Chickenpox: Difference between revisions

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{{Other uses}}
{{Redirect|Varicella}}
{{distinguish|Fowlpox|Smallpox}}
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{{Infobox medical condition (new)
| name = Chickenpox
| synonyms = Varicella
| image = Varicela Aranzales.jpg
| caption = Male with varicella disease
| field = [[Infectious disease (medical specialty)|Infectious disease]]
| symptoms = [[blister|Small, itchy blisters]], [[headache]], [[loss of appetite]], [[tiredness]]<ref name=CDC2011SS/>
| onset = 10–12 days after exposure<ref name=CDC2011T/>
| duration = 5–7 days<ref name=CDC2011SS/>
| causes = [[Varicella zoster virus]]<ref name=CDC2011Over/>
| risks =
| diagnosis =
| differential =
| prevention = [[Varicella vaccine]]<ref name=Rout2012/>
| treatment =
| medication = [[Calamine lotion]], [[paracetamol]] (acetaminophen), [[aciclovir]]<ref name=CDC2011T />
| frequency =
| deaths = 6,400 (with shingles)<ref name=GBD2015De>{{cite journal | last1=GBD 2015 Mortality and Causes of Death | first1=Collaborators. | title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. | journal=Lancet | date=8 October 2016 | volume=388 | issue=10053 | pages=1459–1544 | pmid=27733281 | doi=10.1016/s0140-6736(16)31012-1 | pmc=5388903}}</ref>
}}
<!-- Definition and symptoms -->
'''Chickenpox''', also known as '''varicella''', is a highly [[Infectious disease|contagious]] disease caused by the initial [[infection]] with [[varicella zoster virus]] (VZV).<ref name=CDC2011Over>{{cite web|title=Chickenpox (Varicella) Overview |url=http://www.cdc.gov/chickenpox/about/overview.html|website=cdc.gov|accessdate=4 February 2015|date=November 16, 2011}}</ref> The disease results in a characteristic skin rash that forms [[Vesicle (dermatology)|small, itchy blisters]], which eventually scab over.<ref name=CDC2011SS/> It usually starts on the chest, back, and face then spreads to the rest of the body.<ref name=CDC2011SS/> Other symptoms may include fever, [[Fatigue (medical)|tiredness]], and [[headache]]s.<ref name=CDC2011SS/> Symptoms usually last five to seven days.<ref name=CDC2011SS>{{cite web|title=Chickenpox (Varicella) Signs & Symptoms |url=http://www.cdc.gov/chickenpox/about/symptoms.html|website=Centers for Disease Control and Prevention (cdc.gov)|accessdate=4 February 2015|date=November 16, 2011}}</ref> Complications may occasionally include [[pneumonia]], [[encephalitis|inflammation of the brain]], and bacterial skin infections.<ref name=CDC2011C>{{cite web|title=Chickenpox (Varicella) Complications |url=http://www.cdc.gov/chickenpox/about/complications.html|website=cdc.gov|accessdate=4 February 2015|date=November 16, 2011}}</ref> The disease is often more severe in adults than children.<ref name=CDC2012Pink/> Symptoms begin 10 to 21 days after exposure to the virus.<ref name=CDC2011T/>

<!-- Cause and diagnosis -->
Chickenpox is an [[airborne disease]] which spreads easily through the coughs and sneezes of an infected person.<ref name=CDC2011T/> It may be spread from one to two days before the rash appears until all lesions have crusted over.<ref name=CDC2011T/> It may also spread through contact with the blisters.<ref name=CDC2011T/> Those with [[shingles]] may spread chickenpox to those who are not immune through contact with the blisters.<ref name=CDC2011T/> The disease can usually be diagnosed based on the presenting symptom;<ref>{{cite web|title=Chickenpox (Varicella) Interpreting Laboratory Tests|url=http://www.cdc.gov/chickenpox/hcp/lab-tests.html|website=cdc.gov|accessdate=4 February 2015|date=June 19, 2012}}</ref> however, in unusual cases it may be confirmed by [[polymerase chain reaction]] (PCR) testing of the blister fluid or scabs.<ref name=CDC2012Pink/> Testing for [[antibodies]] may be done to determine if a person is or is not immune.<ref name=CDC2012Pink>{{cite book|last1=Atkinson|first1=William|title=Epidemiology and Prevention of Vaccine-Preventable Diseases|date=2011|publisher=Public Health Foundation|isbn=9780983263135|pages=301–323 |edition=12|url=http://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html|accessdate=4 February 2015}}</ref> People usually only get chickenpox once.<ref name=CDC2011T/> Although reinfections by the virus occur, these reinfections usually do not cause any symptoms.<ref name=pmid20229231>{{cite journal |vauthors=Breuer J |title=VZV molecular epidemiology |journal=Current Topics in Microbiology and Immunology |volume=342 |issue= |pages=15–42 |year=2010 |pmid=20229231 |doi=10.1007/82_2010_9}}</ref>

<!-- Prevention, treatment and epidemiology -->
The [[varicella vaccine]] has resulted in a decrease in the number of cases and complications from the disease.<ref name=Rout2012>{{cite journal|title=Routine vaccination against chickenpox?|date=2012|volume=50|pages=42–5|doi=10.1136/dtb.2012.04.0098|pmid=22495050|journal=Drug Ther Bull}}</ref> It protects about 70 to 90 percent of people from disease with a greater benefit for severe disease.<ref name=CDC2012Pink/> Routine immunization of children is recommended in many countries.<ref name=Flatt2012>{{cite journal|last1=Flatt|first1=A|last2=Breuer|first2=J|title=Varicella vaccines.|journal=British medical bulletin|date=September 2012|volume=103|issue=1|pages=115–27|pmid=22859715|doi=10.1093/bmb/lds019}}</ref> Immunization within three days of exposure may improve outcomes in children.<ref name=Mac2014>{{cite journal|last1=Macartney|first1=K|last2=Heywood|first2=A|last3=McIntyre|first3=P|title=Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults.|journal=The Cochrane database of systematic reviews|date=23 June 2014|volume=6|pages=CD001833|pmid=24954057|doi=10.1002/14651858.CD001833.pub3}}</ref> Treatment of those infected may include [[calamine lotion]] to help with itching, keeping the fingernails short to decrease injury from scratching, and the use of [[paracetamol]] (acetaminophen) to help with fevers.<ref name=CDC2011T/> For those at increased risk of complications [[antiviral medication]] such as [[aciclovir]] are recommended.<ref name=CDC2011T>{{cite web|title=Chickenpox (Varicella) Prevention & Treatment|url=http://www.cdc.gov/chickenpox/about/prevention-treatment.html|website=cdc.gov|accessdate=4 February 2015|date=November 16, 2011}}</ref>

