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Chickenpox (otherwise known as varicella) is a common childhood infection that we are all familiar with. Once you have an outbreak, a whole nursery or school classroom can be infected. We all know of parents also organising chickenpox parties so that their kids get the infection and therefore become immune. The idea is that it's a mild illness and if they’re infected, they get better soon and then become immune for life.
Sounds simple right?
But is chickenpox infection really mild? And what if you never had chickenpox as a child and then become exposed to it as an adult? Is chickenpox in adults also a walk in the park? In this article,We’ll set out to explore chickenpox disease and how it can affect adults.
Why Chickenpox Is More Severe in Adults
Although it can be mild in childhood, chickenpox disease in adults can often be very severe and can lead to life-threatening complications (more of that later).
Why is it that chickenpox in childhood is often mild and adults suffer so much? The answer probably lies in the way the immune system’s response in adults and children differ. There’s very little in the medical literature about this but it's thought to be due to the different types of immune response that we all exhibit: the adaptive and the innate immune system.
The innate immune system consist of primitive immune cells that can easily and quickly fight any virus or bacteria. The key is that it's rapidly responding and is not specific to any microbe. The adaptive immune system consist of much more specialised cells that respond and multiply to a specific virus or bacterium. This system includes B lymphocytes that produce antibodies in response to infection. But in contrast, this is a much slow process and is very specific to the chickenpox virus.
Think of the analogy of an army that consists of soldiers at the front and specialised cavalry at the back. The soldiers being the innate system, can very quickly attack any microbe at will, whereas the cavalry (the adaptive system) is much more thoughtful and slow to respond, but will focus on specific enemy targets. It may simply be that kids have a better innate immune system than adults. If you're a bit of a geek and would like to know more about this you can watch this Khan academy video to learn more about adaptive and innate immunity.
In practice what this means is that chickenpox in adults can be much more severe and can lead to complications such as skin sepsis (potentially life-threatening infection) pneumonia and encephalitis (inflammation of the brain). Chickenpox can also cause inflammation of the lower part of the brain which can lead you to be unsteady and imbalanced (cerebellar ataxia).
Symptoms of Chickenpox in Adults
The key symptoms of chickenpox in adults to look out for are:
Fever
Headache
Fatigue
Cough
A red, blistering rash
Day 1: What to Expect When Chickenpox Appears in Adults
You need to look out for the very first symptoms of Day 1 chickenpox in adults which can be fairly non-specific, like feeling fatigued, headache and a high temperature. This can actually start 1-2 days before you notice the rash and can be confused with other infections such as influenza and Covid. Importantly, you'll also be shedding the chickenpox virus during this period and therefore can be infectious to others.
The rash is initially red and raised and first noticeable on the face, chest and abdomen. It then spreads out further to the arms and legs and begins to form fluid filled blisters, the so-called ‘vesicular’ rash
As we've already discussed, chickenpox in adults is more severe and so the rash is no exception in that it can be much more widespread, with severe blistering and potentially leading to bacterial sepsis (infection in the blood).
You'll also need to look out for the symptoms of the other severe complications such as ‘feeling dreadful or very unwell’, progressive cough with shortness of breath confusion, drowsiness and an unsteady gait. These are all warning signs and if you experience any of these symptoms, you should receive prompt hospital treatment.
Managing Chickenpox Disease in Adults: Essential Care Tips
Thankfully, there is chickenpox treatment for adults but it's important to seek medical advice early and receive prompt treatment. The principles of chickenpox treatment are the following:
Supportive and symptomatic therapy
Medical therapy
Post exposure chickenpox treatment
Let's take each of these in turn:
Supportive therapy
Paracetamol and ibuprofen to relieve pain, discomfort and fever
Over the counter, antihistamines such as cetirizine can help relieve itching
Ask your pharmacist for topical treatments such as calamine lotion or cooling gels to help with the chickenpox rash
Make sure you stay well hydrated and drink plenty of fluids
Nutrition is important to help you recover and meal drinks such as Complan, Fortisips and Ensure can help you stay nourished
Medical therapy
Antibiotics –your skin can get infected with Staphylococcus bacteria that can progress to sepsis. So if in doubt, get it checked out with your GP. Your skin is also much more likely scar if your skin becomes infected.
Treatment with antivirals such as aciclovir or valaciclovir – if you develop chickenpox as an adult, please make sure you see your GP to receive prompt treatment. All adults should be given antivirals whereas children usually have mild disease and usually don’t require specific chickenpox treatment.
Hospital admission - you need specialist care if you develop any of these severe symptoms (see symptoms above)
Post exposure chickenpox treatment. There’s evidence that if you receive the chickenpox vaccine within 72 hours contact with someone with chickenpox then there’s a chance that chickenpox infection can be prevented. Even if it's been more than 72 hours, please contact us as we may still be able to offer the chickenpox vaccine.
Complications of Chickenpox in Adults
We’ve already discussed the complications chickenpox in adults but briefly these are:
Bacterial skin sepsis (a severe infection of the skin)
Chickenpox pneumonitis (The virus directly causing pneumonia and inflammation)
Encephalitis (inflammation of the brain)
Cerebellar ataxia ( inflammation of the lower part of the brain leading to imbalance)
The following symptoms should prompt you to seek emergency medical attention:
Feeling very unwell/dreadful - an ‘impending doom’ not experienced before
Progressive cough and shortness of breath
Drowsiness and/or confusion
Loss of balance and/or unsteadiness
Preventing Chickenpox in Adults
Chickenpox in adults can easily be prevented. The first thing to do is to try and identify whether you've had chickenpox as a child, in which case you would be immune and don’t need vaccination.
The easiest way to do this is to ask a member of your family if they recall you getting the disease. If they’re no help then it’s possible to get a blood test to see if you have immunity to chickenpox.
If you've never had chickenpox as a child then you should strongly consider the varicella vaccine as an adult. The normal vaccine schedule is two jabs usually given two months apart. It's highly effective and will stop you from becoming severely ill from the complications of chickenpox. The vaccine is usually available from private clinics such as Health Klinix. Of course, the benefits of the chickenpox vaccine is not limited to adults as it’s also important in the prevention of the disease in children
Herpes Zoster (commonly known as shingles) is reactivation of the chickenpox virus in adulthood. After you've developed chickenpox in your younger days, it can lay dormant until later in life when it can cause a blistering, painful rash. The pain associated with shingles can be extremely debilitating and long lasting. For this reason, there’s a national shingles UK vaccination programme:
Briefly, it's currently offered to the following:
Those who are turning 65 years of age
Individuals aged 70 years
Anyone with 50 years and over with a severely weakened immune system
The shingles vaccination programme will be rolled out over the next 10 years so that eventually
everyone at 60 years would be offered the vaccination. However, independent clinics such as Health Klinix can offer the shingles vaccination privately for anyone over the age of 50 years or anyone aged over 18 years with a weakened immune system. Please contact us or email for advice.
Whatever your personal circumstances are, it's important for you to take proactive steps to protect you and your family from the potentially life-threatening complications of chickenpox so book now for an appointment.
Sources and References:
Written and Approved by:
Dr Ravi Gowda
Consultant in Infectious Diseases
MBBS, MRCP(UK), MRCGP, DTM&H, DCH, DRCOG, DFFP
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