The facts about Chicken Pox
1. Chicken pox is commonly known as a childhood illness presenting with an initial fever which lasts for 2 to 4 days. After the fever settles, a rash would appear (small “bubbles” or vesicles with clear fluid inside) which appear progressively in 3 to 4 crops over the next ~14 days.
2. However, in Singapore, it is very common for young adults in their twenties or thirties to come down with a Chicken pox infection. This delay in young Singaporeans catching Chicken pox could be explained by the general high hygiene standards, good health and good living conditions found in Singapore.
3. Consequences of Chicken pox infection:
i. for children and young adults - they risk missing 2 weeks of important school work or even school-leaving examinations such as PSLE/’O’ & ‘A’ levels/undergraduate examinations. (The last I would be familiar with, since I missed one of my important medical school examinations and hence had to re-sit the paper.)
ii. for working adults - they risk missing 2 weeks of important or urgent work at the office because they have to be on medical leave away from work for 14 days. In the highly competitive work environment in Singapore, it is probably needless to say that, this is undesirable.
iii. Scarring. Ironically, scarring due to Chicken pox is more of a problem for young adults (who would likely be more concerned about their appearance) compared to children. This is due to the fact that adults tend to have more vesicles or poxes compared to children. Also, adult skin (alas) do not heal as well or as completely compared to children’s skin. All these work against the adult Chicken pox sufferer, who is likely to have more pitting scars.
iv. Complications of Chicken pox infection. Another unfortunate fact for adult sufferers of Chicken pox is that they are more prone to the complications of Chicken pox. These are: pneumonitis (Chicken pox virus entering the lung to cause inflammation and infection, encephlitis (infection of the brain). I had a patient in his thirties, who was ill with Chicken pox. He fell asleep, and his family could not wake him up even 24hrs later. He had developed enephalitis secondary to Chicken pox. At this point, they sent him to the A&E of a restructured hospital which promptly admitted him. This patient of mine did not wake up for another 48hrs, and he had to stay in the Intensive Care Unit (ICU) for 2 months. For most of these 2 months, he had to be hooked up to a ventilator to help him to breathe. He had also developed pneumonitis secondary to Chicken pox (a double whammy). Fortunately, he did survive to relate this tale of his to me after it was all over, but not before racking up a gigantic medical bill.
v. Shingles aka Herpes zoster aka 蛇丹 or simply 蛇. Everybody who catches Chicken pox has the virus hidden latent in their bodies, specifically in their nerves. Although, this does not lead to grave illnesses for us (I caught Chicken pox ‘naturally’ myself too), the re-activation of these virus particles hidden in our nerves can be quite unpleasant. This re-activation disease is called Herpes zoster with the common name of Shingles. Shingles usually present with a pre-rash tingling or painful sensation over the skin where the rash will appear. A few days later, grouped “bubbles” or vesicles will appear, usually on the chest, back or abdomen. (In contrast, for Chicken pox, the vesicles are scattered over the body.) The vesicles usually burst leaving an area of broken skin on the body. When this happens, a secondary bacterial infection of the skin can occur.
The area of the skin where the vesicles appear is painful, and the pain is often severe enough to cause sleepless nights. The vesicles do heal in 1 to 2 weeks, depending on the immune system of the patient. Healing can be accelerated with treatment (anti-viral tablets, appropriate skin treatment and cream). However, even though the vesicles heal relatively quickly (particularly with appropriate treatment), the pain due to Shingles may take a protracted course. It is not unknown for the nerve pain (or neuralgia) due to Shingles to last for a few months.
Okay, now that I know the facts about Chicken pox, how do I protect myself or my loved ones against it?
Two words: get vaccinated.
Check with your parents or other family members if you had Chicken pox before, since you might be too young to remember. If your parents or family members are unsure about your history of Chicken pox, you can do a blood test to check your Chicken pox status.
As for your children who have not had Chicken pox - make sure to get them vaccinated. Children above 12 months of age and not currently having febrile illnesses can be vaccinated.
Our Clinic is using a single-dose vaccine. This is sufficient because this particular brand of vaccine is made from the original strain of Chicken pox virus stock. There are other Chicken pox vaccines out there where it is necessary to have 2 doses i.e. a total of 2 injections over 6 months. Naturally, 2 doses would mean double the cost (or more).
Common questions:
Qn 1: Why not let it “come out naturally” i.e. get infected “naturally”? This is what the older folks at home advice me.
Ans: There is nothing “natural” about catching an infection. Refer to point 3 above on “consequences of Chicken pox infection”, in particular about scarring and complications of Chicken pox. Prevention is always better than treatment after the fact. And with regards to Shingles, Chicken pox vaccination can prevent a person from ever contracting the infection. If a person has never been infected with Chicken pox, it follows that he or she will also never experience Shingles and its unpleasant symptoms.
Don’t be like me. I caught Chicken pox “naturally” and now I stand the chance of getting Shingles in my older years or when my immune system is weaker. Unfortunately for me (and other adults who have already caught Chicken pox before), there were no Chicken pox vaccine during my childhood years. Fortunately, its not too late for our children. Get them vaccinated today*. I have already vaccinated both my kids, have you?
* Children above 12 months of age and not currently having febrile illnesses can be vaccinated.
Qn 2: I (unfortunately) have not vaccinated myself against Chicken pox but I came into contact with my colleague/niece/nephew/neighbour’s kid, a confirmed case of Chicken pox, a few days ago. What do I do now?
Ans: The good news is that you can still take steps to protect yourself. You can get a post-exposure vaccination against Chicken pox. With post-exposure vaccination, there is still a chance that you will not get infected. And even if you do develop Chicken pox, it is likely to be of the (much milder) variety.
Qn 3: I (unfortunately) have not vaccinated myself against Chicken pox but I came into contact with my colleague/niece/nephew/neighbour’s kid, a confirmed case of Chicken pox, 1 to 2 weeks ago. I have not seen your Clinic’s website, in particular Qn 2 and its accompanying answer above. I am starting to have small blisters or “bubbles” on my body. What do I do now? Should I allow the illness to run its course, like what my older relatives have adviced me - “to let all the poxes come out”?
Ans: All is not lost. Please come down to the Clinic to start treatment for Chicken pox infection. It is important to start treatment within 48hrs (at most 72hrs) of devoloping poxes on the body. The advantage of treatment is that it very significantly reduces the length of the illness (and the accompanying need to stay away from school/work) - refer point 3 part i & ii above. Treatment also significantly reduces the number of poxes that a patient will develop. This in turn, reduces the risk of pitted scars on the face and on the rest of the body.
Another important reason to get treated for a Chicken pox infection is to reduce the risk of serious complication - refer point 3 part iv above. I really don’t need another patient to tell me about his/her ordeal with serious complications of Chicken pox.
In summary, Chicken pox may be known as a childhood illness, but its consequences are often serious indeed. In Singapore, residents often get infected when they are young adults in an important phase of their lives, with serious repercussions.
Please call the Clinic at 6258 6096 before coming down to the Clinic for Chicken pox vaccination - ocasionally, we run out of stocks of the Chicken pox Vaccine.