Varicella Vaccine Prevents Unpleasant Infection

In season 2 of the television series “Friends,” unvaccinated Phoebe contracts a childhood viral infection and gives it to her paramour.

Their pruritis is so severe that they don oven mitts to keep them from disturbing the lesions. Technically, the episode should be called “The One With the Varicella,” but as the audience is laypeople, it is called “The One With the Chickenpox.” The itching creates comedy on the show. But it is no laughing matter in real life. Typically, chickenpox is considered a disease of childhood, but adults who have not had it or been vaccinated against it can also contract the disease. In healthy people, it is usually a mild and self-limiting illness.¹

Spotty Eruptions

The word varicella, is a derivative or diminutive of the Latin variola, which means smallpox, or “spotted.”² Clinicians were not sure that chickenpox and smallpox were different infections until the 19th century.^3,4 In many Eastern European languages, the word used for chickenpox often translates to “wind pox,” reflecting its easy, rapid spread.^5-7 It can be spread by direct contact and respiratory inhalation of aerosols from vesicular fluid in skin lesions or coughing or sneezing.¹

Chickenpox is very contagious. In the United States, more than 90% of individuals who have not been vaccinated or previously had the disease who are exposed to this virus will develop the disease. Contagion can occur as early as 3 days before the onset of the rash to 4 days after it erupts.⁸ Immunocompromised individuals, infants, and pregnant women are at increased risk.¹

Chickenpox manifests as a vesicular eruption: a red spotty rash that has water-filled blisters. It is usually accompanied by low-grade fever and malaise.¹ After an incubation period of 10 to 21 days, it usually starts on the back, chest, and face and then spreads to the rest of the body. A typical case lasts 5 to 7 days, at which point the lesions crust. Complications are possible (see Table 1), with bacterial skin sepsis most common in children younger than 5 years. Older children are more likely to develop acute cerebellar ataxia, and varicella pneumonia is the most common complication in adults. In general, it is a more serious condition in adults than in children.¹

Vaccinations Work Wonders

Since 1995, the Advisory Committee on Immunization Practices has recommended a live attenuated varicella vaccine to prevent chickenpox in healthy children as a routine vaccine.⁹ It may also reduce the incidence of chickenpox in healthy unvaccinated children exposed to varicella-zoster virus if administered within 3 days of exposure. Vaccinated children who develop chickenpox usually have mild disease. The recommendation is 2 doses of varicella vaccine for all children, adolescents, and adults without evidence of immunity. If an individual misses the second dose, receiving the second dose as soon as the gap is identified provides the best protection against the disease.⁹

When individuals contract chickenpox, they should follow standard precautions and contact precautions until lesions are dry and crustEd. Table 2^10,11 lists appropriate interventions for typical disease.

In addition, pharmacists and health care providers should actively counsel caregivers and patients not to use aspirin or aspirin-containing products to relieve fever from chickenpox because it has been associated with Reye syndrome. In addition, the American Academy of Pediatrics recommends avoiding treatment with ibuprofen, if possible, because it has been associated with life-threatening bacterial skin infections.

Conclusion

The CDC indicates that varicella vaccination prevents more than 3.5 million cases of varicella, 9000 hospitalizations, and 100 deaths every year in the United States.¹ Although now less of a problem than in the past, chickenpox still occurs, and pharmacy staff members will sometimes field questions about it. In most cases, management is simple, although patients will find the infection bothersome and the itching intrusive.

Jeannette Y. Wick, MBA, RPh, FASCP is the assistant director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy in Storrs.

References

1. Chickenpox (varicella): for healthcare professionals. CDC. Updated April 28, 2021. Accessed October 20, 2021. https://www. cdc.gov/chickenpox/hcp/index.html

2. Lippincott Williams & Wilkins. Stedman’s Medical Dictionary. 2011. Accessed November 17, 2021. https://stedmansonline.com/ public/Learnmore.aspx?resourceID=Medical

3. Trousseau A. Lectures on Clinical Medicine. Lindsay & Blakiston; 1873.

4. Osler W. Varicella. In: The Principles and Practice of Medicine. D. Appleton and Company;1892:65-77.

5. Juel-Jensen BE, MaCallum FO. Herpes Simplex, Varicella and Zoster: Clinical Manifestations and Treatment. Lippincott; 1972.

6. Vaccinations at a glance. October 11, 2021. Accessed November 14, 2021. http://www.reisemed.at/krankheiten/varicellen-windpocken-feuchtblattern

7. Korczyńska MR, Rogalska J. Chickenpox in Poland in 2013. Przeglad Epidemiol. 2013;69(2):219-222, 345-347.

8. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. 5th ed. Elsevier Mosby.

9. Varicella ACIP vaccine recommendations. CDC. Updated November 21, 2014. Accessed October 20, 2021. https://www.cdc. gov/vaccines/hcp/acip-recs/vacc-specific/varicella.html

10. Centers for Disease Control and Prevention (CDC). Updated recommendations for use of VariZIG-United States, 2013. MMWR Morb Mortal Wkly Rep. 2013;62(28):574-576.

11. Chickenpox (varicella): prevention and treatment. CDC. Updated April 28, 2021. Accessed October 20, 2021. https://www.cdc.gov/ chickenpox/about/prevention-treatment.html