Once chickenpox appears in a childcare setting, parents begin counting down the days as they watch for tell-tale spots, only to begin counting again as each new case appears. Chickenpox is a highly contagious disease caused by the varicella zoster virus. Approximately 90% of chickenpox cases are in children 1-14 years of age.
Chickenpox usually begins with a small itchy rash followed by aches and fever. It is spread both directly and airborne through respiratory track secretions (such as from coughing or running noses) or fluid from the infected person’s open sores. In the early stages, chickenpox is so contagious that if a person is not immune to the disease (by either a vaccine or previously having the illness), they have up to a 90% chance of contracting the virus. That means that just one chickenpox case in the classroom could mean that 90% of the children who are not immune to the illness may become ill as well!
The disease is usually mild and not life threatening in healthy children but can cause problems for newborns and adults. In adults, chickenpox can occasionally lead to encephalitis or pneumonia. Newborns with undeveloped immune systems, or adults and children with impaired immune systems, such as those who are on chemotherapy, have AIDS, or take steroids, may experience severe reactions which can lead to death. Chickenpox during pregnancy can cause serious birth defects in the unborn child.
For children with chickenpox, aspirin or salicylate should never be given for pain or fever as the combination of the virus and the medication can lead to Reye’s Syndrome, a potentially fatal condition affecting the brain and liver.
Chickenpox for most children is generally more uncomfortable than serious, however, infected children must be isolated from others until the pox have crusted over. This means that a parent must make arrangements for child homecare for about one week. Each year, chickenpox costs millions of dollars in sick days for parents who miss work. Many parents with a chickenpox-infected child want to return the youngster to the childcare center as soon as possible, so having clear rules on chickenpox exclusion can prevent unnecessary conflict with parents.
In the past few years, the chickenpox immunization, or varicella vaccine, has received much publicity. It is recommended that all healthy children 12-18 months receive one dose, all children 19 months-12 years (who have not had chickenpox) receive one dose, and adolescents and those older than 13 receive two doses 4-8 weeks apart. Chickenpox outbreaks could severely lessen with the usage of the vaccine and many childcare centers are adding this vaccination to their required immunizations.
- Chickenpox is infectious for 1-2 days before the rash and 4-5 days after the start of the rash or until all blisters have formed crusts.
- Symptoms start about 2-3 weeks after exposure.
- Symptoms include fever, tiredness, and an itchy rash with small blisters that dry up and form scabs 2-4 days after the onset of the rash.
- Children (or adults) with chickenpox should be temporarily excluded from the center and not allowed to return until 6 days after the rash starts or until all blisters have scabbed over. State health departments may have varying rules on exclusion so please contact your local health department.
- Notify all staff and parents that a case has occurred.
- Promote the chickenpox vaccine!