When does chickenpox stop being contagious?

chickenpox

chickenpox(Varicella): Infectious disease caused by the varicella zoster virus, which mainly affects kindergarten and elementary school children and typically breaks out in the winter months or in spring.

Chickenpox is so contagious that 90% of all 10 year olds have had the disease. It leaves you with lifelong immunity.

Leading complaints

The symptoms seem to increase the older the child is with the disease.

  • Uncharacteristic preliminary stage with tiredness and malaise, headache and body aches
  • Fever (rarely above 39 ° C) for 3–5 days
  • Characteristic, uncomfortably itchy rash on the head and trunk
  • Initially light red nodules, later fluid-filled vesicles
  • After a few days and for a few more days: again and again blisters burst, dry out and heal.

Incubation period. 11-21 days.

Period of contagion. From 1–2 days before the rash breaks out until the last blister dries up.

When to the doctor

Today if

  • You're not sure if your child has chickenpox or another disease.
  • You cannot control the severe itching in your child yourself (see "What you can do as a parent").
  • the skin becomes very inflamed (you will notice increasing swelling, redness and suppuration).
  • Your child is under 6 months old.

Immediately if

  • Your child gets a stiff neck, cramps, or loss of balance, or becomes listless as these symptoms suggest meningitis.

The illness

Disease origin and transmission

The trigger is the varicella zoster virus, which belongs to the group of herpes viruses. It becomes v. a. transmitted by a droplet infection, i.e. when coughing, sneezing, talking or cuddling.

The viruses enter the bloodstream of healthy individuals via the upper respiratory tract or the conjunctiva. The viruses mainly spread by scratching the vesicles, or when they burst open by themselves and the healthy person comes into contact with the vesicle fluid.

It is practically impossible to prevent infection: If a family member has chickenpox, 80–90% of the other family members will be infected, provided they have not yet developed antibodies from a previous infection.

course

Chickenpox disease is usually mild in children. It is more severe in young children, adults and people with weakened immune systems. Fever and a feeling of illness are most pronounced in adults.

The itchy rash usually starts on the trunk and spreads to the hairy head, face, and extremities. The palms of the hands and soles of the feet are not affected. The rash consists of between 10 and more than 1000 individual blisters, as the individual blisters usually appear gradually. While some blisters are already covered by scabs, others are still filled with liquid (so-called starry sky).

Diagnostic assurance

The diagnosis of "chickenpox" is a visual diagnosis; H. the doctor recognizes the disease relatively clearly based on the typical rash.

Since this initially resembles mosquito bites, you should wait a day and check whether the number of red spots has increased. Chickenpox differs from other childhood diseases such as measles, scarlet fever and rubella in that red spots on the skin can also be seen, but no blisters. Additional examinations are rarely necessary.

Blood test. If in doubt, the doctor will detect specific antibodies in the blood.

Pathogen detection. The virus can be quickly detected from the vesicle secretion using PCR (Polymerase Chain Reaction), but this method is only necessary in individual cases, for example if the birth of an expectant mother is artificially delayed by a few days due to chickenpox or a special therapy must be initiated.

Complications

For otherwise healthy toddlers, chickenpox is rarely dangerous. If older children and adults become infected with chickenpox, the disease often progresses with fever, a severe feeling of illness and also severe skin involvement.

Even in children with neurodermatitis, severe courses can occur because of the already damaged skin. Children with weakened immune systems, e.g. B. Children with leukemia can even become life-threatening.

Scarring. Sometimes the blisters become infected, for example when a child scratches the blisters. Small scars then remain.

Inflammation of the lungs (pneumonia). This serious complication is extremely rare and occurs about 3-5 days after the onset of the disease. Pneumonia affects adults much more often than children.

Heart and kidney involvement. These complications are very rare.

Inflammation of the cerebrum (Encephalitis) or cerebellar (cerebellitis). These serious complications are also extremely rare.

Varicella embryopathy. Pregnant women in particular should avoid sick children, because an infection with chickenpox means a danger to the unborn child. V. a. Before the 20th week of pregnancy, the risk of brain damage, malformations of the limbs, growth disorders or a congenital cataract is 1% in the unborn child. There is also the risk of an abortion.

Neonatal varicella. Young infants usually do not get chickenpox because they are protected by the defense substances (antibodies) transferred from the mother during pregnancy. If a mother who has not yet had chickenpox develops chickenpox 5 days before to 2 days after delivery, the newborn baby lacks this nest protection and it may become very seriously ill. For this reason, they must be treated with antibodies and antiviral agents (antivirals) before the vesicles break out.

Possible consequence: shingles

As with all herpes viruses, there is a risk that the varicella zoster virus will remain in the body after the acute illness. In the course of life, there is a chance that it will reactivate and cause shingles (herpes zoster).

