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|Quick reference medical handouts used
by Pediatric offices
Same Virus Causes Chickenpox, Shingles
After a child
has chickenpox, many parents are told that they will
never have to worry about this childhood illness ever
again. However, this information is only 99% true.
Although typical chickenpox rarely occurs a second time,
the virus that causes it the varicella zoster is
responsible for another disease that appears in both
children and adults shingles. Actually, shingles is
really not a second illness with the varicella zoster
virus, but it is more like the second act of a play with
a long intermission.
reactivation of the varicella
Chronic illness, a weakened
immune system, a bad sunburn,
and stress can result in a
shingles attack in children.
After a child recovers from chickenpox, the
varicella zoster virus is not eliminated from the body
like other viruses. Instead, the virus remains alive in
an inactive, dormant state, making itself a home in some
of the body’s nerve cells.
Years later, for unclear reasons,
the virus reactivates and starts reproducing. When it
does, it begins to infect the surrounding nerve fibers.
What prompts the virus to "awaken" in normal, healthy
children and adults is still not clear
but what is
certain is that "Act II" of the varicella zoster play
has now started.
differently in adults than in children. In "grown ups"
the illness starts with symptoms suggestive of the flu
mild muscle aches, chills, and fever. The virus then
causes several days of burning or severe pain in the
skin as it migrates along the nerve. In children, there
is usually no fever or pain and the child does not feel
all that sick. In all age groups, once the virus reaches
the skin a rash that is characterized by crops of
blisters on a red base, appears on the area shared by
the involved nerve. The pattern of the rash is fairly
characteristic, almost always stopping at the body’s
midline due to its infiltration of only a single nerve
group. New blisters continue to appear for about up to
seven to ten days, gradually getting larger, clouding
up, and forming crusts that will fall off with little or
no scarring. The back, chest, and abdomen are the most
common areas affected, and the whole episode of pain,
rash and healing is generally over in three to five
weeks. Complications rarely occur unless the area around
the eye and nose are involved. The appearance of lesions
in this area usually require treatment by an
ophthalmologist or dermatologist to protect the child’s
While shingles in children
cannot spread it is possible
that other people may get
chicken pox by coming in contact
with a child having shingles.
This is particularly true for
people who have never had
chicken pox or have not been
immunized against it.
The shingles virus is contagious by direct contact
during the blister stage, but exposed individuals will,
interestingly, develop chickenpox, not shingles.
Therefore, the child with shingles should be kept away
from other children (or adults) who have not had
chickenpox. Because shingles results from reactivation
of the virus already in the patient's nervous system,
one cannot "catch" shingles from another person with the
disease. Furthermore, shingles is much less contagious
than chicken pox because shingles can be transmitted
only if the blisters are broken and touched by a
susceptible person. In contrast, chickenpox is spread by
both direct contact and through airborne droplets
containing the virus in the air. The attack of shingles
finally gives the child immunity from subsequent attacks
from the varicella zoster virus. Children recover
without any side effects except for occasional scarring
of the skin from scratching. The pain infrequently lasts
for months but this usually occurs only in affected
There are no antibiotics effective against the zoster varicella
virus. Treatment is aimed at making the child
comfortable until nature does the healing. Pain
relievers such as acetaminophen are usually effective.
Antihistamines may be useful in reducing itching and
discomfort, especially when sleep is disrupted. It is
important not to open the blisters. Cool compresses will
help aid in drying the lesions. Secondary infection of
the blisters by bacteria can also occur, resulting in
delayed healing of skin lesions, and it is only then
that antibiotic treatment may be necessary. Severe cases
of shingles, especially if the eye is involved, may be
treated with the new antiviral drug, acyclovar.
You may have thought your child
has seen the last of the chickenpox virus after the last
blister scabbed over. But the tricky varicella zoster
virus remains dormant in some of the body’s nerve cells,
and years later, for reasons still to be explained,
reemerges to cause the uncomfortable but
self limited, illness known as shingles.
in the body
in life in a
As a reminder, this information should not be relied on as
medical advice and is not intended to replace the advice of your childs pediatrician.
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