Chickenpox

Chickenpox is an acute viral infection, caused by the Varicella-Zoster virus.

The symptoms of Chickenpox are fever, a runny nose, cough and fatigue. This is followed by a rash starting as small pink blotches progressing to blisters. The blisters last three to four days before turning into scabs and drying out. The rash is more concentrated over the trunk, face and scalp, and different stages may occur at any one time. For the majority of children with Chickenpox, it is a mild illness of short duration with complete recovery. The Chickenpox rash is sometimes very itchy and scratching can cause infection in the blisters.

Children with other serious medical conditions, can develop severe complicated Chickenpox and may even die from Chickenpox pneumonia or encephalitis (an inflammation of the brain).

Although much less common, adults can catch Chickenpox. Adults are often more severely affected and can develop pneumonia or encephalitis. If a woman develops Chickenpox in pregnancy, there is a very small but real chance of damage to her unborn baby. Recent studies indicate the greatest period of risk of birth defects is between weeks 13 and 20 of the pregnancy.These defects may include scarring and underdevelopment of limbs or digits. Chickenpox affecting the mother late in the pregnancy or very soon after birth can also be very serious and even life threatening for the newborn baby.

The Chickenpox virus can also cause Shingles (Herpes Zoster).

Shingles can occur in someone who has previously had Chickenpox. Shingles occurs when the Chickenpox virus, which may have been present but inactive in a person's body for some time, is reactivated. Shingles occurs more frequently in the elderly or immunosuppressed. It is characterised by a rash of blisters localised to one site on one side of the body and it can occur on the face. The shingles rash can be very painful and debilitating. A course of antiviral tablets is often prescribed to assist in the management of the severity of Shingles if medical assistance is sought early in the course of the disease.

No specific treatment is recommended or required for otherwise healthy children with Chickenpox. It is important to try to prevent young children from scratching the rash as scratching can result in permanent scarring or secondary infection. Frequent baths can reduce the itchiness, as can the use of anti-itch preparations such as eg. Pinetarsol.

The fingernails of an infected young child should be cut to reduce the chance of introducing further infection through scratching. Antibiotics are occasionally required when secondary skin infections occur. Paracetamol can be used to lower temperature or to reduce discomfort.

Chickenpox vaccine is especially recommended for all non-immune people in high-risk occupations such as health care workers, teachers and workers in child-care services.

Chickenpox is a very infectious illness with outbreaks occurring in winter and early spring, presumably because of greater person-to person contact at the time of the year. One episode of Chickenpox usually gives lifelong protection against further episodes of Chickenpox, but years later may be followed by an episode of Shingles. Since Shingles blisters also contain the Varicella Zoster virus, a person who has never had Chickenpox can become infected with Chickenpox from someone who has Shingles.

The usual time between infection with the virus and the development of the illness is approximately 2 weeks. (between 10-21 days).An individual with Chickenpox is infectious to others from two days before the onset of the rash until the blisters have all scabbed, which takes four to five days. Because the Chickenpox virus is found in the secretions in a person's nose and mouth, the virus is spread through coughing and sneezing, and through direct contact with the fluid in the blisters of the rash. The dry scabs are not infectious.

Tissues used to blow or wipe the noses of affected children must be properly disposed of, eg. flushed down the toilet. Do not share eating utensils, food or drinking cups with an infected person.

Children with Chickenpox need to be excluded from childcare facilities or schools for at least five days after the rash first appeared or until dry scabs have replaced all blisters.

Measles

Measles is an acute viral infection, usually in childhood, which may have serious complications. Measles infection was very common in childhood in the past, but due to immunization campaigns, measles infections are now relatively uncommon.

• The first signs of infection are fever, tiredness, runny nose, cough and sore red eyes. These symptoms usually last for a few days then a red blotchy rash appears. The rash starts on the face over 1-2 days and spreads down to the body, lasting for 4-7 days.
• Up to a third of people with measles will develop a complication. more commonly in young children than in adults. Complications include ear infections, diarrhoea and pneumonia, and may require hospitalisation. About one in every 1000 people with measles develops encephalitis (swelling of the brain).

Measles is usually droplet spread when a person breathes in the virus that has been coughed or sneezed into the air by an infectious person. Measles is a highly infectious condition.

People with measles are usually infectious from just before the symptoms begin until four days after the rash appears. The time from exposure to becoming sick is usually about 10 days. The rash usually appears around 14 days after exposure.

