Chickenpox is an infectious disease caused by the Varicella-Zoster Virus (VZV), primarily transmitted through respiratory droplets or contact with skin lesion exudates. This disease is extremely common among children, but adult infections can lead to more severe symptoms. Although widespread vaccination has reduced the incidence, understanding its basic characteristics remains crucial for prevention and management of infection.
This illness is characterized by a generalized rash and vesicles. The incubation period is approximately 10 to 21 days, followed by prodromal symptoms such as fever and fatigue. Subsequently, skin eruptions develop, initially as redness and then transforming into blisters. While most patients recover spontaneously, complications such as secondary bacterial infections or pneumonia require serious attention. This article systematically analyzes its etiology, symptoms, diagnostic methods, and preventive measures to provide comprehensive knowledge.
The Varicella-Zoster Virus is the sole pathogen responsible for this disease. It is transmitted via droplets released when an infected person coughs or sneezes, or through contact with contaminated clothing or utensils. After entering the human body, the virus first enters a latent phase; during this period, the patient is asymptomatic but contagious. The virus replicates extensively within the body, triggering typical symptoms once the immune system responds.
Risk groups mainly include unvaccinated children, immunocompromised individuals (such as chemotherapy patients), pregnant women, and long-term caregivers exposed to infected persons. Notably, infection during pregnancy may lead to congenital varicella syndrome in the fetus, including retinal abnormalities or brain malformations. Additionally, if immunity is not established after exposure, the household transmission rate can exceed 90%.
Typical symptoms are divided into prodromal and rash phases. The prodromal phase lasts about 1-2 days, during which patients may experience low-grade fever, headache, and loss of appetite. Skin lesions then appear as red macules, which rapidly progress to fluid-filled vesicles within 24 hours, eventually crusting over. The rash usually spreads in the order of head → trunk → limbs, with different stages of lesions possibly present simultaneously.
Severe cases may involve complications such as persistent high fever, purulent skin infections, respiratory difficulty from pneumonia, or encephalitis causing altered consciousness. If vesicles rupture and are not properly cared for, bacterial infections can lead to cellulitis or scarring. Adult patients often experience muscle aches and high fever, with symptoms generally more severe than in children.
Clinical diagnosis mainly relies on symptom observation and characteristic skin lesions. Physicians typically confirm the stage of vesicle development through visual inspection. In cases of suspected complications or unclear diagnosis, blood tests measuring antibody levels or skin lesion sampling for viral culture may be performed. Patients with compromised immune function require more detailed laboratory examinations to assess disease severity.
Differential diagnosis should distinguish from other similar skin conditions, such as herpes zoster, drug allergies, or syphilis. If a vaccinated patient shows symptoms, PCR testing may be necessary to confirm whether it is a vaccine strain or wild-type infection. Children with symptoms like rapid breathing or seizures should undergo immediate imaging to rule out encephalitis.
Treatment focuses on symptom relief. Preschool children are usually advised to stay at home and manage symptoms. Antipyretics such as acetaminophen can reduce fever and discomfort, but aspirin should be avoided to prevent Reye's syndrome. Antiviral drugs like acyclovir are most effective if used within 72 hours of onset, especially for high-risk groups.
Skin care includes cold compresses and calamine lotion to relieve itching, and trimming nails to prevent scratching. Severe complications such as bacterial skin infections require antibiotics. Patients with pneumonia may need hospitalization and oxygen therapy. Immunoglobulin injections can be used for high-risk contacts within 96 hours of exposure as post-exposure prophylaxis.
The primary preventive measure is vaccination. The standard schedule involves two doses: the first at 12-15 months of age and the second at 4-6 years. The vaccine provides over 90% protection. Post-vaccination, mild symptoms similar to side effects may occur, but serious adverse reactions are much less common than natural infection. Monitoring antibody levels after vaccination is recommended, especially for immunocompromised individuals who may need adjusted strategies.
Isolation measures are crucial to control transmission. Patients should be isolated until all vesicles crust over. Schools and childcare centers should establish vaccination verification systems. High-risk groups such as pregnant women and unvaccinated individuals exposed to infected persons should receive immunoglobulin promptly. Good hygiene practices, such as frequent handwashing and surface disinfection, can reduce viral survival time.
Seek medical attention immediately if: fever exceeds 39°C and persists for 48 hours, skin lesions become pustular or show signs of infection, difficulty breathing or chest pain occurs, consciousness is altered, or vomiting persists. Patients with skin conditions or autoimmune diseases should seek early evaluation even with mild symptoms. Pregnant women suspecting infection should consult promptly to assess fetal risk.
Adult patients with symptoms like headache accompanied by blurred vision, spreading skin infections, or fever lasting more than 3 days may have bacterial superinfection or encephalitis and require immediate antibiotic treatment or hospitalization. Any high fever or widespread rash after vaccination should also be evaluated to determine if it is a vaccine-related reaction.
Infection during early pregnancy (before 20 weeks) may increase the risk of congenital varicella syndrome in the fetus, including limb defects or retinal scars. Infection later in pregnancy can lead to neonatal varicella syndrome. It is recommended to confirm immune status before pregnancy. If exposed during pregnancy, seek medical evaluation immediately.
Can people vaccinated against chickenpox still get infected?About 90-95% of vaccinated individuals develop immunity, but a small percentage may still get infected due to insufficient vaccine efficacy. Post-vaccination infections are usually milder, with fewer lesions and less itching. It is advised to avoid contact with confirmed cases and monitor for any changes in health.
How can chickenpox itching be safely relieved? Which methods are not recommended?Cold compresses, oatmeal baths, and over-the-counter antihistamines can help relieve itching. Scratching should be avoided to prevent scarring. Products containing salicylates (like aspirin) are not recommended as they may trigger Reye's syndrome. Keeping nails trimmed and skin clean can also reduce secondary infections.
Can I resume normal activities immediately after recovery? Which activities should be avoided?It is recommended to rest for at least 1-2 weeks after recovery before gradually resuming light activities. Avoid strenuous exercise that may raise body temperature and worsen itching or delay healing. Contact sports should be postponed until all lesions crust and fall off to prevent skin injuries and infections.
Are adults at higher risk of complications from chickenpox than children?Adults have a 2-5 times higher risk of complications, such as pneumonia, encephalitis, or sepsis. Those with weakened immune systems or chronic illnesses should be especially cautious. It is recommended to receive immunoglobulin or antiviral treatment within 48 hours of exposure to reduce risks.
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