DISEASE CONTROL

ROHAN LAL AHUJA-EH SEMESTER-3

CHICKENPOX

HISTORY
Chickenpox is believed to have been first described (discovered) by Giovanni Filippo during the 1500s in Italy. In the 1600s, an English physician named Richard Morton gave the name chickenpox to what he thought was a milder form of smallpox. It is believed that in the 1700s, William Heberden (another English physician), was the first physician to prove that chickenpox was actually different from smallpox.

CHARACTERISTICS
Chickenpox or chicken pox is a highly contagious illness caused by primary infection with varicella zoster virus (VZV).[1] It usually starts with vesicular skin rash mainly on the body and head rather than at the periphery and becomes itchy, raw pockmarks, which mostly heal without scarring. On examination, the observer typically finds lesions at various stages of healing.

CHARACTERISTICS
Chickenpox is an airborne disease spread easily through coughing or sneezing of ill individuals or through direct contact with secretions from the rash. A person with chickenpox is infectious one to two days before the rash appears.[2] The contagious period continues for 4 to 5 days after the appearance of the rash, or until all lesions have crusted over. Immunocompromised patients are probably contagious during the entire period new lesions keep appearing. Crusted lesions are not contagious.[3]

CHARACTERISTICS
It takes from 10 to 21 days after contact with an infected person for

someone to develop chickenpox. Chickenpox is rarely fatal, although it is generally more severe in adult males than in adult females or children. Non-immune pregnant women and those with a suppressed immune system are at highest risk of serious complications. Chickenpox is believed to be the cause of one third of stroke cases in children.[5] The most common late complication of chickenpox is shingles, caused by reactivation of the varicella zoster virus decades after the initial episode of chickenpox.

SIGNS
Fever, feeling tired, headache A stomachache that lasts for one or two days A skin rash that is very itchy and looks like many small blisters Bumps filled with a liquid that looks like milky water Scabs after the blisters break Skin that looks blotchy; the spots fade away

SYMPTOMS
Symptoms of chickenpox can begin with one to two days of low-grade

fever and tiredness. These early symptoms do not always occur before the chickenpox rash develops.
Early chickenpox symptoms are followed by itchy blisters that first appear

on the trunk, face, and scalp. These blisters can spread over the entire body, causing between 250 and 500 itchy blisters. The rash can appear in three or more successive waves. Eventually, the blisters crust over.
Most symptoms of chickenpox occur in people less than 15 years old. Prior

to the use of the chickenpox vaccine, the disease had annual cycles, peaking in the spring of each year.

More Serious Chickenpox Symptoms

High fever
Vomiting Diarrhea Headache Dehydration Worsening of asthma

INFECTIOUS AGENT
The varicella-zoster virus (VZV) is the etiologic agent of the clinical syndrome of chickenpox (varicella). Zoster, a different clinical entity, is caused by reactivation of VZV after primary infection. VZV is a doublestranded deoxyribonucleic acid virus included in the Alphaherpesvirinae subfamily. This enveloped DNA human herpes virus (HHV-3) is one of the eight herpes viruses known to affect humans.

OCCURRENCE
Chickenpox is one of the most readily communicable diseases. It can be spread from person to person by direct contact with fluid from the blisters or with secretions from the respiratory tract or by handling an infected person's clothing or bedding. Airborne transmission is possible through sneezing and coughing. Susceptibility to chickenpox is universal among those not previously infected. The greatest number of cases occur in the winter and early spring.

RESERVOIR
HUMAN

MODE OF TRANSMISSION
Chickenpox transmission usually occurs through direct contact with someone infected with the chickenpox virus. Transmission can also happen when virus from an infected person's coughing or sneezing contaminates the air. In a far less common situation, chickenpox can also be transmitted when someone comes in contact with a person who has an active herpes zoster (shingles) infection.

INCUBATION PERIOD
It takes between 10 and 21 days after contact with an infected person for someone to develop chickenpox (this is known as the chickenpox incubation period). While this is the complete range for the chickenpox incubation period, the usual chickenpox incubation period averages between 14 and 16 days.

Period of communicability
It is usually communicable for one to two days (up to five days) before the

onset of the rash, continuing until all the lesions are crusted. Communicability may be prolonged in patients with altered immunity. Those with zoster are considered infectious for a week after lesions appear when they are moist.

Control measures Preventive measures

In Malaysia, the varicella vaccine is recommended for non-immune, healthy

individuals aged 12 months or older. It provides protection against infection in 7090% of individuals. Non-immune individuals who should be specifically targeted for vaccination include: household contacts of immunosuppressed people health care workers those working with young children women contemplating pregnancy parents of young children.

Control measures Preventive measures

Vaccination is contraindicated in immunosuppressed people and pregnant

women. Immunosuppressed people and newborns should be protected from exposure. If exposure has occurred in these persons varicella zoster immune globulin (VZIG) is effective in modifying or preventing the disease if given within 96 hours of exposure. VZIG is available from the Australian Red Cross.

Control of case Varicella (chickenpox)

In the non-hospitalised patient with a normal immune system and uncomplicated varicella, aciclovir is not recommended because the benefits are only marginal. In immunocompromised patients with severe disease and in normal patients with complications of varicella (such as pneumonitis or encephalitis) aciclovir may be used.

General measures include

tepid bathing or cool compresses may help to alleviate itching
exclude from school until fully recovered, or at least five days after eruption

first appears. Some remaining scabs are not a reason for continued exclusion advise adults to stay away from work for the same period avoid contact with high risk susceptible persons. Aspirin should never be given to children with varicella due to a strong association with the development of Reyes syndrome.

ISOLATION
Until lesions have dried and crusted, or until no new lesions appear, usually by the fifth day.

Minimum Period of Quarantine of Contacts

Neonates born to mothers with active varicella shall be isolated from susceptibles until 21 days of age. Health care workers shall be excluded from their occupations from the tenth through 21st days after their last exposure if they are susceptible. Anyone receiving varicella zoster immune globulin (VZIG) shall extend their exclusion to 28 days post exposure.

Epidemic measures
Outbreaks of varicella are common in schools and other institutional settings; they may be protracted, disruptive and associated with complications. Infectious cases should be isolated, and susceptible contacts immunized promptly (or referred to their health care provider for immunization). Persons ineligible for immunization, such as susceptible pregnant females and those at high risk for severe disease (as above), should be evaluated immediately for administration of VZIG.

REFERENCES
Advisory Committee on Immunization Practices. Recommended adult immunization

schedule: United States, 2009. Ann Intern Med . 2009 Jan 6;150(1):40-4. American Academy of Pediatrics Committee on Infectious Diseases. Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule. Pediatrics . 2007 Jul;120(1):221-31. American Academy of Pediatrics Committee on Infectious Diseases. Recommended immunization schedules for children and adolescents -- United States, 2007. Pediatrics . 2007 Jan;119(1):207-8. Centers for Disease Control and Prevention (CDC). A new product (VariZIG) for postexposure prophylaxis of varicella available under an investigational new drug application expanded access protocol. MMWR Morb Mortal Wkly Rep . 2006 Mar 3;55(8):209-10. Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP). Update: recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding administration of combination MMRV vaccine. MMWR Morb Mortal Wkly Rep . 2008 Mar 14;57(10):258-60. Chaves SS, Gargiullo P, Zhang JX, Civen R, Guris D, Mascola L, et al. Loss of vaccineinduced immunity to varicella over time. N Engl J Med . 2007 Mar 15;356(11):1121-9.