Clinical Notes: Varicella (Chicken Pox) and Zoster

Cause: Varicella zoster virus

Primary infection of VZV is chicken pox, a common childhood disease.
Natural history:
* Respiratory transmission
* Incubation period of 10-24 days, usually 14-18
* Lesions begin on trunk and spread to periphery
* Rash appears abruptly, with or without malaise or fever.
* Contagious 24 hours before the onset of clinical symptoms and until all lesions have crusted over
* Children: new lesions may appear for 4-5 days
* Adults: clinical symptoms often last two weeks
Description of vesicles:
* "Dewdrops on a rose petal"
* Very superficial
* Vesicles break easily
* Does not scar, unless there is a secondary bacterial infection
* VERY itchy
Potential complications:
* varicella pneumonia
* encephalitis
* asceptic meningitis
* bacterial superinfections
* myocarditis
* glomerulonephritis
* purpura fulminans
* Reye's syndrome
* transverse myelitis
* congenital malformations

Herpes zoster
A reactivation of VZV. Vesicles are localized and generally unilateral.
More commonly seen in the immunocompromised population.

The American Academy of Pediatrics recommends immunization with the varicella zoster virus vaccine:
"Varicella vaccine is recommended at any visit on or after the first birthday for susceptible children, ie, those who lack a reliable history of chickenpox (as judged by a health care provider) and who have not been immunized. Susceptible persons 13 years of age or older should receive 2 doses, given at least 4 weeks apart."(AAP)

Other web pages with clinical information on chicken pox and zoster.
Immunization schedule according to the American Academy of Pediatrics
American Medical Association's page on chicken pox
PediaNet: Basics of the disease, care, treatment, warning signs, and prevention.
Sparks Regional Medical Center: helpful info on helpful symptomatic treatments
Center for Health and Wellness: Chicken Pox-Patient Education


Created: March 4, 1999
Last modified: March 4, 1999