Chickenpox Immunisation

Overview

Chickenpox immunisation means getting a vaccine that protects you or your child from chickenpox. Chickenpox is a common, very contagious illness caused by a virus called varicella-zoster. The vaccine contains a weakened form of that virus, or a small part of it, so it teaches the body's defences (the immune system) to recognise and fight the virus without causing the full illness. The chickenpox vaccine can be given on its own or as part of a combined vaccine that also protects against measles, mumps and rubella.

Chickenpox itself is very common, and most people who are not vaccinated catch it at some point, usually in childhood. The vaccine is used routinely in many countries around the world and has been shown to be safe and effective. Whether it is offered as part of the routine childhood schedule depends on where you live, so it is worth asking your GP, health visitor or local health service what is available in your area.

Chickenpox mostly affects children, and in children it is usually mild. Adults and teenagers who catch it tend to feel more unwell and are more likely to have complications. People with a weakened immune system, pregnant women and newborn babies are at higher risk of serious illness. Vaccination is relevant for anyone who has not had chickenpox and is eligible for the vaccine, whether child or adult.

Symptoms

Common symptoms

• An itchy rash that begins as small red spots, often starting on the face, chest or back
• The spots fill with fluid and become blisters, then dry out and form scabs
• New spots appear in waves over a few days, so you may see spots, blisters and scabs at the same time
• A mild fever
• Feeling tired, achy or generally unwell
• Headache
• Loss of appetite
• Feeling itchy all over, which is often the most uncomfortable part

Causes

Main causes

• Chickenpox is caused by the varicella-zoster virus, which spreads easily from person to person
• It spreads through tiny droplets in the air when someone coughs or sneezes, and through direct contact with the fluid in chickenpox blisters
• Someone with chickenpox is usually infectious from about 2 days before the rash appears until all the blisters have crusted over
• The vaccine works by exposing the immune system to a harmless, weakened version of the virus so it can build protection without causing the illness

Risk factors

• Never having had chickenpox and never having been vaccinated
• Living in the same household as someone with chickenpox — this makes catching it very likely if you are not protected
• Having a weakened immune system, for example because of certain medical conditions or treatments
• Being pregnant or being a newborn baby, which raises the risk of complications
• Working in healthcare, schools or childcare, where contact with chickenpox is more likely

When to see a doctor

See a doctor urgently if:

• You or your child has trouble breathing, is very drowsy, confused, or has a severe headache with a stiff neck
• The rash looks infected — spreading redness, swelling, pain or pus
• A fever that returns or lasts more than 4 days
• You are pregnant, have a weakened immune system, or have a newborn baby and have been in contact with chickenpox
• Signs of dehydration, such as very little urine, a dry mouth or unusual sleepiness

Book a routine appointment if:

• You want to know whether chickenpox vaccination is available or recommended for you or your child
• You are an adult who has never had chickenpox and would like to discuss protection
• You or your child has a health condition, or takes a medicine, that might affect whether the vaccine is suitable
• You are planning a pregnancy and want to check your protection beforehand
• You have recently been in contact with chickenpox and want advice about vaccination

Diagnosis

Chickenpox is usually recognised from the rash and the pattern of symptoms, without any tests. A doctor or nurse will look at the spots, ask when they appeared and whether you have been in contact with anyone who had chickenpox. Because the vaccine is given as a planned injection rather than to treat an illness, 'diagnosis' here is really about checking whether the vaccine is suitable for you — for example, asking about pregnancy, allergies, medicines and health conditions.

Tests that may be done

• Usually none — the illness is recognised from the rash and symptoms
• Occasionally a swab from a blister may be taken if the diagnosis is unclear
• A blood test may be offered to check whether you are already immune, for example if you are pregnant or work in healthcare
• Before vaccination, your GP or nurse will review your medical history and any allergies rather than run routine tests

What to expect at your appointment

If you are having the vaccine, expect a quick injection, usually into the upper arm or thigh. You may be asked to wait at the clinic for around 15 minutes afterwards so staff can check you are well. The area may be a little sore or red for a day or two. If you or your child has chickenpox, expect a short appointment where the doctor looks at the rash and checks for warning signs, and gives advice about rest, fluids and keeping comfortable.

Treatment

There is no cure for chickenpox — the body clears the virus itself, and treatment focuses on easing symptoms and watching for complications. Vaccination is the best way to prevent it in the first place. Most healthy children need only rest, fluids and comfort measures at home. Some people, such as those with a weakened immune system, pregnant women or newborns, may be offered medicines by a doctor to make the illness milder.

