Chickenpox (Varicella)

What is chickenpox? What are the symptoms of chickenpox?

Chickenpox, also known as varicella, is a highly infectious The early symptoms of chickenpox may include a mild fever,
disease caused by the varicella zoster virus. After recovery from loss of appetite, headache and feeling tired, followed by the
chickenpox the virus stays dormant (inactive) in the nerves near appearance of a red rash that becomes itchy and blisters, mostly
the spine. Years later the virus can become active again and on the trunk and face with some on the arms and legs. Blisters
cause herpes zoster, which is also known as shingles. can occur in the eyes, mouth/throat, vagina and urinary tract.
How do you catch chickenpox? The blisters release liquid containing the virus, then form crusts/
Chickenpox is more commonly seen in children. In countries scabs that fall off after 1—2 weeks.
where chickenpox is common, very few people avoid getting Reducing pain, discomfort and itching associated with the
the disease. Adults who have grown up in tropical countries are blisters, preventing dehydration and skin infection, and
much less likely to have had chickenpox. providing early antibiotic medicine if skin infection occurs are
Although rare, some people get chickenpox more than once. the main treatment measures for healthy children.
Shingles is more common in older adults and people of any age For healthy adolescents and adults, the use of antiviral medicine
with an immune system weakness. should be considered in addition to comfort measures. Antiviral
The virus is transferred person to person through contact with medicine started within 24 hours of the rash appearing may
infected droplets of saliva in the air from coughing, sneezing or reduce the severity of the disease.
laughing, or the liquid from the rash blisters. How do you prevent infection?
A person with chickenpox can pass the virus on from 1—2 days Children with chickenpox are advised not to attend early
before they get the rash until after the rash blisters have dried childhood services, school or public places for at least one week
up, which usually takes 5—7 days. It is possible for a person with from the appearance of the rash, until all the blisters are dry and
shingles to pass the chickenpox virus on to someone not immune crusted. Adults are advised not to attend work or public places
to chickenpox through contact with liquid from the rash blisters. for the same period of time.
How serious is chickenpox? Chickenpox vaccine can be given from nine months of age,
Chickenpox is usually less severe in healthy children than in ideally before but if necessary after exposure to the disease.
adolescents and adults. Most healthy children will only need Studies have shown that giving the vaccine to children aged 12
relief from itching and to continue drinking, however some will years or younger within 3—5 days of exposure to chickenpox
develop complications as listed below. Complications may be may prevent the disease developing or reduce the severity of
serious enough to require hospitalisation, and can occasionally the disease. The vaccine can also be given to older children and
lead to death. Adolescents and adults are more likely to develop adults after exposure to chickenpox. However, a single dose
complications than children. after exposure in this age group may not prevent or reduce the
Complications of chickenpox include: severity of disease. Receiving the vaccine after exposure to the
»» Difficulty drinking and eating. disease will not make the disease more severe at any age.
»» Changes in skin colour after the crusts fall off that may last Zoster immunoglobulin (ZIG), a human blood product that
for months. Permanent scarring may also occur. provides protection against the disease, can be given to people
»» Around one in 20 healthy children develop a bacterial skin with a known risk for developing serious complications from
infection that needs to be treated with antibiotic medicine. chickenpox and who cannot receive the vaccine.
»» Bacterial skin infections can lead to bacterial infection in
Pregnant women with no reliable history of chickenpox should
other parts of the body, including the blood (septicaemia).
have an urgent blood test to check for immunity after exposure
»» Although rare, chickenpox infection can cause inflammation
to chickenpox. If the blood test suggests no immunity against
of the central nervous system (cerebellar ataxia), joints
chickenpox, they can receive ZIG or wait for the onset of
(arthritis), bones (osteomyelitis), liver (hepatitis), blood symptoms and begin antiviral medicine immediately.
vessels supplying the brain with blood (intracranial vasculitis),
What vaccines protect against chickenpox?
and brain (encephalitis).
From 1 July 2017, Varilrix® will be the free chickenpox vaccine
»» Pneumonia is more likely to occur as a complication in adults,
on the National Immunisation Schedule for some healthy
particularly women in the last trimester of pregnancy. children at the 15 months of age immunisation visit or at 11
»» Maternal chickenpox during pregnancy can infect the years of age.
growing baby.
»» The highest risk period is during the first 20 weeks of Varilrix will continue to be free for children and adults with a
medical condition that meets the eligibility criteria for one of the
pregnancy when up to two in 100 babies will be born with
‘special groups’ described in the Pharmaceutical Schedule.
congenital varicella syndrome and may have skin scarring,
eye, limb and brain abnormalities, developmental delay Varilrix is also available for purchase through your family doctor.
and a poor outcome. Who can receive free chickenpox vaccine?
»» Maternal chickenpox within the five days before to two days »» Children born on/after 1 April 2016 can have one free
after delivery can infect the newborn baby. chickenpox vaccine dose when they turn 15 months, including
»» Up to 30 in 100 newborns with chickenpox develop severe those who have previously had one purchased chickenpox
disease that can result in death. vaccine dose.
Continued...