<!-- History and epidemiology -->
Chickenpox occurs in all parts of the world.<ref name=CDC2012Pink/> In 2013 there were 140 million cases of chickenpox and [[herpes zoster]] worldwide.<ref name=GBD2013>{{cite journal|last1=Global Burden of Disease Study 2013|first1=Collaborators|title=Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.|journal=Lancet|date=22 August 2015|volume=386|issue=9995|pages=743–800|pmid=26063472|doi=10.1016/s0140-6736(15)60692-4|pmc=4561509}}</ref> Before routine immunization the number of cases occurring each year was similar to the number of people born.<ref name=CDC2012Pink/> Since immunization the number of infections in the United States has decreased nearly 90%.<ref name=CDC2012Pink/> In 2015 chickenpox resulted in 6,400 deaths globally – down from 8,900 in 1990.<ref name=GBD2015De/><ref name=GBD204>{{cite journal|last1=GBD 2013 Mortality and Causes of Death|first1=Collaborators|title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.|journal=Lancet|date=17 December 2014|pmid=25530442|doi=10.1016/S0140-6736(14)61682-2|volume=385|issue=9963|pages=117–71|pmc=4340604}}</ref> Death occurs in about 1 per 60,000 cases.<ref name=CDC2012Pink/> Chickenpox was not separated from [[smallpox]] until the late 19th century.<ref name=CDC2012Pink/> In 1888 its connection to shingles was determined.<ref name=CDC2012Pink/> The first documented use of the term ''chicken pox'' was in 1658.<ref name=OED2014>{{cite web|author1=Oxford University Press|title=chickenpox, n.|url=http://www.oed.com/view/Entry/31556?redirectedFrom=Chickenpox|website=oed.com|accessdate=February 4, 2015|date=December 2014}}</ref> Various explanations have been suggested for the use of "chicken" in the name, one being the relative mildness of the disease.<ref name=OED2014/>

==Signs and symptoms==
[[File:Chickenpox blister.jpg|thumb|A single blister, typical during the early stages of the rash]]

The early ([[Prodrome|prodromal]]) symptoms in adolescents and adults are nausea, loss of appetite, aching muscles, and headache. This is followed by the characteristic rash or oral sores, [[malaise]], and a low-grade fever that signal the presence of the disease. Oral manifestations of the disease (enanthem) not uncommonly may precede the external rash (exanthem). In children the illness is not usually preceded by prodromal symptoms, and the first sign is the rash or the spots in the oral cavity. The rash begins as small red dots on the face, scalp, torso, upper arms and legs; progressing over 10–12 hours to small bumps, blisters and [[Cutaneous condition#Pustule|pustules]]; followed by [[Cutaneous condition#Umbilication|umbilication]] and the formation of scabs.<ref name = Medscape>{{ cite web | url = http://emedicine.medscape.com/article/1131785 | title = Chickenpox Clinical Presentation | author = Anthony J Papadopoulos | editor = Dirk M Elston | accessdate = 4 August 2012 | work = Medscape Reference }}</ref><ref name="Symptoms of Chickenpox">{{cite web|title=Symptoms of Chickenpox|url=http://www.nhs.uk/Conditions/Chickenpox/Pages/Symptoms.aspx|work=Chickenpox|publisher=NHS Choices|accessdate=14 March 2013}}</ref>

At the blister stage, intense itching is usually present. Blisters may also occur on the palms, soles, and genital area. Commonly, visible evidence of the disease develops in the oral cavity and tonsil areas in the form of small ulcers which can be painful or itchy or both; this enanthem (internal rash) can precede the exanthem (external rash) by 1 to 3 days or can be concurrent. These symptoms of chickenpox appear 10 to 21 days after exposure to a contagious person. Adults may have a more widespread rash and longer fever, and they are more likely to experience complications, such as varicella [[pneumonia]].<ref name="Medscape"/>

Because watery nasal discharge containing live virus usually precedes both exanthem (external rash) and enanthem (oral ulcers) by 1 to 2 days, the infected person actually becomes contagious one to two days before recognition of the disease. Contagiousness persists until all vesicular lesions have become dry crusts (scabs), which usually entails four or five days, by which time nasal shedding of live virus ceases.

The condition usually resolves by itself within a couple of weeks.<ref>{{cite web |url=http://www.netdoctor.co.uk/diseases/facts/chickenpox.htm | title=Chickenpox (varicella) |accessdate= 6 November 2010}}</ref> The rash may, however, last for up to one month.{{medcn|date=April 2017}} Chickenpox is contagious starting from one to two days before the appearance of the rash and lasts until the lesions have crusted.<ref>{{Cite web | url = https://www.cdc.gov/chickenpox/hcp/clinical-overview.html | publisher = Centers for Disease Control and Prevention | title = Chickenpox (Varicella): Clinical Overview}}</ref>

Chickenpox is rarely fatal, although it is generally more severe in adult men than in women or children. Non-immune pregnant women and those with a suppressed immune system are at highest risk of serious complications. [[Arterial ischemic stroke]] (AIS) associated with chickenpox in the previous year accounts for nearly one third of childhood AIS.<ref name=Askalan>{{cite journal |vauthors=Askalan R, Laughlin S, Mayank S, Chan A, MacGregor D, Andrew M, Curtis R, Meaney B, deVeber G | title = Chickenpox and stroke in childhood: a study of frequency and causation | journal = Stroke | volume = 32 | issue = 6 | pages = 1257–62 | date = June 2001 | pmid = 11387484 | doi = 10.1161/01.STR.32.6.1257 | url = http://stroke.ahajournals.org/content/32/6/1257 }}</ref> The most common late complication of chickenpox is [[herpes zoster|shingles]] (herpes zoster), caused by reactivation of the ''varicella zoster'' virus decades after the initial, often childhood, chickenpox infection.
<gallery>
File:Chickenpox Adult back.jpg|The back of a 30-year-old male after five days of the rash
File:Ploketes d' aiwe dj3 costé.jpg|A 3-year-old girl with a chickenpox rash on her torso
File:Bem chickenpox vannkopper 20140318.jpg|Lower leg of a child with chickenpox
File:Vicki Pandit - Howrah 2014-04-06 9845.JPG|A child with chickenpox
File:A child with chickenpox (01).jpg|A child with chickenpox on her face.
</gallery>