Anyone who comes in contact with measles during the infectious phase and has not been infected with measles in the past or has not received two doses of vaccine is at risk of contracting measles.

• If it is less than three days since you came into contact with measles, immunisation with MMR can prevent infection.
• If more than three days and less than seven days have passed since coming into contact with measles, an injection called immunoglobulin can protect you.

While a person is infectious with measles (i.e., up to 4 days after the onset of the rash) it is important that they remain at home to reduce the possibility of spread to other people.

The best protection against measles is through immunisation with a vaccine called MMR or Priorix (measles, mumps and rubella vaccine). This vaccine provides protection against infection with measles, as well as against mumps and rubella.

• Measles Mumps and Rubella vaccine should be given to children at age 12 months and a second dose at age four years. These two doses of MMR provide protection against measles to over 98% of those immunised.
• Measles Mumps and Rubella vaccine is a safe and effective vaccine that has been used worldwide for many years. It is safe to have the vaccine even in those who have had previous measles or vaccination

There is no specific treatment for Measles. The treatment includes rest, plenty of fluids, and paracetamol for fever.While a person is infectious with measles it is important that he or she remains at home to reduce the possibility of spreading it to other people.

Doctors, hospitals and laboratories must notify cases of measles to the local public health unit. Public health unit staff will interview the doctor or patient (or carers) to find out how the infection occurred, identify other people at risk of infection, implement control measures (such as immunisation and restrictions on attending school or work) and provide other advice. In the event of an outbreak of Measles occurring your local public health unit will provide advice regarding the need for immunisation, immunoglobulin and exclusions from work and school in the case of exposure to measles.

Meningococcal Disease

What is meningococcal disease?

• Meningococcal disease is an infection, meningitis or septicaemia, caused by a bacteria known as meningococcus.
• Up to 10% of healthy people carry the bacteria in their throat or nose without the bacteria causing illness.
• There are different serogroups (types) of meningococcal bacteria.

How common is it?

• The disease is quite rare and affects less than one in ten thousand people in NSW each year.
• It can occur at any age, but is mostly seen in children and young adults.

How is it spread?

The disease is NOT easily spread. It is passed on by close person-to-person contact through saliva, eg. mouth kissing or sharing drink bottles, toothbrushes or cigarettes.

What are the symptoms ?

• Meningococcal infections can lead to meningitis (infection of the lining of the brain), septicaemia (blood poisoning) and other illnesses.
• Symptoms may include sudden onset of fever, headache, tiredness, neck stiffness, vomiting or nausea, sore eyes sensitive to light, joint pain and a distinctive rash.
• Symptoms are often less specific in young children and may include fever, drowsiness, vomiting, being unsettled and a rash. The rash is quite distinctive and may look like bleeding into the skin or purple-red spots. However, a rash does not always appear.

IT IS IMPORTANT TO SEEK MEDICAL ATTENTION EARLY. Most people recover completely from meningococcal disease with early treatment with antibiotics. In a few individuals, however, the disease can be serious and life-threatening.

What are contacts?

• Contacts are people who have been identified as having VERY close contact with a person who has the disease, such as family and household members, or those who have been exposed to the person’s saliva.
• Contacts are offered a special antibiotic to kill the bacteria in the nose or throat, and therefore reduce the risk of further cases. This antibiotic does NOT treat the disease but simply stops the likelihood of the bacteria being carried in the nose and throat.
• Different antibiotics are used if symptoms develop.

Is there a vaccine?

• Vaccines are available against some types of meningococcal disease.
• A vaccine is NOT available against all types of meningococcal disease
• Meningococcal vaccine is recommended for travellers to certain countries visiting countries where meningococcus frequently causes disease (eg. Parts of Africa), and to persons with specific health conditions (eg. a person with no spleen).
• Free vaccine is available to 1 to 5 year olds and 15 to 19 year olds. Students aged 19 and under who have missed out at school and need a catch-up vaccine can have free vaccine at the Health Centre.

Mumps

Symptoms of Mumps include fever, headache, muscle aches, tiredness, and loss of appetite; followed by swelling of salivary glands. The parotid salivary glands (which are located within your cheek, near your jaw line, below your ears) are most frequently affected.

