Prevention of chickenpox

Specifics of taking an epidemiological history

Since the Varicella virus is highly volatile and capable of spreading via air currents over significant distances, a standard interview regarding direct contacts is insufficient. When taking the history, the physician must actively identify non-obvious routes of transmission.

It is essential to clarify:

• The presence of infected neighbors in the apartment building entry.
• Casual, even brief contacts on the street. For example, the patient might have simply walked past a child with characteristic rash elements already treated with brilliant green solution.
• Contacts with infected individuals within the last 23 days before the onset of the disease.
• The use of emergency prophylaxis methods, specifically whether the patient was administered donor immunoglobulin.
• The epidemiological situation in organized groups (for example, whether there are confirmed cases of chickenpox in the kindergarten attended by the patient's child, and whether the child had contact with them).

Management tactics for contacts and pregnant women

The development of moderately severe chickenpox in a pregnant woman is characterized by an acute onset, pronounced intoxication syndrome, and the simultaneous appearance of a typical exanthema. In such a situation, the patient is indicated for hospitalization in an infectious diseases hospital to ensure dynamic monitoring.

Despite the severity of the mother's condition, the prognosis for the fetus at this gestational age remains favorable, as specific malformations form extremely rarely. Immediate initiation of specific antiviral therapy is required only if the condition worsens or complications develop, such as viral pneumonia or meningoencephalitis.

Special attention is required regarding the management tactics for the contact child of the sick woman:

1. If the child has already been documented to have had contact with infected individuals directly in the childcare facility, they continue to attend it.
2. If there were no contacts in the kindergarten itself (the outbreak is exclusively familial), strict isolation is introduced. The child is suspended from attending the childcare facility for a period from the 10th to the 23rd day from the moment of contact with the sick mother.

Treatment and criteria for lifting isolation

Patients are subject to hospitalization in the presence of strict clinical and epidemiological indications. In other cases, treatment is carried out on an outpatient basis and includes pathogenetic and local therapy.

Pathogenetic treatment:

• Body detoxications: abundant fractional drinking is prescribed, while diuresis monitoring is mandatory.
• Antipyretics for fever management.
• Vitamin therapy.

Local treatment:

• Treatment of skin vesicles: a 1% brilliant green solution is used.
• Oral cavity sanitation: rinses with a 1:5000 aqueous solution of furatsilin are used.

Criteria for discharge and lifting isolation: A patient can be discharged only upon complete clinical recovery. However, the epidemiological rule states: discharge is permitted no earlier than the 5th day from the moment the very last vesicle appears. Prior to this period, the patient is considered potentially contagious.

Nervous system complications

Severe chickenpox may be accompanied by central nervous system involvement in the form of neurotoxicosis or specific meningoencephalitis. This can occur both in the acute period and during the convalescent stage.

In the acute phase, complications manifest with febrile fever (up to 39.8°C), severe headache, dizziness, vomiting, and diplopia (double vision).

Late neurological complications are of particular concern. The patient may exhibit false improvement: normothermia, clearing of the oropharynx, formation of typical chickenpox crusts on the torso, face, head, and limbs, as well as preparation for discharge. However, 2 weeks after the onset of the disease, a sharp deterioration to a severe condition is possible.

The symptom complex of specific encephalitis/neuroinfection includes:

• Return of febrile fever (up to 39°C).
• Convulsive syndrome with brief loss of consciousness.
• Lethargy.
• General cerebral and focal neurological symptoms: ataxia (unsteady gait), generalized tremor, dysarthria, anisocoria, and reflex asymmetry.
• Meningeal signs: bilateral positive Kernig's sign and weakly positive nuchal rigidity.

At the same time, hemodynamics may remain stable (pulse 90 bpm, BP 130/80 mmHg), lung breathing vesicular, and abdominal organs without pathology (abdomen painless, hepatosplenomegaly absent). In such cases, the emergency medical team is obliged to urgently hospitalize the patient for intensive care.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Assessment of neurological status and meningeal symptoms in viral encephalitis
• Management tactics for pregnant women with moderately severe viral infections
• Differential diagnosis of neurotoxicosis and specific CNS involvement
• Algorithm of actions for the emergency team in convulsive syndrome against the background of infection

Other topics in the "Respiratory Infections" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.