Chickenpox is a mild infectious disease that occurs in 90% of cases during childhood. It can sometimes appear late in adolescents and adults following contact with the virus. What about adults: is it more severe, dangerous? And how to guard against it?
Chickenpox is not common in adults (10% of cases). It usually occurs between 3 and 6 years old, at the time of the first steps in the crèche and at school: “it is a disease linked to the socialization of children. She is therefore very uncommon in adulthood“, underlines Dr. Paul-Henri Consigny, infectiologist.
The varicella virus remains dormant for the lifetime when one has contracted it. The recurrences that can be observed are in the form of shingles. “Shingles is the recurrent form of chickenpox. You can’t get chickenpox twice. On the other hand, as the diagnosis is clinical, the error is possible“, he adds. This pathology generally occurs in people weakened by a satellite disease.
Chickenpox is contagious and it is the eruption of the vesicles which will determine the duration of its contagion knowing that there are usually several outbreaks of 48 to 72 hours. Its transmission is of two types: by air at first and per contact in a second time. Two to three days before the appearance of pimples, infection occurs through the respiratory tract. It lasts a few days after the presence of the pimples, as long as the scabs have not fallen off. “The risk of contagion is therefore at the beginning before the onset of the disease and when we look for the diagnosis“, explains Dr. Consigny.
Healing takes place in about ten days unless there are complications. “The last pimples disappear in 10 to 14 days when there are no more severe symptoms.
As with all childhood illnesses, chicken pox contracted in adulthood can be more severe: the process is fairly identical but symptoms often more severe. To the classic symptomatology, the vesicular eruption which scratches and which will evolve by outbreaks towards scabs which fall over two weeks, may be added fever, fatigue, cough and/or shortness of breath more or less severe. “The person may be minimally symptomatic and based on an X-ray of the lungs, abnormalities may be observed“. It may then be a varicella pneumonia, which usually appears within the first few days. Complications are often of a respiratory nature but can also more rarely appear in the form encephalitis or central nervous system infection. “This is why we are quite vigilant in the face of chickenpox in adults and the different symptoms”.
Chickenpox-related mortality is exceptional today
Cleaning with soap and water or using a disinfectant for blisters and pimples is recommended to avoid superinfections with staphylococcus or streptococcus. “You have to let the rash set in, wait for the pimples to dry up and go away, cut fingernails to avoid scratching. There are no contraindications to bathing or showering. You have to let time do things“. In addition, anti-itch treatment can also be offered. Antiviral treatment against the virus varicella will be considered only for immunocompromised people or in the case of severe forms.
There are two categories of population at risk of chickenpox: pregnant women and immunocompromised people. In pregnant women, the acquisition of varicella during the 1st and/or 2nd trimester can expose risk of fetal malformation. “In the absence of certainty, the ideal is to check through serology if you have already contracted chickenpox. And if it is negative, we offer vaccination outside of pregnancy.“. In fragile people with an immune deficiency (organ transplant recipient, HIV-positive, cancer or chronic illnesses, etc.), antiviral treatment is systematically offered when there has been contact with chicken pox to avoid the occurrence of complications.
Mortality linked to varicella is exceptional today. “Some complications such as encephalitis, brain infection linked to the varicella virus, have been able to cause death, but fortunately this remains infrequent and today severe forms are taken care of.
Vaccination against varicella exists. It can be offered people without a history of chickenpox and can be programmed outside of any exposure (couple of childbearing age, for example), and in particular within 3 days following exposure to a patient with an eruption. Vaccination corresponds to 2 injections 1 to 3 months apart, without reminder.
Thank you to Dr. Paul-Henri Consigny, infectiologist specializing in consultation of infectious and tropical pathology and travel medicine, at the Necker Pasteur Infectiology Center, Institut Pasteur in Paris.
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