Chickenpox (Varicella) for Health Services web page:
Chickenpox (Varicella):
Chickenpox is a viral illness characterized by rapid onset of fever, fatigue, and generalized eruption of
the skin. It is highly contagious and is spread person-to-person with direct contact, through droplets or
airborne secretions of the respiratory tract or indirectly through articles freshly soiled by discharges
from the blisters and the mucous membranes of infected persons.
The period of communicability is from 1-2 days before the rash appears and until all lesions are crusted
over (4-7 days after rash onset).
This illness is often more severe in teens and adults than in younger children. Use of antiviral medication
such as acyclovir, may decrease the number of lesions and duration of outbreak of lesions but is most
beneficial if started within 24 hours of rash development. This is especially important for people who
are exposed to chickenpox and do not have immunity against the disease and are not eligible for
vaccination if prescribed by their healthcare provider.
Persons at risk of severe varicella include—
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immunocompromised patients without evidence of immunity to varicella, such as—
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children with leukemia or lymphoma who have not been vaccinated
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people on medications that suppress the immune system, such as high-dose systemic
steroids or chemotherapeutic agents
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people with cellular immune-deficiencies or other immune system problems
pregnant women without evidence of immunity to varicella
Individuals with certain high-risk conditions: anemia, immunodeficiencies and pregnancy, may be at
increased risk for complications and should contact their health care provider. Pregnant women who
have been exposed to somebody with chicken pox should contact their doctor immediately. Those who
are not sure if they had chickenpox can have a blood test to see if they are protected against the virus.
Live chickenpox vaccine should not be given to any woman who is known to be pregnant.
CDC recommends two doses of chickenpox vaccine for children, adolescents, and adults. Two doses of
the vaccine are about 98% effective at preventing chickenpox. Some people who are vaccinated
against chickenpox may still get the disease. However, it is usually milder with fewer blisters and little
or no fever. If you do not have immunity against chickenpox and are exposed to someone with this
disease or shingles, talk with your doctor about getting chickenpox vaccine. If you previously got one
dose of chickenpox vaccine, you should get a second dose. You should get chickenpox vaccine within 3
to 5 days of being exposed. Getting vaccinated after you are exposed to someone with chickenpox
can—
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prevent the disease or make it less serious
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protect you from chickenpox if you are exposed again in the future
How much does a varicella (chickenpox) titer cost? (A titer is a blood test to prove immunity to a
disease.)
The price of testing varies between labs and providers. The cost of a “varicella-zoster antibody IGG”
serologic (blood) testis at least 50$, if paid for out-of-pocket. There may be additional costs, e.g., blood
drawing fee and office visit.
How much does a chickenpox vaccine cost?
The vaccine is provided without cost to everyone under 19 in Washington. The vaccine cost for other
family members will depend on what kind of insurance the family has. There may be costs associated
with giving the vaccine and the office visit. Many insurance plans cover the vaccine administration with
no out-of-pocket cost to the patient. Many pharmacies also offer vaccination. Patients should call their
health care provider and the Health Department to discuss specific costs.
Community Resource:
Clallam County Dept. Health & Human Services
111 E. 3rd St, Suite 1A, Port Angeles, WA 98362 360-417-2274
Is it safe for a person to get a chickenpox vaccination if they think they have had chickenpox, but
illness was never confirmed by a healthcare provider?
A varicella antibody titer (blood test) is available to check immunity, but it is not required before
vaccination. Since 70% to 90% of adults who don’t remember having chickenpox actually show
immunity when their blood is tested, testing adults who don’t have a healthcare provider verified
history of chickenpox, may be cost saving. Check with your healthcare provider to make sure it is safe to
receive the vaccine.
Should staff members be immunized against shingles, if there is an outbreak of chickenpox in their
school?
No. If a staff member has never been infected with chickenpox, they are not at risk for getting shingles
(herpes zoster skin lesions). If exposed for the first time to the virus, people develop chickenpox:
shingles is a re-activation of a previous chickenpox infection. If a person is less than 60 years old and
unsure of their immunity, they should be vaccinated with the chickenpox vaccine or tested for
immunity. The CDC recommends shingles vaccination for everyone 60 years and older, even if they have
previously suffered a bout of shingles. Shingles has a much lower rate of transmission than that of
chickenpox. Virus from the vesicle fluid (skin lesions) of a person with shingles can rarely cause
chickenpox in a non-immune individual.
Note: Students and adults who have shingles if their skin lesions can be appropriately managed
(covered, no leakage through covering) and they have the capacity to maintain appropriate hygiene
(regular hand washing), can be at school. Students and adults with chickenpox cannot be at school until
they are no longer contagious (when all skin lesions have crusted over).
Is there a post-exposure treatment for those who are unimmunized or under-immunized?
Yes, people who are unimmunized (no shots, no documentation of immunity) or under-immunized (one
shot of the chickenpox vaccine) should call their healthcare provider and arrange to receive the vaccine
after exposure. Vaccination within 72 hrs of exposure is 70-100% protective. Post-exposure vaccination
is not effective for prevention if given more than 5 days after exposure, but will proved protection
against future exposure, if the person is not infected.
Is there a post-exposure treatment for people at high risk for complications?
In December 2012, the Federal Drug Administration approved VariZIG for use as post-exposure
treatment to chickenpox in persons at high risk for severe disease, who lack evidence of immunity to
chickenpox and for whom chickenpox vaccine is contraindicated. If prescribed, it is most effective within
96 hours of exposure to chickenpox, but may be acceptable for use within 10 days.
How do I protect myself from infectious diseases?
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Remind everyone the importance of washing hands frequently and well.
Clean or dispose of any articles soiled with nose and throat discharges.
Instruct family members never to share items that may be contaminated with saliva
such as beverage containers.
Encourage family members to cover mouth with tissue, or “catch your cold in your
elbow” when coughing or sneezing.
Disinfect surfaces that have been in direct contact with fluid from the vesicles.
Information taken from the CDC website: http://www.cdc.gov/chickenpox/vaccination.html, the Office
of the Superintendent of Public Instruction and Varicella, Chickenpox Outbreak Management from the
Spokane Regional Health District.