Dr Niyaf's Online Clinic

After a much needed and lengthy leave, I returned to work at IGMH today to find an increased number of children being brought to the Paediatric clinics with chickenpox. I have myself seen 5 cases of chickenpox within the past 24 hours both at the hospital and privately.

With schools scheduled to open on the 13th of this month, affected children are almost certainly going to miss the start of their academic year.

Chickenpox cases have been reported by myself and colleagues since October 2007 but they were few and far between. My colleagues tell me that they have themselves witnessed an increase in the number of cases since December 2007.

This highly contagious disease cause minor epidemics every few year in the Maldives and this apparent increase in case load could be a call for improved public health awareness in preventing one this year.

What is Chickenpox?
It is a highly contagious viral infection caused by Varicella Zoster virus. It is usually a disease of childhood but could affect non-immune adults as well.

How does one get Chickenpox?
Chickenpox is contagious, meaning capable of spreading from an affected individual to a non-immune individual. It is spread by inhalation of air-borne infective droplets from a patient (release during coughing, sneezing or even talking) or contact with infective lesions. Therefore infection is easily spread within a household or among peers sharing a classroom or other living or working environment.

What happens if you get infected?
Most people infected will initially have a mild to moderately high fever for a few days. This is followed by the appearance of vesicular (fluid filled) rash all over the body; mostly over the face, trunk and limbs. The lesions quickly rupture to form ulcers and later form crust. The lesions appear in crops, with fresh lesions appearing in about 1-5 days of the appearance of the first vesicles.

Are there complications?
Most cases don’t have any complications. Pneumonia is one of the most common complications, particularly in the affected adults, that needs specific attention. Other, usually rare, complications include: hepatitis (inflammation of the liver), encephalitis (infection or inflammation of the brain parenchyma) and secondary bacterial infections.

How do we know it is Chickenpox?
It is best to have the child seen by a medical practitioner to diagnose the condition. The diagnosis is established on clinical ground and no investigation is required. Consultation by a medical practitioner also provides an opportunity for public health surveillance system to be notified.

What could be done at home if one gets infected?
During the febrile phase Paracetamol can be used to reduce the discomfort associated with the elevated temperature. It is very important to isolate the affected child from other non-immune children and adults as soon as the disease is identified and until all skin lesions have crusted. The skin should be kept clean and child allowed to rest. Taking a bath is not harmful!

How is Chickenpox treated?
The disease is self-limiting and clears without any treatment. Acyclovir, an antiviral medication is increasingly being accepted and used to shorten the length of the illness and minimize the severity of symptoms. It is still not commonly used for childhood Chickenpox. The medication is relatively expensive and not as useful once the skin lesions have progressed.
No antibiotics are needed unless secondary bacterial infection complicate the clinical picture. Itching is a common symptom which maybe relieved with medications.

What can be done to prevent infection?
Cases of Chickenpox should be kept isolated from non-immune individuals. The isolation helps is preventing spread of infection and preventing epidemics. The period of isolation is until all lesions crust over and could typically take between 10 and 21 days. Children should not be sent to school during this period.
A vaccine for Chickenpox is available for purchase in Male’. The vaccine confers considerable immunity from infections and is one of the best tools available today to prevent Chickenpox.
Individuals who have had Chickenpox infection in the past would also have typically acquired immunity.

I hope that this information is helpful in educating the public on the illness and what can be done to help prevent spread of the disease.

NB: I would like to invite all readers to use the information contained within the above post to spread awareness in whatever way they can.