Fact sheet June 2017

Chickenpox (Varicella)
Who can receive free chickenpox vaccine? Continued Vaccine recipients who develop a rash should avoid contact
»» Children who have had chickenpox disease prior to the with women who are pregnant and not immune to chickenpox,
15 month Schedule varicella immunisation do not need to newborn babies and people known to have a weakened immune
have a chickenpox vaccine dose. system, until the rash has gone. If this is not possible, close
»» A parent only needs to recall their child having chickenpox contacts with a known risk for developing serious complications
or the characteristic rash. A blood test is NOT required. from chickenpox should contact their doctor.
»» If there is any doubt about whether your child has had Although there is no evidence that the vaccine affects a baby’s
chickenpox in the past, give them the vaccine.
development, women should delay pregnancy for one month
»» There are no safety concerns around giving the vaccine to
after receiving a chickenpox immunisation.
someone who is already protected.
»» Children born 1 July 2006 to 31 March 2016 can have one Who should seek further advice before having
free chickenpox vaccine dose when they turn 11 years IF the vaccine?
they have not already had a chickenpox immunisation or had »» People known to have a weakened immune system.
chickenpox disease. »» People receiving high-dose steroid medicine, e.g. prednisone,
»» If there is no record showing a past chickenpox for more than 14 days. They should wait for at least four
immunisation, give the chickenpox vaccine. weeks after their treatment has finished before receiving the
»» A parent only needs to recall their child having chickenpox vaccine.
or the characteristic rash. A blood test is NOT required. »» People taking antiviral medication, e.g. tablets for cold sores.
»» If there is any doubt about whether your child has had These should be stopped for 24 hours prior to immunisation
chickenpox in the past, give them the chickenpox vaccine. and not restarted for 14 days afterwards.
»» There are no safety concerns around giving the vaccine to »» Children taking aspirin. Whilst there has been no association
someone who is already protected. between chickenpox immunisation and Reye’s Syndrome,
»» Children born before 1 July 2006 and adults do not get a free avoidance of aspirin around the time of immunisation and for
chickenpox vaccine dose unless they have a medical condition six weeks afterward is advised as a precaution.
»» People who have received a blood product in the year before
that meets the eligibility criteria for one of the ‘special groups’.
»» Talk to your doctor or nurse if you think you or your child immunisation.
may qualify. »» People expecting to receive a blood product in the two
months after immunisation. These should not be given for
Who can purchase chickenpox vaccine? two months after immunisation unless their use outweighs
»» Parents who want to protect their child from 9 months of age. the benefits of the immunisation.
»» Parents who want to protect a child who is not eligible for a »» Immunisation should be postponed in individuals suffering
free chickenpox vaccine dose. from a fever over 38°C. However, the presence of a minor
»» Parents who want to increase their child’s likelihood of infection is not a reason to delay immunisation.
protection by giving them a second chickenpox vaccine dose. »» Chickenpox vaccine can be administered to a person living
»» Adults who have no history of chickenpox disease or with a newborn baby, pregnant woman or person who is
immunisation, e.g. those born and raised in tropical countries. immune suppressed.
The combination measles, mumps, rubella and chickenpox
vaccine is available in other countries but not available in New
Who should not have the vaccine?
»» Anyone who has a severe weakness of the immune system
Zealand at this time.
»» Anyone who had a severe allergic response (anaphylaxis) to a
Will children be given four injections at the 15 previous dose of this vaccine or a component of this vaccine.
months of age immunisation visit? »» Women who are currently pregnant.
Yes. Giving four injections at the same visit is safe and avoids »» People who have received another live injected vaccine
parents and children having to make multiple visits. When within the previous four weeks.
receiving just one injection, most children become distressed How protective is the vaccine?
and settle quickly. Increasing the number of injections won’t Immunisation against chickenpox may not protect every person
always mean more distress, and they can still settle quickly. completely.
Delaying immunisation could also leave children unprotected »» After a single chickenpox vaccine dose, 70—90% of children
from serious diseases for longer. are expected to be fully protected against all chickenpox
and more than 95% protected from moderate to severe
How safe is the vaccine? chickenpox.
Chickenpox vaccine contains live-weakened varicella-zoster »» After two chickenpox vaccine doses, 97—99% of children are
virus. The vaccine has an excellent safety profile and is well protected against all chickenpox and 100% protected from
tolerated. Common vaccine responses include redness, swelling moderate to severe chickenpox.
and/or pain at the site of injection. Headache, mild fever and »» After two chickenpox vaccine doses, 79—91% of adults are
tiredness after immunisation are also common. Around five in protected against moderate to severe chickenpox.
100 healthy vaccine recipients develop a mild vaccine-related For the very few people immunised against chickenpox who
rash sometime between 6—43 days after immunisation. still get the disease, it is less severe than the disease in an
It is possible but extremely rare for a person with a vaccine- unimmunised person. Available information suggests that
related rash to transfer the vaccine virus to another person, only chickenpox immunisation may reduce the risk of developing
10 cases have been reported from around 60 million vaccine shingles later in life in comparison with those who had wild-type
doses in the U.S. There is no risk of the vaccine virus being disease.
transferred to another person if there is no vaccine-related rash. Continued...

