Chickenpox

Description

General Measures

Medicine Treatment

Referral

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ICD-10 codes: B01.9/B01.8

DESCRIPTION

A mild viral infection that presents 2–3 weeks after exposure, with:

• mild fever preceding the rash
• lesions beginning on the trunk and face, later spreading to the arms and legs
• small, red, itchy spots that turn into blisters and crusts. These stages may all be present at the same time.

Chickenpox is infective from the start of the fever until 6 days after the lesions have appeared or until all the lesions have crusted.
The infection is self-limiting, with a duration of about 1 week.
Complications such as secondary bacterial infection, encephalitis, meningitis and pneumonia may occur (more common in adults and immunocompromised patients).

GENERAL MEASURES

• Isolate from immunocompromised people and pregnant women until all lesions have crusted.
• Ensure adequate hydration.
• Cut fingernails short and discourage scratching.

MEDICINE TREATMENT

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CAUTION:
Avoid the use of aspirin in children and adolescents < 16 years of age with acute febrile illness because of risk of Reye’s syndrome.

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For itch:

• Calamine lotion, applied as needed.

In severe cases 

Children

• Chlorphenamine, oral, 0.1mg/kg/dose 6–8 hourly. See: dosing table.

Adults

•  Chlorphenamine, oral, 4mg, 6–8 hourly.

For fever with distress: 

Children

• Paracetamol, oral, 10–15 mg/kg/dose 6 hourly when required. See: dosing table.

Adult

• Paracetamol, oral, 1g 4–6 hourly when required to a maximum of 4 doses per 24 hours.
  • Maximum dose: 15mg/kg/dose.
  • Maximum dose: 4g in 24 hours.

If skin infection is present due to scratching, treat as for bacterial skin infection. See: Bacterial infections (Cellulitis, Impetigo and Boil, Abscess) of the skin.

Treatments with antiviral agents are recommended for: 

• Immunocompromised patients.
• All patients with severe chickenpox (irrespective of duration of rash).
  • Extensive rash.
  • Visceral involvement.
  • Haemorrhagic rash.
  • Presence of complications.
• Adults and adolescents presenting within 48 hours of the onset of the rash.
• Pregnant women.

Children

• Aciclovir, oral, 20mg/kg/dose 6 hourly for 7 days (Doctor prescribed).

^{Click on table to enlarge}
Adults

• Antiviral, (active against varicella zoster) e.g.:
  • Aciclovir, oral, 800mg 6 hourly for 7 days (Doctor prescribed).

LoE:IIIb¹

REFERRAL

• Complications such as:
  • meningoencephalitis
  • pneumonia
• Severely ill patients.
• Pregnant women.
• Asymptomatic neonates whose mothers had developed chickenpox during the period from 7 days before to 7 days after delivery.
• Neonates with clinical chickenpox.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.1_20 January 2025

Chapter 10: Infections and Related Conditions_10.2 Chickenpox