Expert Advice on chickenpox – a rite of passage or should you vaccinate?

Irish Pharmacist, Sheena Mitchell and founder of the WonderCare podcast and health advice platform recently put it to her 22,000 strong social following whether they believed treatment or prevention was a better plan for the infamous chickenpox disease. The response was phenomenal, it seems our recollection of childhood blisters and lifelong scars are being strongly influenced by our new understanding of how viruses operate and their countermeasures, the vaccine.

Here the mum of three children, medical professional and now family health podcaster, takes us through the facts, symptoms, treatment options, and vaccination pros and cons of chickenpox for the millennial mum.

Pharmacist Sheena Mitchell says, “For many of us, getting the chickenpox was simply a part of growing up. While it was uncomfortable for a short period, and some of us still have the scars to show, it was rarely a serious illness. In fact, chickenpox parties were a real thing to get it over with once your child had reached the more robust toddler stage. Usually, younger children present with a milder dose, and so it made sense even just for logistical reasons, to get the whole house infected in one go.”

Pharmacist Sheena Mitchell

The Facts:

In Ireland, chickenpox is largely seasonal peaking between January and April.

Chickenpox is a highly infectious disease caused by the varicella zoster virus. A person is contagious for up to 2-days before the spots appear and 7-days afterwards, or longer depending on how quickly the spots scab over.

The incubation period for chickenpox is typically 10-21 days after initial exposure. It is important to stay away from small babies, pregnant women and the immunocompromised if you have come into close contact with the virus. 

Chickenpox is most prevalent in children and infants under 12-years but can affect anyone. Adults are usually more adversely affected, while complications can arise for pregnant women, their unborn or brand-new babies, and those with skin conditions.

The Symptoms:

Chickenpox presents as a rash that normally starts as small red spots, which then turn into fluid filled blisters, after about 12-hours. These blisters can be extremely itchy and uncomfortable and will remain like this for up to two days before becoming cloudy and drying up. Some spots may burst, and new spots can appear in clusters for up to 5-days, making it important to stay in isolation until all spots have scabbed over.

Chickenpox spots most commonly appear on the chest, back, and face but can also affect the arms and legs. The rash can also appear inside the ears, mouth, throat and in the genital or nappy area. Children can become very distressed by the itch caused by the chickenpox rash, which can lead to scratching, infection, and scarring.

Other symptoms of the chickenpox infection include a high temperature, aches and pains, nausea, and a loss of appetite.

In a small number of cases, chickenpox can develop a secondary bacterial infection arising from the Group A Streptococci (GAS) bacteria which lives on a person’s skin and in their throat. With the scratching of itchy blisters, there is a risk of very serious infection called Invasive Group A Streptococci or iGAS. This can result in sepsis or necrotising fasciitis, both extremely serious conditions but which can be treated if caught early. Signs of a secondary bacterial infection include large red areas around the spots which can be hot and painful, a high fever, serious headaches, nausea or vomiting, lethargy or difficulty breathing.

The Treatment:

Poxclin cool mousse – this mousse can provide cooling and soothing relief from the rash with the antibacterial agent also helping to prevent infection and reduce scarring. If you have sensitive skin or suffer from allergies, it is recommended that you do a patch test before full use.

Calamine lotion – this lotion can help to cool the skin but can be tedious to apply. The cream version is effective at helping to dry up any weeping spots.

Aveeno Dermexa bath emollient – gentle and soothing the oat base moisturises the skin and promotes healing.

Bread Soda bath – adding two tablespoons of bread soda to the bath can also help as it contains both antibacterial and anti-inflammatory properties.

Oats – unless you are a coeliac, adding oats to a tepid bath will promote healing and ease irritation. Put the oats in a long sock or stocking to allow the milk to be released from the oats or soak the sock first in a warm saucepan for an hour and add the milk to the bath.

Pain Relief medicine - Calpol or Paralink paracetamol-based medicines are essential to help keep temperatures and sore spots under control, especially if the rash extends to in the mouth and throat. Avoid ibuprofen (Nurofen) unless necessary as some studies have shown it can increase the chance of bacterial infection when used during chickenpox.

Difflam spray – this mouth and throat spray is suitable for use from any age and works to relieve the pain of mouth and throat chickenpox blisters. Spray on your finger and rub on to the affected areas. Use 15-minutes before food or drink.

Antihistamines – taken in liquid or tablet form depending on age, these work effectively to reduce the itch of the chickenpox.

The Vaccine:

Varivax is the name of the vaccine used to protect children and adults against the chickenpox virus. It is administered in two doses, one month apart from 12-months of age and can be given at the same time as other vaccines on the childhood immunisation schedule.

The chickenpox vaccine is a live vaccine and works by stimulating your immune system to produce the antibodies that will help protect against the chickenpox virus. Side effects are mild and consistent with other vaccines including a high temperature, soreness around the injection site, and in a small number of cases a mild rash may occur.

The chickenpox vaccination is not currently a part of Ireland’s routine childhood immunisation schedule, although this has been scheduled for review by Irish health authorities.

There's a worry that introducing the chickenpox vaccination for all children could increase the risk of chickenpox and shingles in adults. Both illnesses can be quite severe in adults and the risk of complications increase with age.

There is a school of thought that while chickenpox during childhood is unpleasant, most children recover quickly and easily. Whereas the same cannot be said when the virus is contracted as an adult. Children who get infected with chickenpox as a child develop lifelong immunity against the virus.  

If a childhood chickenpox vaccination programme was introduced, people would not catch chickenpox as children, because the infection would no longer circulate in areas where most children had been vaccinated.

This would leave unvaccinated children susceptible to contracting chickenpox as adults, when they could develop a more severe infection or a secondary complication such as pneumonia or encephalitis. While those vaccinated as children may need a booster vaccine later as the antibodies are said to last around 15 years.

For women who plan on having a family, their antibodies against chickenpox are usually checked when preparing to conceive. However, those who fall pregnant without an antibody check, even if they were vaccinated as a child, may not have sufficient antibodies to carry them through their pregnancy safely. Only those who contracted the illness as a child are protected from chickenpox for life.

With all of the latest medical and scientific information available to her Sheena the Pharmacist took to the airwaves in the form of her WonderCare podcast to answer the flood of questions from parents asking about the chickenpox vaccine.

She said, “Since the development of a safe vaccine for chickenpox, there is a growing number of parents who don’t wish their children to suffer unnecessarily, miss school and run the risk of infecting a vulnerable member of their family. While other parents get their children vaccinated in order to protect their vulnerable child from any complications of the disease, including those with skin conditions like eczema and psoriasis.”

“Frustratingly those infected with chickenpox are highly contagious for a couple of days before the first spots appear, and usually just feel generally unwell. The virus can be passed by coughing, sneezing and close contact in the early stages, and later through the blisters before they scab over.”

“I am surprised at how many parents contacted me for advice on the chickenpox vaccine. As a medical professional, I can only provide all of the information I have at my disposal in a balanced and easily digestible format. That way each person can make their own informed decision on what is best for their family. This is where my podcast really comes into its own, parents can listen to all the information regarding the pros and cons at a time that is convenient for them.”

The Irish Pharmacist, and owner of totalhealth pharmacy in Milltown, has recently launched the third series of her popular podcast. This series is dedicated to infectious diseases, with two episodes on the chickenpox, looking at both the treatments available and the arguments for and against vaccination. Followers of the social media channels and regular listeners have also raised their own questions which are answered in-depth throughout the two informative episodes.


Chickenpox Part 1 – Signs & Symptoms Treatment

Chickenpox Part 2 – Vaccination Discussion with Q&A