Understand the Impact of Chickenpox From a Doctor's Diary

Childhood is indeed fun and full of new experiences that will shape a child’s personality throughout their growing process. In these early years, the child's body also learns to adapt to the outside world and day by day increases the body's immune system against various “attacks” of viruses and bacteria. 

There are several diseases that commonly infect children, and these diseases do not recognise age, gender, race, or family health background. Among the common ones experienced by them are cough and flu; bronchitis; gastroenteritis; sore throat; bacterial infections in the ears; chickenpox and more¹.

Chickenpox: Important Facts

• It is also known as varicella virus²
• The same virus that causes shingles²

• Signs/Symptoms²:
  • Fever and fatigue about five days before the onset of the rash.
  • The rash is in the form of small itchy red spots, starting on the chest and back of the body, then spreading to the face and the rest of the body.
  • Within 24 hours, the rash will turn into water blisters, which will then rupture, dry up and turn into crusts.
  • New spots continue to appear for up to five days.
• Method of infection²:
  • Through coughing and sneezing from an infected individual 
  • Sniffing or touching "virus particles" from fluid coming out of blisters
• Chickenpox infection actually occurs 10-21 days after exposure to a person with chickenpox. Patients can infect others 1-2 days before the rash appears until all crusts are dry².
• It is usually not so serious if it infects healthy children. However, chickenpox can be serious if infecting adults and newborn babies².

Complications of Chickenpox

Most children will recover well from a chickenpox infection. However, the disease can also lead to complications that require careful treatment.

Those who may be at high risk for chickenpox complications are newborns, adults, pregnant women and individuals with weakened immune systems such as human immunodeficiency (HIV) patients, cancer patients, individuals who have had organ transplants, are undergoing chemotherapy, taking steroids for a long time or immunosuppressive drugs³. 

Among the complications from chickenpox that can occur in this high-risk group are³:

• Bacterial infections of the skin (Group A Streptococcal disease)
• Pneumonia
• Infections of the bloodstream (sepsis)
• Inflammation of the brain (cerebellar ataxia, encephalitis)
• Dehydration

Serious complications require the patient to be admitted to a ward and in some cases, can even lead to death. However, deaths from chickenpox are rare today since immunisation for the varicella virus was introduced.

To learn more in depth about the complications of chickenpox, we interviewed Dr. Ng Yi-Ki, a renowned paediatrician to get her real-life experience in treating cases of chickenpox infection throughout her career. 

Question: Can you share your personal experience in treating children with chickenpox complications?

Dr. Ng Yi-Ki: “The group of children whom I see are at the highest risk of contracting complications from chickenpox are the very young ones. They would be admitted to the hospital with severe rash and often complicated with lung infection, requiring oxygen supplementation. They were often lethargic and fed poorly, needing intravenous drip to keep the body hydrated and also had to be monitored very closely.  I have also seen chickenpox complicated with bacterial skin infection and requiring antibiotics. Those with complications often require hospitalisation up to a week  or longer!”*

 Question: Were there any unique cases of chickenpox complications that you can share with us?

Dr. Ng Yi-Ki: “I have also treated newborn babies who were infected with the virus because their mother had chickenpox just a few days before giving birth. These mothers are usually not vaccinated against chickenpox, or have never gotten chickenpox when they were younger.”*

Important Information For Pregnant Mothers

All pregnant mothers are advised to be vigilant against the varicella virus because if infected, the impact can be greater as it threatens not one, but two lives at the same time.

In addition to the pneumonia mentioned above, the following are complications that can occur if a pregnant mother is infected with the varicella virus:

• If the infection occurs during the first 20 weeks of pregnancy, especially between the 8th and 20th week, your baby is at risk of a birth defect condition (but rare) i.e. congenital varicella syndrome. Babies with this syndrome may have scars on the skin and defects of the gastrointestinal tract, eyes, hands, feet and brain⁴.
• If the infection occurs during a few days before birth to 48 hours after birth, your baby might be at risk of being born with neonatal varicella, a potentially fatal infection^4,5.