===Pregnancy and neonates===
{{anchor|pregnancy}}
During pregnancy the dangers to the fetus associated with a primary VZV infection are greater in the first six months. In the third trimester, the mother is more likely to have severe symptoms.<ref name="pmid11297117">{{cite journal |vauthors=Heuchan AM, Isaacs D | title = The management of varicella-zoster virus exposure and infection in pregnancy and the newborn period. Australasian Subgroup in Paediatric Infectious Diseases of the Australasian Society for Infectious Diseases. | journal = The Medical journal of Australia | volume = 174 | issue = 6 | pages = 288–92 | date = 19 March 2001 | pmid = 11297117 | url = https://www.mja.com.au/journal/2001/174/6/management-varicella-zoster-virus-exposure-and-infection-pregnancy-and-newborn }}</ref>
For pregnant women, [[antibody|antibodies]] produced as a result of immunization or previous infection are transferred via the [[placenta]] to the [[fetus]].<ref>{{cite web |first = Heather|last = Brannon |title = Chickenpox in Pregnanc |url = http://dermatology.about.com/cs/pregnancy/a/chickenpreg.htm |work = Dermatology |publisher = About.com |date = 22 July 2007 |accessdate = 20 June 2009}}</ref>
Varicella infection in pregnant women could lead to [[transmission (medicine)|spread]] via the placenta and infection of the fetus. If infection occurs during the first 28 weeks of [[gestation]], this can lead to fetal varicella syndrome (also known as ''congenital varicella syndrome'').<ref name="pmid17845179">{{cite journal |vauthors=Boussault P, Boralevi F, Labbe L, Sarlangue J, Taïeb A, Leaute-Labreze C | title = Chronic varicella-zoster skin infection complicating the congenital varicella syndrome | journal = Pediatr Dermatol | volume = 24 | issue = 4 | pages = 429–32 | year = 2007 | pmid = 17845179 | doi = 10.1111/j.1525-1470.2007.00471.x | url = http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0736-8046&date=2007&volume=24&issue=4&spage=429 }}</ref> Effects on the fetus can range in severity from underdeveloped toes and fingers to severe anal and bladder malformation. Possible problems include:

* Damage to brain: [[encephalitis]],<ref>{{cite journal |vauthors=Matsuo T, Koyama M, Matsuo N | title = Acute retinal necrosis as a novel complication of chickenpox in adults | journal = Br J Ophthalmol | volume = 74 | issue = 7 | pages = 443–4 | date = July 1990 | pmid = 2378860 | pmc = 1042160 | doi = 10.1136/bjo.74.7.443 }}</ref> [[microcephaly]], [[hydrocephaly]],<ref>{{cite journal |vauthors=Mazzella M, Arioni C, Bellini C, Allegri AE, Savioli C, Serra G | title = Severe hydrocephalus associated with congenital varicella syndrome | journal = Canadian Medical Association Journal | volume = 168 | issue = 5 | pages = 561–563 | year = 2003 | pmid = 12615748 | pmc = 149248 }}</ref> [[aplasia]] of brain
* Damage to the eye: [[optic stalk]], [[Optic cup (ophthalmology)|optic cup]], and lens [[vesicle (dermatology)|vesicle]]s, [[microphthalmia]], [[cataracts]], [[chorioretinitis]], [[optic atrophy]]
* Other neurological disorder: damage to cervical and lumbosacral [[spinal cord]], motor/sensory deficits, absent deep [[tendon reflex]]es, [[anisocoria]]/[[Horner's syndrome]]
* Damage to body: [[hypoplasia]] of upper/lower extremities, anal and bladder [[sphincter]] dysfunction
* Skin disorders: ([[cicatricial]]) skin lesions, [[hypopigmentation]]

Infection late in gestation or immediately following birth is referred to as "''neonatal varicella''".<ref>{{cite journal |vauthors=Sauerbrei A, Wutzler P | title = Neonatal varicella | journal = J Perinatol | volume = 21 | issue = 8 | pages = 545–9 | date = December 2001 | pmid = 11774017 | doi = 10.1038/sj.jp.7210599 | url = http://www.nature.com/jp/journal/v21/n8/abs/7210599a.html }}</ref> Maternal infection is associated with premature delivery. The risk of the baby developing the disease is greatest following exposure to infection in the period 7 days before delivery and up to 8 days following the birth. The baby may also be exposed to the virus via infectious siblings or other contacts, but this is of less concern if the mother is immune. Newborns who develop symptoms are at a high risk of [[pneumonia]] and other serious complications of the disease.<ref name="pregnancy">{{cite web | author=Royal College of Obstetricians and Gynaecologists | title=Chickenpox in Pregnancy | url=http://www.rcog.org.uk/files/rcog-corp/uploaded-files/GT13ChickenpoxinPregnancy2007.pdf | format=PDF | date=September 2007 | accessdate=22 July 2009 | deadurl=yes | archiveurl=https://www.webcitation.org/5qLtfGCcc?url=http://www.rcog.org.uk/files/rcog-corp/uploaded-files/GT13ChickenpoxinPregnancy2007.pdf | archivedate=9 June 2010 | df=dmy-all }}</ref>

==Diagnosis==
[[File:Chickenpox.png|thumb|Chickenpox.]]
The diagnosis of chickenpox is primarily based on the signs and symptoms, with typical early symptoms followed by a characteristic [[rash]]. Confirmation of the diagnosis is by examination of the fluid within the vesicles of the [[rash]], or by testing blood for evidence of an acute immunologic response.