Cancer patients are particularly affected by this. They are about twice to 8 times more likely to develop shingles than healthy people. But high blood pressure, diabetes, kidney failure or rheumatoid arthritis also increase the risk of developing shingles.

Since both diseases - chickenpox and shingles - are caused by the same virus, it is possible that e.g. For example, a grandmother who has shingles infects her grandson with chickenpox.

treatment

Therapy is not required in otherwise healthy children.

Pharmacotherapy

Treatment with antiviral drugs (acyclovir) is only necessary if the sick person is over 20 years old, has an immune deficiency, has severe neurodermatitis or if complications occur.

If the itching is very annoying, the doctor will prescribe lotions (e.g. Tannosynth® or Anaesthesin®) or, in severe cases, antihistamines as drops. These help against the itching and also make you a little tired and thus ensure a better sleep. The application is therefore suitable for the evening.

If the vesicles that are scratched become inflamed, the doctor will prescribe antibiotics. Local anesthetics with polidocanol also help against acute itching, but can lead to hypersensitivity reactions.

Your pharmacy recommends

What you can do as a parent

Isolation.

Children are not allowed to attend community facilities such as kindergarten or school until they are free of fever and the rash is dry, d. i.e., until the blisters are covered with scabs.

Zinc lotions.

The main problem with chickenpox is usually the itching, which is alleviated with over-the-counter lotions from the pharmacy (e.g. Lotio alba). At the same time, the lotion dries out the blisters and prevents the weeping areas from becoming inflamed.

Dress.

The clothing should be as loose as possible and not chafe.

Cool compresses and washes.

Briefly applied cool compresses also relieve the itching. Cool washes or a short shower with cool water also work. Baths should be avoided, as the blisters soften in the bath and are then more easily scratched (promotes scarring).

Cool room temperature.

The room should not be too warm, because heat and sweating increase the itching.

Diaper change.

Babies and toddlers should be swaddled more often than usual, as the warm, humid environment in the diaper increases itching and promotes inflammation.

Skin care.

Scratching should be avoided whenever possible to prevent skin infection. To avoid this, it is best to cut the child's fingernails short. Gloves may also help to prevent your child from scratching.

Appropriate medication

If you have a fever, calf compresses or antipyretic drugs such as paracetamol and ibuprofen are recommended. The dosage is strictly based on the weight of the child. Ask your doctor or pharmacist!

Complementary medicine

Homeopathy.

Classic homeopathic remedies for chickenpox are Belladonna D4 and Rhus toxicodendron for fever.

Prevention

Active vaccination.

The vaccination against chickenpox from the age of 11 months is one of the recommended regular vaccinations. The Standing Vaccination Commission (STIKO) has recommended varicella vaccination for all children and adolescents since August 2004, preferably as a combination vaccination (4-fold vaccination) against measles, mumps and rubella (MMRV).

Since July 2012 it has been recommended not to give the primary vaccination as a quadruple vaccination, but to vaccinate the varicella vaccine simultaneously with the MMR vaccine on different parts of the body. This is to avoid the slightly increased risk of febrile seizures.

However, many paediatricians take a critical view of the vaccination against chickenpox: It is to be feared that natural chickenpox infections will occur less and less and that children who are not vaccinated will only become infected late, possibly even in adulthood or pregnancy. The course of the disease is then more severe and there is more risk of complications.

The STIKO gives the following vaccination recommendations against chickenpox, broken down by age:

  • 11-14 Month of life: First vaccination takes place at the same time as the 1st measles, mumps and rubella vaccination (MMR) or at the earliest 4 weeks afterwards.
  • 15-23 Month of life: 4–6 weeks after the first vaccination, the second vaccination is carried out, also possible as a combination vaccine against measles, mumps, rubella and chickenpox (MMRV combination vaccine). The vaccination will only be postponed if there is a serious illness that requires treatment.

Passive vaccination.

In addition to active vaccinations, which aim to develop an immune memory, there are also passive vaccinations (passive immunization). The body is injected directly with the finished antibodies (immunoglobulins) that the immune system of the donor organism (human or animal) has produced to defend itself against the pathogen.

While active vaccinations often take months to achieve vaccination protection, passive vaccinations take effect after a few hours to days. They are therefore v. a. then used when z. B. a immune-weakened, not vaccinated child or a pregnant woman has had contact with a chickenpox patient and must not wait until the body has formed sufficient antibodies.

The disadvantage of passive vaccination, however, is that the injected immunoglobulins in the blood also break down quickly and the vaccination protection does not last longer than a few weeks.

Authors

Dr. med. Herbert Renz-Polster in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the sections "Description", "Symptoms and complaints", "When to see the pediatrician", "The disease", "Your pharmacy recommends", "Medical treatment" and "Prevention": Dagmar Fernholz | last changed on at 09:40


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.