Chickenpox is caused by the Varicella-Zoster virus (VZV, a double stranded DNA herpesvirus), and is common in spring and early summer in temperate zones. The latest astounding figures for New Zealand are 50,000 cases per year, 150-200 hospitalisations and 1 or 2 deaths1.

Chickenpox is spread either by droplet infection or contact with the spots of a person with chicken pox. The incubation period is 2 – 3 weeks, during which time the virus replicates in the lymph nodes, liver and spleen, with a second more intense viraemia occurring just before the rash appears. The infectious period starts one day before the rash appears and continues until the scabs fall off..

Chickenpox usually occurs in children under the age of ten with the peak age between 2 and 6 years. 90% of the population has been infected by the age of 15. Two percent of chickenpox cases are reported in adults, but 25-50% of the deaths.

SYMPTOMS:

Shortly before the rash appears, the infected person may have a temperature of about 38.5°C, not feel like eating, be tired, and have photophobia. The rash usually appears on the body and spreads to arms, legs, face and scalp. In

some children, the rash can spread into the mouth, and in girls, it can cause discomfort in the vagina. At first the rash is pimple-like, but quickly turns into blisters, which, after a few days, scab over. The scabs then fall off, and should leave little or no scarring.

Chickenpox is usually self limiting with low morbidity and mortality in healthy children. However, in babies under 1 month (where the mortality rate is 20%), adults and immunocompromised children the following should be noted:

COMPLICATIONS (rarely seen in normal healthy children):

A high and prolonged fever is a good predictor of how severe the disease will be, and may be associated with severe complications:

Pneumonia – usual cause in adults is Staphylococcus aureas
Bacterial superinfection and encephalitis (rare in children)
Reye’s syndrome, mainly associated with the use of aspirin to control fever and pain
Otitis media
EXTREMELY RARE COMPLICATIONS:

Osteomyelitis, necrotising fasciitis, toxic shock syndrome, Guillain-Barré Syndrome, carditis, uveitis, myocarditis, bullous varicella, septic arthritis, deep tissue abscess, Group A beta-haemolytic streptococcus, nephritis, orchitis, thrombocytopenia, fulminant hepatitis, acute cerebellar ataxia, premature labour (pregnant women only).

0.7 – 2% of births to women infected in the first 4 months of gestation lead to congenital varicella syndrome – chorioretinitis, ocular defects, cutaneous scars, hypoplastic limbs, micrognathia, encephalomyelitis, cortical atrophy, and pneumonitis2.

Most doctors have never seen any of these, and would consider discussion of them laughable. However, lest we should be accused of being simplistic, and in the interests of total disclosure, we believe you should know all the information.

A recent American study showed that 6% of admissions for the complications of varicella were musculoskeletal disorders ranging from necrotising fasciitis to toxic-shock syndrome requiring multiple amputations2. Complications were not related to severity of chickenpox. Since the routine mantra from medical people to parents is ‘paracetamol for fevers’ despite medical literature clearly demonstrating that such advice is highly dangerous; since the majority or parents follow such advice unquestioningly; and since necrotising fasciitis has primarily been associated with people who regularly pop paracetamol and other anti-inflammatory drugs, it is hardly surprising.

IMMUNE SYSTEM RESPONSES:

Both cell-mediated (Th1) and humoral (Th2) immune responses stop the virus replication (antibody alone does not guarantee total immunity). The most important immune response is the Th1 response which is cell mediated immunity (search and destroy the virus), but the precise laboratory markers of that immunity are unknown3 . This is why people with agammaglobulinaemia (no antibody production) usually have uncomplicated chickenpox, whereas people with defective cell-mediated (or search and destroy immunity) can die from chickenpox.

Treatment for chickenpox: (and the costs)

NATURAL MEDICINE:

Because chickenpox is a virus, vitamins A and C are the treatment of choice. The dosages required depend on the individual child. Total cost would be no more than$50.00.

Keep the skin clean and cool with frequent baths using 1 cup baking soda or 5 drops lavender essential oil in the bath water. Rubbing the juice from the fresh stems of aloe vera can also help the itching23, 24.

Sleep and rest with plenty of fluids is the best cure, as for all viral infections. Keep children away from others while they are infectious, especially older people, as exposure to chicken pox may bring on a case of shingles.

Aromatherapy

Add 5 drops tea tree, 5 drops chamomile, 5 drops lavender and 5 drops bergamot essential oils to 50ml rose water or chamomile tea and apply to the spots to help stop itching. Re-mix well before each application25.

Use 2 drops lavender, 2 drops roman chamomile and 2 drops bergamot essential oils in the bath, especially for under 5 year olds25

Costs for essential oils vary depending on the oil. If buying essential oils, the label should always state 100% pure essential oil, the country of origin and a use by date. Do not buy fragrant oils, as they do not have the therapeutic value, being artificial substitutes in most cases. As a guide, a 10ml bottle of lavender oil will probably cost around $20.

Homoeopathy

Antimonium tartaricum – for use when the child is bad-tempered and the spots are slow in coming out. The child will have a white-coated tongue.

Pulsatilla – for use when the child is clingy and whiny with a low fever. The itch is worse for heat.

Rhus toxicodendron – use when the tongue is coated white or yellowy white and has a red tip which may be sore. The spots are maddeningly itchy and the child very restless.

Sulphur – use if the child is generally restless, sweaty and feverish and the spots are severe, very red and much worse for heat. The spots become crusty, smelly and weep after scratching. Sulphur may also be needed where recovery from the illness is slow.

Varicella 200c (nosode) – use to help clear a severe case or for lingering after-effects of the disease. Do

not use while disease is incubating26, 27.

Cell Salts

Ferr Phos – when fever, irritability and discomfort are present.

Kali Mur – After the fever has passed, usually with white or greyish white coated tongue. Spots filled with whitish substance.

Calc Sulph – where the eruptions have yellow infected-looking discharge.

Kali Sulph – use when the spots have finished coming out and alternate with Ferr Phos to promote perspiration.

Dosages: Two celloids of the required remedy every half-hour in the early stage, less frequently once the fever has subsided28.

Costs for homoeopathic remedies and cell salts are very reasonable, usually around $5 - $10 per bottle.

PHARMACEUTICAL MEDICINE:

Zovirax (Acyclovir), foscarnet or Vidarabine for older children. Dosage = 20 mg/kg of body weight with a maximum of 800 mgs for 5 days = $170.00.

For the immunocompromised, Zovirax for 7 days intravenously minimum costs = $3,300.

For Zovirax resistant virus, foscarnet (Foscavir) 40 mg/kg IV x 10 days + $2,100. (Not FDA approved.)

Anti-histamines, paracetamol and sometimes, corticosteroids such as prednisone are used.

With regard to drug treatment, the following extract speaks volumes:

A POX ON ACYCLOVIR:

Newspapers and TV gave a big play to the supposed efficacy of huge (and expensive) dosages of oral acyclovir for treatment of otherwise normal children with chickenpox when the reports appeared a few months ago (New Engl. J Med. 1991; 325:1539). We were mostly impressed with the fact that, if you have large enough numbers of study patients, you can make clinically insignificant differences highly statistically significant. Now the report of acyclovir versus placebo for adolescents with chickenpox has appeared (J Pediatr 1992; 120:627.) Once again clinically insignificant or marginally significant differences favouring acyclovir are statistically significant. The dosage was 800 mg 4 times daily for 5 days (compared with 200 mg 5 times daily used for genital herpes simplex infection)10.

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