Vesicular fluid can be examined with a [[Tzanck test|Tzanck smear]], or by testing for [[direct fluorescent antibody]]. The fluid can also be "cultured", whereby attempts are made to grow the virus from a fluid sample. Blood tests can be used to identify a response to acute infection (IgM) or previous infection and subsequent immunity (IgG).<ref>{{cite book |author1=Pincus, Matthew R. |author2=McPherson, Richard A. |author3=Henry, John Bernard |title=Henry's clinical diagnosis and management by laboratory methods |publisher=Saunders Elsevier |year=2007 |isbn=1-4160-0287-1 |edition=21st |chapter=Ch. 54}}</ref>

Prenatal diagnosis of fetal varicella infection can be performed using [[ultrasound]], though a delay of 5 weeks following primary maternal infection is advised. A [[polymerase chain reaction|PCR]] (DNA) test of the mother's [[amniotic fluid]] can also be performed, though the risk of [[spontaneous abortion]] due to the [[amniocentesis]] procedure is higher than the risk of the baby's developing fetal varicella syndrome.<ref name="pregnancy"/>

==Pathophysiology==
{{main article|Varicella zoster virus}}
Exposure to VZV in a healthy child initiates the production of host [[immunoglobulin G]] (IgG), [[immunoglobulin M]] (IgM), and [[immunoglobulin A]] (IgA) [[Antibody|antibodies]]; IgG antibodies persist for life and confer immunity. [[Cell-mediated immunity|Cell-mediated immune responses]] are also important in limiting the scope and the duration of primary varicella infection. After primary infection, VZV is hypothesized to spread from [[mucosa]]l and [[Epidermis (skin)|epidermal]] lesions to local [[sensory nerve]]s. VZV then remains latent in the [[Dorsal root ganglion|dorsal ganglion]] cells of the sensory nerves. Reactivation of VZV results in the clinically distinct syndrome of [[herpes zoster]] (i.e., ''shingles''), [[postherpetic neuralgia]],<ref>{{cite journal |vauthors=Kanbayashi Y, Onishi K, Fukazawa K, Okamoto K, Ueno H, Takagi T, Hosokawa T | title = Predictive Factors for Postherpetic Neuralgia Using Ordered Logistic Regression Analysis | journal = The Clinical Journal of Pain | volume = 28 | issue = 8 | pages = 712–714 | year = 2012 | pmid = 22209800 | pmc = | doi = 10.1097/AJP.0b013e318243ee01 }}</ref> and sometimes [[Ramsay Hunt syndrome type II]].<ref>{{cite journal |vauthors=Pino Rivero V, González Palomino A, Pantoja Hernández CG, Mora Santos ME, Trinidad Ramos G, Blasco Huelva A | title = Ramsay-Hunt syndrome associated to unilateral recurrential paralysis | journal = Anales otorrinolaringologicos ibero-americanos | volume = 33 | issue = 5 | pages = 489–494 | year = 2006 | pmid = 17091862 }}</ref> Varicella zoster can affect the arteries in the neck and head, producing stroke, either during childhood, or after a latency period of many years.<ref>{{cite journal |title = The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. |journal = Neurology |date=March 2008 |pmid=18332343 |doi=10.1212/01.wnl.0000304747.38502.e8 |volume=70 |pmc=2938740 |pages=853–60 |vauthors=Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Häusler M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, Brown WD, Terborg C, Gilden DH }}
</ref>

===Shingles===
{{Main article|Herpes zoster}}
After a chickenpox infection, the virus remains dormant in the body's nerve tissues. The [[immune system]] keeps the virus at bay, but later in life, usually in an adult, it can be reactivated and cause a different form of the viral infection called [[herpes zoster|shingles]] (also known as herpes zoster).<ref>{{cite web |title=Chickenpox |date=19 April 2012 |work=NHS Choices |publisher=UK Department of Health |url=http://www.nhs.uk/conditions/chickenpox/Pages/Introduction.aspx}}</ref>
The United States Advisory Committee on Immunization Practices (ACIP) suggests that every adult over the age of 60 years get the ''herpes zoster'' vaccine.<ref>{{cite web|title=Shingles Vaccine|url=http://www.webmd.com/skin-problems-and-treatments/shingles/shingles-vaccine|publisher=WebMD}}</ref>

Shingles affects one in five adults infected with chickenpox as children, especially those who are immune-suppressed, particularly from cancer, HIV, or other conditions. Stress can bring on shingles as well, although scientists are still researching the connection.<ref name="webmd2">{{cite web|title=An Overview of Shingles|url=http://www.webmd.com/skin-problems-and-treatments/shingles/shingles-skin|publisher=WebMD}}</ref> Shingles are most commonly found in adults over the age of 60 who were diagnosed with chickenpox when they were under the age of 1.<ref>{{cite web|title=Shingles|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001861/|publisher=PubMed Health}}</ref>

==Prevention==

===Hygiene measures===
The spread of chickenpox can be prevented by isolating affected individuals. Contagion is by exposure to respiratory droplets, or direct contact with lesions, within a period lasting from three days before the onset of the rash, to four days after the onset of the rash.<ref>{{cite book |author1=Murray, Patrick R. |author2=Rosenthal, Ken S. |author3=Pfaller, Michael A. |title=Medical Microbiology |publisher=Elsevier Mosby |year=2005 |isbn=0-323-03303-2 |page=551 |edition=5th}}, edition'' (Elsevier), p.</ref> The chickenpox virus is susceptible to disinfectants, notably [[bleach|chlorine bleach]] (i.e., [[sodium hypochlorite]]). Like all [[viral envelope|enveloped viruses]], it is sensitive to desiccation, heat and detergents.

===Vaccine===
{{Main article|Varicella vaccine}}
The [[varicella vaccine]] is recommended in many countries.<ref name=Flatt2012/> Some countries require the varicella vaccination or an exemption before entering elementary school. A second dose is recommended five years after the initial immunization.<ref>{{cite journal |vauthors=Chaves SS, Gargiullo P, Zhang JX, Civen R, Guris D, Mascola L, Seward JF | title = Loss of vaccine-induced immunity to varicella over time | journal = N Engl J Med | volume = 356 | issue = 11 | pages = 1121–9 | year = 2007 | pmid = 17360990 | doi = 10.1056/NEJMoa064040 }}</ref> A vaccinated person is likely to have a milder case of chickenpox if they become infected.<ref name=NHS2012>{{cite web |title=Chickenpox (varicella) vaccination |date=19 April 2012 |work=NHS Choices |publisher=UK Department of Health |url=http://www.nhs.uk/conditions/varicella-vaccine/pages/introduction.aspx}}</ref> Immunization within three days following household contact reduces infection rates and severity in children.<ref name=Mac2014/>