Self-care at home

• Rest and drink plenty of fluids to avoid dehydration
• Keep cool — light clothing, a cool room and a cool bath can ease itching
• Ask a pharmacist about soothing creams and anti-itch preparations suitable for your age
• Keep nails short and discourage scratching, which can lead to infection and scarring
• Wash hands often and keep the rash clean and dry
• Keep children off school or nursery until all the blisters have crusted over — usually about 5 days after the rash first appears
• Check local guidance about staying away from pregnant women, newborn babies and people with a weakened immune system until the blisters have crusted
• Absolutely never give aspirin or aspirin-containing products to anyone under 16

Medical treatments

Doctors may prescribe antiviral medicine for people at higher risk of complications — for example adults, pregnant women, newborns, or people with a weakened immune system. These medicines work best when started early, so seek advice quickly if you are in a higher-risk group. For fever or pain, a pharmacist can advise on a suitable over-the-counter medicine for your age; never give aspirin to a child under 16. If a bacterial skin infection develops, a doctor may prescribe an antibiotic. For people who have been in contact with chickenpox, a doctor may sometimes advise vaccination or a medicine called an antibody treatment to reduce the risk of severe illness.

When is surgery considered?

Surgery is not used to treat chickenpox or to give the chickenpox vaccine. Very rarely, surgery may be needed for a serious complication, such as a deep skin or tissue infection, but this is uncommon.

Living with this condition

The main challenge is usually itching and disturbed sleep for a few days. Keep the room cool, dress lightly, and distract younger children with quiet activities. Offer drinks often. Most people feel much better once the blisters start to crust over, which usually happens within about 5 to 7 days. Arrange time off school, nursery or work as needed, and let close contacts know so they can check their own protection.

Lifestyle tips

• Keep hydrated with water, milk and diluted juice; ice lollies can help a sore mouth
• Avoid hot baths and overheating, which make itching worse
• Keep the home cool and ventilated
• Use gentle, unperfumed bath products
• Rest more than usual while the fever lasts, then return gradually to normal activity
• Wash bedding and towels regularly on a hot wash
• Plan for childcare or time off work before the rash appears, so you are not caught out

Diet and exercise

There is no special diet for chickenpox — the aim is simply to keep eating and drinking enough. Offer small, frequent, easy-to-eat foods, and cool, soft foods if there are spots in the mouth. Avoid salty or acidic foods if the mouth is sore. Exercise is not advisable while there is a fever, but gentle activity around the house is fine once you start to feel better. Rest is more important than exercise during the illness.

Mental health and emotional wellbeing

A week or two of illness, broken sleep and time off school or work can be tiring and worrying for the whole family. It is normal to feel anxious about a poorly child or about missing commitments. If you are an adult with chickenpox, being unwell can feel isolating, and the itch and disturbed sleep can affect mood. If worry or low mood is lasting or feeling overwhelming, tell your GP — support is available. If you have thoughts of harming yourself, contact your local emergency number or an urgent mental health support service straight away.

Prevention

Yes. Chickenpox can largely be prevented by vaccination, and vaccinated people who still catch it usually have a much milder illness. Good handwashing and staying away from others while infectious also helps to limit spread, but because chickenpox spreads so easily through the air, vaccination is by far the most effective protection.

Vaccines

The chickenpox vaccine is given as an injection. In many countries it is part of the routine childhood immunisation schedule, often given in two doses in early childhood, and it is sometimes combined with the measles, mumps and rubella vaccine. In other places, including parts of the UK, it may be offered to particular groups rather than everyone — for example to people in close contact with someone at high risk, to healthcare workers without immunity, or on request. It can also be given soon after exposure to reduce the chance of illness. Because it is a live vaccine, it is not suitable for everyone: people who are pregnant, have a significantly weakened immune system, or have certain allergies may need to avoid it or delay it, and your doctor or nurse will check this. Ask your GP, health visitor or pharmacist what is recommended and available where you live.

Screening programmes

There is no general screening programme for chickenpox. However, a blood test can check whether you are already immune. This is sometimes offered to pregnant women, healthcare workers, and people who are unsure whether they had chickenpox as a child, so that vaccination can be arranged where appropriate.

Complications

If left untreated

• Bacterial skin infection, where the spots become infected — this is the most common complication in children
• Chest infection or pneumonia, which is more common in adults
• Dehydration, especially in young children who are reluctant to drink
• Rarely, inflammation of the brain or other serious infection
• In pregnancy, a small risk of severe illness for the mother and of chickenpox in the newborn
• After recovery, the virus stays quietly in the body and can later cause shingles — vaccination reduces the chance of this

Long-term outlook

For most children, chickenpox is an uncomfortable but short illness and they recover fully within one to two weeks, usually without any lasting effects. Vaccination makes catching it much less likely and makes any illness that does happen milder. If you or your child is in a higher-risk group, early advice from a doctor can greatly reduce the chance of complications. Most people who need treatment for a complication make a full recovery.

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