeficiency virus or HIV ) is more severe and lasting than in healthy children, in whom it is a generally benign disease that it lasts between three and five days ”.

In adults, encephalitis is a more serious and potentially fatal complication and is estimated to affect 0.1 to 0.2% of patients with chickenpox. The pneumonia Chickenpox is one of the most serious complications of this infection, and is more common in adolescents and adults than in children.

In this regard, the pediatrician explains that “complications of chickenpox are rare in immunocompetent patients. In immunosuppressed individuals, the disease may have a more serious course. Thus, the most frequent complications are those that affect the skin such as impetigo or superinfection, almost always from scratching. Also pneumonia, either by the virus itself or by bacterial superinfection. And, less frequently, cerebellar ataxia ”.

People most at risk for complications

In the words of the family doctor, “the risk of complications from chickenpox varies according to age; they are rare in healthy children and there is a greater risk for those over 15 years of age, under 1 year of age and immunocompromised people . Also pregnant women are risk group and those suffering from disorders and chronic lung skin « .

The relationship between chickenpox and shingles

Is herpes zoster in adults usually the reactivation of the chickenpox virus that you have passed on as a child? Sánchez Peinador explains that “when a person suffers from chickenpox, some viruses remain latent in the sensory ganglia, and during adulthood, by reducing defenses against the virus, it can reactivate locally and reappear in the form of herpes zoster, affecting the area of the nerve that leaves the affected sensory ganglion ”.

Chickenpox treatment

Camacho Conde mentions antipyretic drugs as medication for chickenpox , if necessary for fever, and an antihistamine that improves itching.

» Treatment with antivirals (valaciclovir, famciclovir or acyclovir) should be considered in those patients at risk of suffering more serious disease (patients older than 13 years, suffering from chronic skin or lung disorders and immunosuppressed patients)», adds Sánchez Peinador.

In addition, bacterial infection of the lesions should be avoided . For this, according to the family doctor, “patients must bathe regularly and keep their underwear and hands clean, with their nails trimmed. Antiseptics should not be applied unless the lesions become infected, in which case antibiotics are required. The relief of itching and the prevention of scratching -which predisposes to bacterial superinfection-, can be treated with wet compresses or, in case of intense itching, with the administration of systemic antihistamines and baths with colloidal oatmeal ”.

To prevent superinfection, the pediatrician advises “avoid rubbing the lesions during the shower. Dry well and blotting lotions can be used on the lesions ”.

Who should get vaccinated?

The experts consulted are clear: the best way to prevent chickenpox is to get vaccinated against this disease.“Currently, two doses of vaccine are administered at 15 months and at 3 years of life. Chickenpox is no longer the most common exanthematic disease in childhood. Only immunosuppressed patients and pregnant women should not be vaccinated, ”says Camacho Conde.
 Sánchez Peinador recalls that, “in Spain, systematic vaccination with two doses of vaccine is recommended for all healthy people over 12 years of age who do not have evidence of immunity. It is especially recommended for non-immunized people at risk of exposure (health workers and caregivers of chronically ill patients), people who live with immunosuppressed patients (with impaired defenses) who are at high risk of contracting the disease and developing severe forms, and women of childbearing age, bearing in mind that they must allow at least four weeks between the vaccine and a possible pregnancy ”. The family doctor states that vaccination is also recommended for post-exposure prophylaxis . Vaccination in the first three to five days after exposure to chickenpox can be effective in preventing the disease.

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