It is part of the routine immunization schedule in the US.<ref>{{cite web |title=Child, Adolescent & "Catch-up" Immunization Schedules |work=Immunization Schedules |publisher=Centers for Disease Control and Prevention |url=http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html}}</ref> Some European countries include it as part of universal vaccinations in children,<ref>{{cite journal|last1=Carrillo-Santisteve|first1=P|last2=Lopalco|first2=PL|title=Varicella vaccination: a laboured take-off.|journal=Clinical Microbiology and Infection|date=May 2014|volume=20 Suppl 5|pages=86–91|pmid=24494784|doi=10.1111/1469-0691.12580}}</ref> but not all countries provide the vaccine due to its cost.<ref name=Flatt2012/> In the UK as of 2014, the vaccine is only recommended in people who are particularly vulnerable to chickenpox.<ref name=NHS2>{{cite web|title=Why aren't children in the UK vaccinated against chickenpox?|url=http://www.nhs.uk/chq/Pages/1032.aspx?CategoryID=62&SubCategoryID=63|website=NHS Choices|publisher=UK National Health Service|accessdate=10 June 2015}}</ref> In populations that have not been immunized or if immunity is questionable, a clinician may order an Enzyme [[immunoassay]]. An immunoassay measures the levels of antibodies against the virus that give immunity to a person. If the levels of antibodies are low (low titer) or questionable, reimmunization may be done.<ref name=Leeuwen2015>{{cite book | last = Leeuwen | first = Anne | title = Davis's comprehensive handbook of laboratory & diagnostic tests with nursing implications | publisher = F.A. Davis Company | location = Philadelphia | year = 2015 | isbn = 9780803644052 |page=1579}}</ref>

==Treatment==
Treatment mainly consists of easing the symptoms. As a protective measure, people are usually required to stay at home while they are infectious to avoid spreading the disease to others. Cutting the [[Nail (anatomy)|nails]] short or wearing [[gloves]] may prevent scratching and minimize the risk of secondary [[infections]].

Although there have been no formal clinical studies evaluating the effectiveness of topical application of [[calamine lotion]] (a topical barrier preparation containing [[zinc oxide]], and one of the most commonly used interventions), it has an excellent safety profile.<ref>{{cite journal |vauthors=Tebruegge M, Kuruvilla M, Margarson I | title = Does the use of calamine or antihistamine provide symptomatic relief from pruritus in children with varicella zoster infection? | journal = Arch. Dis. Child. | volume = 91 | issue = 12 | pages = 1035–6 | year = 2006 | pmid = 17119083 | pmc = 2082986 | doi = 10.1136/adc.2006.105114 | url = http://adc.bmj.com/cgi/content/extract/91/12/1035 | format = Abstract }}</ref> It is important to maintain good hygiene and daily cleaning of [[Human skin|skin]] with warm water to avoid secondary [[bacterial infection]].<ref>{{cite book |author=Domino, Frank J. |title=The 5-Minute Clinical Consult |publisher=Lippincott Williams & Wilkins |year=2007 |isbn=978-0-7817-6334-9 |page=248 }}</ref> Scratching may also increase the risk of secondary infection.<ref>Brannon, Heather (21 May 2008). [http://dermatology.about.com/cs/chickenpox/a/chickentreat.htm Chicken Pox Treatments]. [[About.com]].</ref>

[[Paracetamol]] (acetaminophen) but not [[aspirin]] may be used to reduce fever. Aspirin use by someone with chickenpox may cause the serious, sometimes fatal disease of the liver and brain, [[Reye syndrome]]. People at risk of developing severe complications who have had significant exposure to the virus may be given intra-muscular varicella zoster immune globulin (VZIG), a preparation containing high titres of antibodies to varicella zoster virus, to ward off the disease.<ref>{{cite journal |vauthors=Parmet S, Lynm C, Glass RM | title = JAMA patient page. Chickenpox | journal = JAMA | volume = 291 | issue = 7 | pages = 906 | date = February 2004 | pmid = 14970070 | doi = 10.1001/jama.291.7.906 | url = http://jama.ama-assn.org/cgi/content/full/291/7/906 }}</ref><ref name=CCDR>{{cite journal|author=Naus M |journal=Canada Communicable Disease Report |volume = 32|issue= ACS-8|date=15 October 2006|title=Varizig™ as the Varicella Zoster Immune Globulin for the Prevention of Varicella In At-Risk Patients |url=http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/06vol32/acs-08/index-eng.php|display-authors=etal}}</ref>

Antivirals are sometimes used.<ref name="pmid3339143">{{cite journal | author = Huff JC | title = Antiviral treatment in chickenpox and herpes zoster. | journal = Journal of the American Academy of Dermatology | volume = 18 | issue = 1 Pt 2 | pages = 204–6 | date = January 1988 | pmid = 3339143 | doi = 10.1016/S0190-9622(88)70029-8 }}</ref><ref>{{cite book|last=Gnann Jr|first=John W.|title=Human herpesviruses : biology, therapy, and immunoprophylaxis|year=2007|publisher=Cambridge University Press|location=Cambridge|isbn=978-0-521-82714-0|url=https://www.ncbi.nlm.nih.gov/books/NBK47401/|editor=Arvin, Ann |display-editors=etal |accessdate=20 January 2014|chapter=Chapter 65Antiviral therapy of varicella-zoster virus infections}}</ref><!-- The entire section can be reformatted with information derived from this source -->

===Children===
If [[aciclovir]] by mouth is started within 24 hours of [[rash]] onset, it decreases symptoms by one day but has no effect on complication rates.<ref name="pmid11136958">{{cite journal | title = Allergy and allergic diseases. First of two parts | journal = The New England Journal of Medicine | volume = 344 | issue = 1 | pages = 30–7 | year = 2001 | pmid = 11136958 | doi = 10.1056/NEJM200101043440106 | last = Kay | first = A. B. }}</ref><ref name="pmid11150362">{{cite journal | title = Allergy and allergic diseases. Second of two parts | journal = The New England Journal of Medicine | volume = 344 | issue = 2 | pages = 109–13 | year = 2001 | pmid = 11150362 | doi = 10.1056/NEJM200101113440206 | last = Kay | first = A. B.}}</ref> Use of acyclovir therefore is not currently recommended for individuals with normal immune function. Children younger than 12 years old and older than one month are not meant to receive [[antiviral drug]]s unless they have another medical condition which puts them at risk of developing complications.<ref name="urlAntiviral medications for chickenpox">{{cite web |url=http://children.webmd.com/vaccines/antiviral-medications-for-chickenpox |title=Antiviral medications for chickenpox |accessdate=27 March 2011 |deadurl=yes |archiveurl=https://web.archive.org/web/20101228111741/http://children.webmd.com/vaccines/antiviral-medications-for-chickenpox |archivedate=28 December 2010 |df=dmy-all }}</ref>