Severe complications are rare. However, mumps can cause:

• inflammation of the brain and/or tissue covering the brain and spinal cord (encephalitis/meningitis)
• inflammation of the testicles (orchitis)
• inflammation of the ovaries and/or breasts (oophoritis and mastitis)
• spontaneous abortion
• deafness, usually permanent

The mumps virus is present in the upper respiratory tract and is spread through direct contact with respiratory secretions or saliva. The time that an infected person can transmit mumps to a non-infected person is from 3 days before symptoms appear to about 9 days after the symptoms appear. The incubation time, which is the period from when a person is exposed to virus to the onset of any symptoms, can vary from 16 to 18 days (range 12-25 days).

There is no specific treatment for mumps.

The mumps vaccine, contained in the MMR or Priorix (measles, mumps, and rubella) vaccine, can prevent this disease.

Rubella

Rubella infection is commonly known as German measles. It is a generally mild disease in children. However the main medical danger of rubella is the when the infection occurs in pregnant women, which may cause “congenital rubella syndrome” in developing babies.

Rubella epidemics used to occur every 6 to 9 years. Children ages 5 to 9 were primarily affected, and many cases of congenital rubella occurred as well. Now, due to our national immunization program, there are fewer cases of congenital rubella.

Rubella infection may begin with 1 or 2 days of mild fever ,swollen, tender lymph nodes, usually in the back of the neck or behind the ears. On the second or third day, a rash appears that begins on the face and spreads downward. It appears as either pink or light red spots, which may merge to form evenly coloured patches. The rash can itch and lasts up to 3 days. Other symptoms of rubella, which are more common in teenagers and adults, may include: headache; loss of appetite; mild conjunctivitis (inflammation of the lining of the eyelids and eyeballs); a runny nose; swollen lymph nodes in other parts of the body; and pain and swelling in the joints (especially in young women). Many people with rubella have few or no symptoms at all.

When rubella occurs in a pregnant woman, it may cause “congenital rubella syndrome”. This consists of growth retardation, mental retardation, malformations of the heart and eyes, deafness, and liver, spleen, and bone marrow problems.

The rubella virus passes from person to person from the nose and throat secretions. People who have rubella are most contagious from 1 week before to 1 week after the rash appears. Someone who is infected but has no symptoms can still spread the virus.

Infants who have congenital rubella syndrome can shed the virus in urine and fluid from the nose and throat for a year or more and may pass the virus to people who have not been immunized.

Rubella can be prevented by a Rubella vaccine (MMR or Priorix). Widespread immunization against rubella is critical to controlling the spread of the disease, thereby preventing birth defects caused by congenital rubella syndrome.

Whooping Cough (Pertussis)

Whooping cough (Pertussis) is a serious, contagious respiratory infection caused by the bacterium Bordetella pertussis. The disease begins like a cold and then the characteristic cough develops. This cough may last for months, even after antibiotic treatment when the patient is no longer infectious. The 'whoop' - which is not always obvious, especially in adults - is due to a deep breath at the end of a bout of coughing. Vomiting after coughing is common.

The symptoms include:

• Severe cough, which occurs in bouts of coughing
• Characteristic 'whooping' sound on inhalation
• Vomiting at the end of a bout of coughing
• Apnoea - the child stops breathing for periods of time and may go blue.

These symptoms may be associated with poor appetite, fatigue and dehydration. The person may appear normal between bouts of coughing. During the convalescent phase, the cough gradually decreases, but it often takes weeks to disappear.

Babies are at increased risk

In young babies less than six months of age, the symptoms can be severe or life threatening. Some of the complications of whooping cough in young babies include:

• Haemorrhage (bleeding)
• Apnoea (stopping breathing for long periods of time)
• Pneumonia
• Inflammation of the brain
• Convulsions and coma
• Permanent brain damage
• Death.

The Bordetella pertussis bacterium is highly infectious. An infected person spreads the disease when they cough and sneeze. If immunisation rates are high in the community, the risk of catching whooping cough is low.

The incubation period for whooping cough is between six and 20 days. A person is infectious for the first 21 days of their cough or until they have had five days of a 10-day course of antibiotics.

In its early stages, the symptoms of whooping cough can be reduced by taking antibiotics. Treatment will reduce the risk of passing the infection to others, if it is given in the first 21 days of the illness. Members of the patient's family are at increased risk of acquiring the disease, and are usually prescribed an antibiotic as a preventative measure, regardless of whether or not they are fully vaccinated.

Further information

For more information please contact the University of Canberra health Service or your doctor, or the local public health unit, ACT Health Communicable Diseases www.health.act.gov.au