Fact sheet June 2017

Chickenpox (Varicella)
Should children and adults have one or two Special groups aged 9 months or older
chickenpox immunisations? Two vaccine doses are recommended and funded for infants,
Children aged less than 13 years children and adults who meet the eligibility criteria for one of
Parents may choose to purchase a second dose of varicella the ‘special groups’ described in the Pharmaceutical Schedule.
vaccine, which can be administered a minimum of 4 weeks How long does vaccine protection last?
before or after the first dose. Protection after two doses of vaccine appears to be very long
»» One dose gives good protection, two doses give optimal term for most people immunised, however, it is not known if it is
protection. lifelong at this stage. Countries that have been using the vaccine
Children aged 13 years or older and adults for a long time have not identified a need for booster doses.
The standard varicella vaccine schedule is two doses
administered a minimum of 4 weeks apart for individuals in this
age group receiving varicella vaccine for the first time.

Disease Possible complications of disease Possible vaccine responses

A highly contagious viral • Permanent skin scarring. Common responses

illness causing fever and a rash • Bacterial skin infection in around 1 child out of 20 • Headache and/or tiredness.
that becomes itchy blisters. child cases. • Mild rash 6—43 days after
• Nerve inflammation (cerebral ataxia) for around immunisation.
Years later the virus can 1 child out of 4000 child cases.
become active again and • Bone, joint, liver, blood vessel inflammation. Rare responses
cause herpes zoster, which is • Encephalitis (brain inflammation) for around 4 • High fever.
also known as shingles. people out of 10,000. • Transfer of vaccine virus from a
• Pneumonia in adults, especially pregnant women. vaccine rash to another person.
• Hospitalisation for 2—6 people out of 100,000 • Severe allergic reaction (anaphylaxis).
cases.
• Death for 2—4 people out of 100,000 cases.
• Chickenpox during pregnancy can cause severe
abnormalities in unborn babies including skin
scarring, eye, limb or brain abnormalities,
developmental delay, and a poor outcome.
• Maternal chickenpox close to delivery can infect
the newborn, causing severe disease and death.
• Shingles in later life.

Vaccines are prescription medicines. Talk to your doctor or nurse about the benefits or any risks.

References
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cohort study. Pediatrics. 2013;131(5):138-1396.
• Centers for Disease Control and Prevention. Prevention of varicella recommendations of the Advisory Committee on Immunization
Practices (ACIP). MMWR Recomm Rep. 2007;56(RR-04):1-40.
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children and adolescents after implementation of varicella vaccination. Pediatr Infect Dis J. 2009;28(11):954-9.
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2013;26(4):728-43.
• Heininger U, Seward JF. Varicella. Lancet. 2006;368(9544):1365-76. Tarlow MJ, Walters S. Chickenpox in childhood: A review prepared
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• Ministry of Health. Immunisation handbook 2017. Wellington:Ministry of Health; 2017.
• Ozaki T, Nishimura N, Muto T, Sugata K, Kawabe S, Goto K, et al. Safety and immunogenicity of gelatin-free varicella vaccine in
epidemiological and serological studies in Japan. Vaccine. 2005;23(10):1205-8. Pace D. Review of varicella zoster virus: From
epidemiology to prevention. Malta Medical Journal. 2008;20(3):7-11.
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Fact sheet June 2017