Treatment of chickenpox in children is aimed at symptoms while the immune system deals with the virus. With children younger than 12 years, cutting [[Nail (anatomy)|nails]] and keeping them clean is an important part of treatment as they are more likely to scratch their blisters more deeply than adults.<ref>{{cite web|url=http://www.patient.info/health/Chickenpox-in-Children-Under-12.htm|title=Chickenpox in Children Under 12|accessdate= 6 November 2010}}</ref>

[[Aspirin]] is highly contraindicated in children younger than 16 years, as it has been related to [[Reye syndrome]].<ref name="urlReyes Syndrome-Topic Overview">{{cite web |url=http://children.webmd.com/tc/reyes-syndrome-topic-overview |title=Reye's Syndrome-Topic Overview |accessdate=27 March 2011}}</ref>

===Adults===
[[Infection]] in otherwise healthy adults tends to be more severe.<ref name="pmid18555533">{{cite journal |vauthors=Tunbridge AJ, Breuer J, Jeffery KJ | title = Chickenpox in adults - clinical management | journal = The Journal of Infection | volume = 57 | issue = 2 | pages = 95–102 | date = August 2008 | pmid = 18555533 | doi = 10.1016/j.jinf.2008.03.004 | url = }}</ref> [[therapy|Treatment]] with antiviral [[drugs]] (e.g. [[acyclovir]] or [[valacyclovir]]) is generally advised, as long as it is started within 24–48 hours from rash onset.<ref name="urlAntiviral medications for chickenpox"/> Remedies to ease the symptoms of chickenpox in adults are basically the same as those used for children. Adults are more often prescribed antiviral medication, as it is effective in reducing the severity of the condition and the likelihood of developing complications. Antiviral medicines do not kill the virus but stop it from multiplying. Adults are advised to increase water intake to reduce dehydration and to relieve headaches. Painkillers such as [[paracetamol]] (acetaminophen) are recommended, as they are effective in relieving itching and other symptoms such as fever or pains. Antihistamines relieve itching and may be used in cases where the itching prevents sleep, because they also act as a [[sedative]]. As with children, antiviral medication is considered more useful for those adults who are more prone to develop complications. These include [[pregnant women]] or people who have a weakened immune system.<ref>{{cite web|url=http://www.patient.info/health/Chickenpox-in-Adults-and-Teenagers.htm| title=What is chickenpox?|accessdate= 6 November 2010}}</ref>

[[Sorivudine]], a nucleoside analogue, has been reported to be effective in the treatment of primary varicella in healthy adults (case reports only), but large-scale clinical trials are still needed to demonstrate its efficacy.<ref>{{EMedicine|article|1131785|Chickenpox|treatment}}</ref>

After recovering from chickenpox, it is recommended by doctors that adults take one injection of [[VZV immune globulin]] and one injection of [[varicella vaccine]] or [[Zostavax|herpes zoster vaccine]].{{citation needed|date=June 2017}}

==Prognosis==
The duration of the visible blistering caused by varicella zoster virus varies in children usually from 4 to 7 days, and the appearance of new blisters begins to subside after the fifth day. Chickenpox infection is milder in young children, and symptomatic treatment, with [[sodium bicarbonate]] baths or [[antihistamine]] medication may ease itching. It is recommended to keep new infants from birth up to age 6 months away from an infected person for 10 to 21 days because their immune systems are not developed enough to handle the stress it can bring on.<ref>{{cite journal |vauthors=Somekh E, Dalal I, Shohat T, Ginsberg GM, Romano O | title = The burden of uncomplicated cases of chickenpox in Israel | journal = J. Infect. | volume = 45 | issue = 1 | pages = 54–7 | year = 2002 | pmid = 12217733 | doi = 10.1053/jinf.2002.0977 }}</ref> [[Paracetamol]] (acetaminophen) is widely used to reduce fever. [[Aspirin]], or products containing aspirin, should not be given to children with chickenpox, as it can cause [[Reye's Syndrome]].<ref>{{cite web | author=US Centers for Disease Control and Prevention | url=http://www.cdc.gov/vaccines/vpd-vac/varicella/dis-faqs-gen-treatment.htm | title=Varicella Treatment Questions & Answers | work=CDC Guidelines | publisher=CDC | accessdate=23 August 2007}}</ref>

