Protected: Chickenpox

Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). It can cause an itchy, blister-like rash among other symptoms. The rash first appears on the chest, back, and face, and then spreads over the entire body.

Chickenpox can be serious, especially during pregnancy, in babies, adolescents, adults, and people with weakened immune systems (lowered ability to fight germs and sickness).

If NIAS staff are aware that the patient is potentially symptomatic or a confirmed case of Chickenpox then this should be communicated to EAC and ED staff when transferring the patient to ensure effective patient care and management.

The virus can be spread from person to person by direct contact, inhalation of aerosols from vesicular fluid of skin lesions of acute varicella or zoster, and possibly through infected respiratory secretions that also may be aerosolized.

A person with chickenpox is considered contagious beginning 1 to 2 days before rash onset until all the chickenpox lesions have crusted (scabbed).

The varicella-zoster virus also causes shingles. After chickenpox, the virus remains in the body (dormant). People get shingles when VZV reactivates in their bodies after they have already had chickenpox. People with shingles can spread VZV to people who have never had chickenpox or never received the chickenpox vaccine. This can happen through direct contact with fluid from shingles rash blisters or through breathing in virus particles that come from the blisters. If they get infected, they will develop chickenpox, not shingles.

It takes about 2 weeks (from 10 to 21 days) after exposure to a person with chickenpox or shingles for someone to develop chickenpox. For most people, getting chickenpox once provides immunity for life. It is possible to get chickenpox more than once, but this is not common.

Anyone who has not had chickenpox or gotten the chickenpox vaccine can get the disease. Chickenpox illness usually lasts about 4 to 7 days.

The classic symptom of chickenpox is a rash that turns into itchy, fluid-filled blisters that eventually turn into scabs. The rash may first show up on the chest, back, and face, and then spread over the entire body, including inside the mouth, eyelids, or genital area. It usually takes about one week for all of the blisters to become scabs.

Other typical symptoms that may begin to appear one to two days before rash include:

• fever
• tiredness
• loss of appetite
• headache

• Hand Hygiene should be completed as per the 5 moments in line with usual practice.
• Eye protection should be worn
• FFP3 Mask should be worn
• Gloves and Aprons should be worn.
• The patient should be transported via ambulance with no other patients present.
• Ideally should be care for by staff with a known immunity and those not in a high risk category including immunosuppression and pregnancy.
• All equipment and the ambulance should have a deep clean paying particular attention to touch points.
• Laundry should be treated as contaminated, placed into an alginate bag and placed into a red laundry bag.

If staff have been exposed to a confirmed or suspected case of chickenpox the Line Manager and the IPC team should be contacted to ensure a risk assessment is completed.

If required the staff member will be referred to Occupational Health.

Significant Exposure includes Non-immune individuals who have had:

• Non-close contact in the same room as a person with chickenpox (e.g. in a house, classroom, hospital bay/ dayroom) for 15 minutes or more
• Close contact (more than 5 minutes) with a person with chickenpox
• Contact with disseminated shingles and exposed lesions e.g. ophthalmic shingles
• Contact with immunosuppressed patients with shingles

Staff who have a known immunity:

• Do not need post exposure prophylaxis
• Do not need work restrictions

The IPC team can be contacted for further advice. The team will be able to help staff risk assess the patient and precautions required and to provide support where required.