Susceptible To Varicella Virus (Chickenpox Or Shingles)?

Since the varicella virus is highly contagious, act as soon as you know that you or your children have been exposed to the virus. Contact your doctor immediately for advice on what precautions to take.

If your child has been immunised for chickenpox, your child may still get the disease. However, the symptoms are usually mild⁶. 

Doctor's Tips For Caring For Children Infected With Chickenpox At Home

Most children infected with chickenpox generally only need care at home. Here's what parents can do as recommended by Doctor Ng Yi-Ki:

• Quarantine the child at home as soon as the symptoms begin to show
• Give paracetamol if your child is having a fever
• Always wash your hands after caring for your child
• Ensure your child eats nutritious and balanced food and drinks enough water
• Apply calamine lotion on the rashes to relieve itching

• If the itching gets to the point of disturbing the child's comfort, state to the doctor.
• Make sure the child's nails have been cut short to prevent the child from scratching the rash.

For patients 12 years of age and older and those in high-risk groups, doctors may also prescribe antiviral medications for chickenpox⁶.

You may be wondering, when do you need to go to the clinic or hospital? Seek further treatment immediately if your child experiences any of the following symptoms⁶:

• Fever more than 4 days
• Fever over 38.9 ° C
• Frequent vomiting
• Neck cramps
• Difficulty walking or moving
• Rash begins to purulent (signs of bacterial infection)
• Difficulty breathing
• Extreme stomach pain 
• Severe cough
• Bleeding spots or bruises

Prevention Is Better Than Cure 

In general, chickenpox is not serious. However, because the virus is so contagious, it is better to control its spread than to treat the effects of the infection, which is likely to lead to serious complications if it infects high-risk groups.  

Although chickenpox immunisation is not mandatory in the National Immunisation Schedule, parents should not take the disease lightly. Parents of young children should be aware of the consequences of not getting their children the chickenpox immunisation. Dr Ng Yi-Ki’s bottom line? “Even if it was a mild case, the child would have to miss school for 1-2 weeks. One of the ways to help prevent chickenpox is to get the chickenpox vaccine.”*   

As parents, the responsibility to ensure the well-being of your children and the whole family is paramount. By taking care of your own family's health, you are also indirectly taking care of the well-being of the community. Therefore, protect your loved ones from infectious diseases such as chickenpox so that they can enjoy a more enjoyable and quality childhood. 

If you have any doubts about how to prevent chickenpox, for example chickenpox immunisation, seek the advice of a specialist doctor. The doctor will definitely give you advice that benefits your child’s health. Don't wait until it's too late.    

*This information is provided as a professional service by MSD. The views expressed in the publication reflects the experience and opinions of the authors.

MY-VVX-00136 Oct/2022

REFERENCES:

1. Nidirect. Childhood illnesses. Available From: https://www.nidirect.gov.uk/conditions/childhood-illnesses. Last Accessed 5 September 2022.
2. PORTAL MyHealth. Chickenpox. Available From: https://www.myhealth.gov.my/en/chickenpox/. Last Accessed 5 September 2022. 
3. Centers for Disease Control and Prevention. Chickenpox (Varicella). Available From: https://www.cdc.gov/chickenpox/about/complications.html. Last Accessed 5 September 2022. 
4. Mayo Clinic. What are the risks associated with chickenpox and pregnancy?. Available From: https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/chickenpox-and-pregnancy/faq-20057886. Last Accessed 5 September 2022. 
5. National Institutes of Health. Congenital Varicella Syndrome. Available From: https://www.ncbi.nlm.nih.gov/books/NBK568794/. Last Accessed 5 September 2022. 
6. Centers for Disease Control and Prevention. Chickenpox (Varicella). Available From: https://www.cdc.gov/chickenpox/about/prevention-treatment.html. Last Accessed 5 September 2022.