In adults, the disease is more severe,<ref>{{cite journal |vauthors=Baren JM, Henneman PL, Lewis RJ | title = Primary Varicella in Adults: Pneumonia, Pregnancy, and Hospital Admissions | journal = Annals of Emergency Medicine | volume = 28 | issue = 2 | pages = 165–169 | date = August 1996 | pmid = 8759580 | doi = 10.1016/S0196-0644(96)70057-4 | url = http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WB0-4HG68T8-7&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1152674350&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=079d9dd0e57fad57f6095f23278630aa }}</ref> though the incidence is much less common. Infection in adults is associated with greater morbidity and mortality due to [[pneumonia]] (either direct [[viral pneumonia]] or secondary [[bacterial pneumonia]]),<ref name=varipneumo>{{cite journal |vauthors=Mohsen AH, McKendrick M | title = Varicella pneumonia in adults | journal = Eur. Respir. J. | volume = 21 | issue = 5 | pages = 886–91 | date = May 2003 | pmid = 12765439 | doi = 10.1183/09031936.03.00103202 | url = http://www.erj.ersjournals.com/cgi/content/abstract/21/5/886 }}</ref> [[bronchitis]] (either viral bronchitis or secondary bacterial bronchitis),<ref name=varipneumo /><!--Consider pneumonia as bronchitis as infection of a part of lungs affects other parts of lungs.--> [[hepatitis]],<ref>{{cite journal | last1 = Anderson | first1 = D.R. | last2 = Schwartz | first2 = J. | last3 = Hunter | first3 = N.J. | last4 = Cottrill | first4 = C. | last5 = Bissaccia | first5 = E. | last6 = Klainer | first6 = A.S. | title = Varicella Hepatitis: A Fatal Case in a Previously Healthy, Immunocompetent Adult | journal = Archives of Internal Medicine | volume = 154 | issue = 18 | pages = 2101–2106 | year = 1994 | doi = 10.1001/archinte.1994.00420180111013 | url = http://archinte.jamanetwork.com/article.aspx?articleid=619374 | accessdate = | format = | publisher = JAMA | jstor = | pmid=8092915}}</ref> and [[encephalitis]].<ref>{{cite journal |vauthors=Abro AH, Ustadi AM, Das K, Abdou AM, Hussaini HS, Chandra FS | title = Chickenpox: presentation and complications in adults | journal = Journal of Pakistan Medical Association | volume = 59 | issue = 12 | pages = 828–831 | date = December 2009 | pmid = 20201174 | url = http://www.jpma.org.pk/full_article_text.php?article_id=1873 | accessdate = 17 April 2013 }}</ref> In particular, up to 10% of pregnant women with chickenpox develop pneumonia, the severity of which increases with onset later in gestation. In England and Wales, 75% of deaths due to chickenpox are in adults.<ref name=pregnancy/> Inflammation of the brain, or [[encephalitis]], can occur in immunocompromised individuals, although the risk is higher with [[herpes zoster]].<ref>{{cite web | title=Definition of Chickenpox | url=http://www.medterms.com/script/main/art.asp?articlekey=2702 | publisher=MedicineNet.com | accessdate=18 August 2006}}</ref> [[Necrotizing fasciitis]] is also a rare complication.<ref>{{cite web| title=Is Necrotizing Fasciitis a complication of Chickenpox of Cutaneous Vasculitis?| url=http://www.atmedstu.com/exam%20plus/Is%20Necrotizing%20Fasciitis%20a%20complication%20of%20Chickenpox%20or%20of%20Cutaneous%20Vasculitis.php| publisher=atmedstu.com| accessdate=18 January 2008| deadurl=yes| archiveurl=https://web.archive.org/web/20080415040053/http://atmedstu.com/exam%20plus/Is%20Necrotizing%20Fasciitis%20a%20complication%20of%20Chickenpox%20or%20of%20Cutaneous%20Vasculitis.php| archivedate=15 April 2008| df=dmy-all}}</ref>

Varicella can be lethal to adults with impaired immunity. The number of people in this high-risk group has increased, due to the HIV epidemic and the increased use of immunosuppressive therapies.<ref>{{cite journal |vauthors=Strangfeld A, Listing J, Herzer P, Liebhaber A, Rockwitz K, Richter C, Zink A | title = Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents | journal = JAMA | volume = 301 | issue = 7 | pages = 737–44 | date = February 2009 | pmid = 19224750 | doi = 10.1001/jama.2009.146 | url = http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2009.146 }}</ref> Varicella is a particular problem in hospitals, when there are patients with immune systems weakened by drugs (e.g., high-dose steroids) or [[HIV]].<ref name=Weller>{{cite book |author=Weller TH |chapter=Varicella-herpes zoster virus |title=Viral Infections of Humans: Epidemiology and Control |veditors=Evans AS, Kaslow RA |publisher=Plenum Press |year=1997 |pages=865–92 |isbn=978-0-306-44855-3}}</ref>

Secondary bacterial infection of skin lesions, manifesting as [[impetigo]], [[cellulitis]], and [[erysipelas]], is the most common complication in healthy children. Disseminated primary varicella infection usually seen in the immunocompromised may have high morbidity. Ninety percent of cases of varicella pneumonia occur in the adult population. Rarer complications of disseminated chickenpox include [[myocarditis]], [[hepatitis]], and [[glomerulonephritis]].<ref name="autogenerated1">[http://dermatology.about.com/cs/chickenpox/a/chickencomp.htm Chicken Pox Complications<!-- Bot generated title -->]</ref>

Hemorrhagic complications are more common in the immunocompromised or immunosuppressed populations, although healthy children and adults have been affected. Five major clinical syndromes have been described: febrile purpura, malignant chickenpox with [[purpura]], postinfectious purpura, [[purpura fulminans]], and [[Henoch–Schönlein purpura|anaphylactoid purpura]]. These syndromes have variable courses, with febrile purpura being the most benign of the syndromes and having an uncomplicated outcome. In contrast, malignant chickenpox with purpura is a grave clinical condition that has a mortality rate of greater than 70%. The cause of these hemorrhagic chickenpox syndromes is not known.<ref name="autogenerated1" />

==Epidemiology==
Primary varicella occurs in all countries worldwide. In 2013 the disease resulted in 7,000 deaths – down from 8,900 in 1990.<ref name=GBD204/>

In [[temperate zone|temperate]] countries, chickenpox is primarily a disease of children, with most cases occurring during the winter and spring, most likely due to school contact. It is one of the classic diseases of childhood, with the highest prevalence in the 4–10-year-old age group. Like [[rubella]], it is uncommon in preschool children. Varicella is highly communicable, with an infection rate of 90% in close contacts. In temperate countries, most people become infected before adulthood, and 10% of young adults remain susceptible.

In the tropics, chickenpox often occurs in older people and may cause more serious disease.<ref name=pmid8856352>{{cite journal | author = Wharton M | title = The epidemiology of varicella-zoster virus infections | journal = Infect Dis Clin North Am | volume = 10 | issue = 3 | pages = 571–81 | year = 1996 | pmid = 8856352 | doi = 10.1016/S0891-5520(05)70313-5 }}</ref> In adults, the pock marks are darker and the scars more prominent than in children.<ref name="EpidemiologyURL">{{cite web|url=http://virology-online.com/viruses/VZV3.htm|title=Epidemiology of Varicella Zoster Virus Infection, Epidemiology of VZV Infection, Epidemiology of Chicken Pox, Epidemiology of Shingles|work=|accessdate=22 April 2008}}</ref>

In the United States, the Centers for Disease Control and Prevention (CDC) does not require state health departments to report infections of chickenpox, and only 31 states currently volunteer this information.<ref name="OnlineAthens">{{cite web|url=http://onlineathens.com/health/2013-06-13/georgia-ranks-10th-social-media-admissions-chickenpox|title=Georgia ranks 10th for social media admissions of chickenpox|work=|accessdate=13 June 2013}}</ref> However, in a 2013 study conducted by the social media [[disease surveillance|disease surveillance tool]] called Sickweather, anecdotal reports of chickenpox infections on Facebook and Twitter were used to measure and rank states with the most infections per capita, with Maryland, Tennessee and Illinois in the top three.<ref name="Sickweather">{{cite web|url=http://www.sickweather.com/blog/post_061213.php|title=Chickenpox in the USA|work=|accessdate=12 June 2013}}</ref>

