Chickenpox in Adults

What is chickenpox?

Chickenpox is a very contagious disease caused by a virus. Chickenpox is sometimes called varicella because that is the name of the virus that causes it.

How does it occur?

The virus is spread through the air by infected people when they sneeze or cough. It can also spread if you touch the chickenpox sores and don’t carefully wash your hands afterwards.

If you have already had chickenpox, you are probably immune. This means that if you are exposed to chickenpox again, your body can fight off the infection and you will not get sick. If you had a very mild case of chickenpox with just a few sores, you may have chickenpox again, but this is rare.

After infection, the virus stays in your body for the rest of your life. The virus can later cause shingles. Shingles causes a painful, blistering rash on one side of the body. Anyone who has not had chickenpox or the chickenpox shot can get chickenpox from close contact with someone who has shingles.

Fewer than 5% of adults are at risk of having chickenpox. Most adults are immune because they have had chickenpox or the shot. (The shot became available in the US in 1995.) However, when an adult does have chickenpox, the infection can be more serious than it is in children.

What are the symptoms?

Symptoms usually appear 10 to 21 days after exposure to the virus. The symptoms include:

• a red, itchy, rash of blisters (sores) that usually appears first on the face, scalp, or trunk
• tiredness
• fever
• aches and pains
• mild headache
• feeling irritable

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you.

How is it treated?

If you have been exposed to chickenpox or you think you have chickenpox, see your healthcare provider as soon as you can. Your provider may prescribe an antiviral medicine, such as acyclovir. The medicine can help you have fewer sores. It also can shorten the time you are sick. It does not prevent other problems caused by chickenpox. Antiviral medicine helps only if you start taking it no later than 24 hours after you first start having blisters.

If you are pregnant and think you have been recently exposed to chickenpox, you may have a blood test to see if you are immune. Chickenpox during pregnancy can cause birth defects or even cause the baby to be stillborn. If a baby is born when the mother has chickenpox, the baby may get infected. If you are not immune, you may be given a shot of Varicella-zoster immune globulin (VZIG). When given within 72 hours after exposure, this shot helps prevent chickenpox or lessens its severity. The shot is safe for the mother and the baby.

For treatment of the symptoms, follow the guidelines provided below under the heading "How can I take care of myself?"

How long do the effects last?

Chickenpox is contagious 1 to 2 days before you start having the rash. It stays contagious until all of the blisters have crusted over. This usually takes 4 to 7 days.

Teens and adults are more likely to have complications from chickenpox than children. People who have trouble fighting infections are especially at risk for problems. This includes people being treated for cancer with chemotherapy or radiation, people who use steroids or other medicines that suppress the immune system, and people who have HIV infection. Possible complications are pneumonia or problems with the kidneys, heart, or joints. The brain and nervous system may be affected. Sometimes an infection of the skin develops because bacteria get into sores when they are scratched.

If there are no complications, adults have the chickenpox infection for 3 to 7 days.

How can I take care of myself?

• For itching take a lukewarm bath every few hours for the first few days. Add 2 ounces (4 tablespoons) of baking soda, cornstarch, or oatmeal (dry, uncooked oats) to a tub of water. Use soap in one of the baths each day to clean as much bacteria off the skin as possible. Gently pat your skin dry. Do not rub it dry. The bathtub should be cleaned before someone else uses it.
• You can try using calamine lotion on sores to help relieve itching, but do not put it on your face.
• Put a towel-covered ice pack or cool moist washcloth on itchy areas for 20 to 30 minutes. Do not share the towel or washcloth with anyone else.
• If itching is severe or is making it hard to sleep, take a nonprescription antihistamine, such as Benadryl (diphenhydramine). Antihistamines may cause side effects, especially for older adults. Side effects may include drowsiness, dizziness, confusion, dry mouth and eyes, constipation, and trouble urinating. They may worsen other medical problems. Ask your provider to recommend a safe antihistamine for you.
• Trim your fingernails and wash your hands often with soap and warm water to help keep the rash from getting infected if you scratch it.
• If you have sores in your mouth, eat foods that are cool, soft, and bland. Avoid any foods that are acidic, spicy, or salty.
• Take a nonprescription pain reliever, such as acetaminophen, for headache, fever, or general aches and pains. Don’t give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye's syndrome.
• Call 911 for emergency care if:
  • You become confused, disoriented, or extremely sleepy or have trouble waking up.
  • You have a severe headache or a stiff neck.
  • You have trouble standing up or walking.
  • You have a rash in one or both eyes or you are very sensitive to bright light.
• Call your healthcare provider right away if:
  • You have trouble breathing or a severe cough.
  • You are an adult and have a fever over 101.5° F (38.6 C).
  • The blisters look infected:
    • The area around a blister is red.
    • A red streak is spreading from the blister.
    • Pus (usually yellow) starts leaking from the blisters.

How can I help prevent chickenpox?

A vaccine is available to protect against chickenpox. Two shots are recommended for people 13 years or older who have not had chickenpox and who have not been previously vaccinated. The chickenpox vaccine is about 70 to 85% effective in preventing a mild infection. It is 95% effective in preventing moderate to severe infection.

If you have not had chickenpox or the chickenpox shot and you are exposed to chickenpox, your healthcare provider may give you a shot of Varicella-zoster immune globulin (VZIG) to help prevent the infection. You may also be given this shot if you have trouble fighting infections.