Chapter 93

### Common childhood infectious diseases (including skin eruptions)

The physical signs of measles are nearly the same as those of smallpox, but nausea and inflammation is more severe. The rash of measles usually appears at once, but the rash of smallpox spot after spot

Avicenna (980–1037)

##### Chickenpox (varicella)
Epidemiology

Chickenpox has become much less common since the introduction of the varicella vaccine in 2000 and its inclusion on the National Immunisation Program in 2005, because of both individual and herd immunity.1 Prior to this, nearly all children acquired it (<80% of the Australian population were seropositive by their teens). Chickenpox has a complication of only 1%, and is often thought of as not being a serious disease—which mostly it isn’t—but because it was so common prior to the vaccine’s introduction it resulted in 1500 hospital admissions and 7–8 deaths a year.1

Chickenpox is a highly contagious infection caused by the varicella zoster virus, a DNA virus within the herpes virus family. Primary infection causes chickenpox (varicella), with the virus establishing latency in the dorsal root ganglia. Reactivation leads to herpes zoster (shingles), which is relatively uncommon in children and can be more difficult to diagnose as it often presents with only a few lesions.

Note: shingles can happen in childhood.

Clinical features

The clinical features of varicella are shown in Table 93.1 and the complications in Table 93.2. Children are not normally very sick but tend to be lethargic and have a mild fever. Adults have an influenza-like illness. The typical distribution is shown in FIGURES 93.1 and 93.2.

Table 93.1

Clinical features of varicella

Table 93.2

Complications of varicella

###### FIGURE 93.1

Varicella (chickenpox) in a 12-year-old girl showing a maculopapular vesicular rash with a centripetal distribution

###### FIGURE 93.2

Chickenpox: typical distribution

Congenital varicella syndrome can occur from varicella in pregnancy, and may result in skin scarring, limb ...

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