==Etymology==

Why the term was used is not clear but it may be due to it being a relatively mild disease.<ref name=OED2014/> It has been said to be derived from ''[[chickpea]]s'', based on resemblance of the vesicles to chickpeas,<ref name=OED2014/><ref name="Belse">{{cite book |author=Belshe, Robert B. |title=Textbook of human virology |publisher=PSG |location=Littleton MA |year=1984 |isbn=0-88416-458-6 |page=829 |edition=2nd}}</ref><ref name="Shors">{{cite book |author=Teri Shors |chapter=Herpesviruses: Varicella Zoster Virus (VZV) |title=Understanding Viruses |url=https://books.google.com/books?id=Uk8xP5LRHr4C&pg=PA459 |year=2011 |publisher=Jones & Bartlett |isbn=978-0-7637-8553-6 |page=459 |edition=2nd}}</ref> or to come from the rash resembling chicken pecks.<ref name="Shors"/> Other suggestions include the designation ''chicken'' for a child (i.e., literally 'child pox'), a corruption of ''itching-pox'',<ref name="Belse"/><ref>{{cite book |author1=Pattison, John |author2=Zuckerman, Arie J. |author3=Banatvala, J.E. |title=Principles and practice of clinical virology |publisher=Wiley |year=1994 |page=37 |isbn=0-471-93106-3 |edition=3rd }}</ref> or the idea that the disease may have originated in chickens.<ref name=oed>Chicken-pox is recorded in Oxford English Dictionary 2nd ed. since 1684; the OED records several suggested etymologies</ref> [[Samuel Johnson]] explained the designation as "from its being of no very great danger."<ref>{{cite book |author=Johnson, Samuel |title=Dictionary of the English language |publisher=Williamson |location=London |year=1839 |page=195 }}</ref>

==Society and culture==
Because chickenpox is usually more severe in adults than it is in children, some parents deliberately expose their children to the virus, sometimes by taking them to "[[pox party|chickenpox parties]]." Doctors counter that children are safer getting the vaccine, which is a weakened form of the virus, rather than getting the disease, which can be fatal.<ref>{{cite web |title=Chicken Pox parties do more harm than good, says doctor |publisher=KSLA News 12 Shreveport, Louisiana News Weather & Sports |url=http://www.ksla.com/story/16317324/chicken-pox-parties-do-more-harm-than-good-says-doctor}}</ref>

==Other animals==
Humans are the only known species that the disease affects naturally.<ref name=CDC2012Pink/> However, chickenpox has been caused in other animals, such as [[primate]]s, including [[chimpanzee]]s<ref>{{cite journal |vauthors=Cohen JI, Moskal T, Shapiro M, Purcell RH | title = Varicella in Chimpanzees | journal = Journal of Medical Virology | volume = 50 | issue = 4 | pages = 289–92 | date = December 1996 | pmid = 8950684 | doi = 10.1002/(SICI)1096-9071(199612)50:4<289::AID-JMV2>3.0.CO;2-4 }}</ref> and [[gorilla]]s.<ref>{{cite journal |vauthors=Myers MG, Kramer LW, Stanberry LR | title = Varicella in a gorilla | journal = Journal of Medical Virology | volume = 23 | issue = 4 | pages = 317–22 | date = December 1987 | pmid = 2826674 | doi = 10.1002/jmv.1890230403 }}</ref>

==References==
{{Reflist|32em}}

==External links==
{{Medical condition classification and resources
|ICD10 = {{ICD10|B|01| |b|00}}
|ICD9 = {{ICD9|052}}
|DiseasesDB = 29118
|ICDO =
|OMIM =
|MedlinePlus = 001592
|eMedicineSubj = ped
|eMedicineTopic = 2385
|eMedicine_mult = {{eMedicine2|derm|74}}, {{eMedicine2|emerg|367}}
|MeshName = Chickenpox
|MeshNumber = C02.256.466.175
}}
{{Portalbar|Medicine|Viruses}}
{{offline|med}}

{{Commons}}
*{{DMOZ|Health/Child_Health/Conditions_and_Diseases/Infectious_Diseases/Chickenpox/}}
*{{cite web|title=Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP)|url=http://www.cdc.gov/mmwr/preview/mmwrhtml/00042990.htm|publisher=[[Centers for Disease Control and Prevention]] (CDC)|accessdate=18 May 2013|date=12 July 1996}}
*{{cite web|title=Management of Varicella Zoster Virus (VZV) Infections|url=http://www.bop.gov/news/PDFs/varicella.pdf|publisher=Federal Bureau of Prisons: Clinical Practice Guideline|accessdate=18 May 2013|date=December 2011|deadurl=yes|archiveurl=https://web.archive.org/web/20130219180715/http://www.bop.gov/news/PDFs/varicella.pdf|archivedate=19 February 2013|df=dmy-all}}
*{{cite journal | author = John W. Gnann Jr. | title = Chapter 65 Antiviral therapy of varicella-zoster virus infections | year = 2007 | pmid = 21348091 }}
*{{cite web|title=The Health Care of Homeless Persons - Part I - Varicella (Chickenpox|url=http://www.bhchp.org/BHCHP%20Manual/pdf_files/Part1_PDF/VaricellaChickenpox.pdf|publisher=Boston Health Care for the Homeless Program|accessdate=18 May 2013|author=Sarah McSweeney-Ryan|author2=Megan Sandel|deadurl=yes|archiveurl=https://web.archive.org/web/20150908105703/http://www.bhchp.org/BHCHP%20Manual/pdf_files/Part1_PDF/VaricellaChickenpox.pdf|archivedate=8 September 2015|df=dmy-all}}

{{Diseases of the skin and appendages by morphology}}
{{Viral cutaneous conditions}}
{{Varicella zoster}}

[[Category:Chickenpox| ]]
[[Category:Virus-related cutaneous conditions]]
[[Category:Animal viral diseases]]
[[Category:Pediatrics]]
[[Category:RTT]]
[[Category:RTTEM]]

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