Chickenpox
What is chickenpox?
Chickenpox is a highly contagious viral illness caused by the varicella-zoster virus. Most
people recover completely, but sometimes the infection can lead to serious complications,
such as pneumonia and inflammation of the brain. Rarely, the infection can be fatal.
What are the symptoms?
Chickenpox usually begins with a sudden onset of fever, runny nose, cough and tiredness.
About one to two days later a rash appears, starting as pink blotches that quickly become
fluid filled blisters. The rash is usually more concentrated over the trunk, face and scalp.
The blisters can be very itchy and last four to six days before drying out and forming scabs.
The rash can occur in different stages; at any one time new blisters may be forming while
old blisters are drying out.
Most children experience a relatively mild illness. Chickenpox can be severe in newborns,
and individuals with a weakened immune system, such as those with human
immunodeficiency virus (HIV) or those receiving treatment for cancer. Non-immune
pregnant women are also at risk of developing severe complications from chickenpox.
How is chickenpox spread?
Chickenpox is very easily spread from one person to another when an infected person
coughs or sneezes. It can also be spread by direct contact with fluid from the nose and
throat or contact with the liquid in the blisters.
People with chickenpox should cover their mouth and nose when sneezing and coughing,
dispose of used tissues immediately, wash their hands carefully and not share eating
utensils, food or drinking cups. Carers should wash their hands thoroughly after contact with
the blisters or soiled items (such as tissues, clothes, utensils etc.).
How long does a person remain infectious?
A person is infectious from one to two days before the rash starts until all of the blisters
have formed dry scabs (usually around five days).
A person with chickenpox should be excluded from school, childcare or work for at least five
days from when the rash first appeared, and should not return until all the blisters have
formed dry scabs.
Who is most at risk from chickenpox?
Chickenpox is highly contagious. People who have not had chickenpox infection or
vaccination before are at most risk of catching chickenpox if exposed to someone who is
infectious.
People who have been vaccinated may still get chickenpox but it is more likely to be mild
and less likely to lead to severe complications.
People who have had chickenpox in the past are likely to be immune to the virus and are
unlikely to become infected again.
What if I have been in contact with someone with
chickenpox?
It generally takes between 10 and 21 days after exposure to the varicella-zoster virus to
develop symptoms of chickenpox. People who are not immune to chickenpox should see
their doctor for advice if they have had close contact with a person with chickenpox.
The chickenpox vaccine may prevent infection in non-immune people if given within 3 days
(and possibly up to 5 days) after first exposure to an infectious person.
People at higher risk of developing severe disease or complications from exposure to
chickenpox may need to have Zoster immunoglobulin (ZIG). If given within 96 hours of
exposure to the infection, ZIG may prevent or reduce the severity of the infection.
ZIG may be recommended for:
• Pregnant women who are not immune to chickenpox;
• Infants less than one month old whose mother may not be immune to chickenpox;
• Premature or low birth weight infants who are still hospitalised; and
• People with weakened immune systems, such as those receiving immunosuppressive
medications or undergoing chemotherapy, organ transplant recipients, burns patients
and people with HIV.
What is the treatment?
There is no specific treatment for uncomplicated chickenpox infection. Antiviral medications
may be prescribed for those at risk of complications or for those with severe disease.
The risk of secondary infection through scratching can be reduced by the use of anti-itch
soaps and lotions and by keeping fingernails short.
Immunisation Recommendations
Young Children
Two doses of chickenpox vaccine (given at least one month apart) are recommended to
provide the best protection for children under 14 years of age.
A single dose of chickenpox vaccine is routinely offered at 18 months of age and is funded
by the National Immunisation Program (NIP). This dose is given as part of a combination
vaccine with measles, mumps and rubella (MMRV).
A second dose of chickenpox vaccine for children under 14 years of age is not funded by the
NIP but may be purchased on private prescription.
Children can receive the chickenpox vaccine from as young as 12 months of age. This can
provide earlier protection, which may be needed before travelling or during an outbreak.
Older children and adults
For optimum protection, if the person receiving the vaccine is 14 years of age or older, two
doses of vaccine (given at least one month apart) are required.
Vaccination is free for adolescents under the age of 20 years who have not been previously
vaccinated.
Vaccination is also recommended (but not funded) for non-immune adults, particularly
those in high risk occupations (such as health care workers, teachers and child care
workers); for non-immune women prior to pregnancy; for non-immune parents of young
children and for non-immune household contacts of people with a weakened immune
system.
If there is uncertainty whether a person has previously had chickenpox, it is still safe to have
the vaccine and there is no need to test for immunity prior to having the vaccine.
Are there any side effects from the vaccination?
The chickenpox vaccine is generally well tolerated and any side effects are usually mild. Side
effects may include fever and localised pain, redness and swelling at the injection site.
A mild chickenpox-like rash may develop at the injection site or elsewhere on the body. If
this occurs, the rash usually appears between five and 42 days following vaccination.
The vaccine is not recommended for people with a weakened immune system (e.g. those
with some medical conditions; those receiving chemotherapy or radiotherapy, or people
who take high-dose steroid medications); recipients of recent blood transfusions; or
pregnant women.
Need more information?
For more information about chickenpox, contact your doctor or call the Health Protection
Service, Communicable Diseases Information Line during business hours on (02) 6205 2155.
Communicable Disease Control Section at the Health Protection Service is responsible for
the investigation and surveillance of notifiable or infectious conditions in the ACT in order to
control or prevent their spread in the community. This includes the promotion of
immunisation, education and other strategies that help to limit the spread of diseases.
Chicken pox is a notifiable disease. Cases are notified to ACT Health.
Acknowledgements
1. Heymann DL. Control of Communicable Diseases Manual. 20th edn. Washington: American
Public Health Association, USA; 2015.
2. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation
Handbook, Australian Government Department of Health, Canberra, 2018. Available
from: https://immunisationhandbook.health.gov.au
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www.health.act.gov.au | Phone: 132281 | Publication No HPS-00-0039
© Australian Capital Territory, Canberra October 2018
