Summary
Definition
History and exam
Key diagnostic factors
- history of exposure
- fever
- vesicular rash
- vesicles on mucous membranes
Other diagnostic factors
- pruritus
- headache
- fatigue/malaise
- sore throat
- tachycardia
Risk factors
- exposure to varicella
- age 1 to 9 years
- unvaccinated status
- occupational exposure
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- polymerase chain reaction
- viral culture
- direct fluorescent antibody testing (DFA)
- Tzanck smear
- latex agglutination (LA)
- enzyme-linked immunosorbent assay (ELISA)
- complement fixation
- ultrasound (pregnant women)
Treatment algorithm
otherwise healthy children at low risk of severe disease
increased risk of moderate to severe disease
high risk of severe disease
severe disease
Contributors
Authors
Andrew Riordan, MD, FRCPCH, MRCP, DTM&H
Consultant in Paediatric Infectious Diseases and Immunology
Royal Liverpool Children's Hospital (Alder Hey)
Liverpool
UK
Disclosures
AR declares that he has no competing interests.
Acknowledgements
Dr Andrew Riordan would like to gratefully acknowledge Dr Steven Pergam, Dr Rupali Jain, and Dr Anna Wald, previous contributors to this topic.
Disclosures
SP has served as a consultant for Merck & Co., Inc, Optimer/Cubist, and Chimerix, and has participated in clinical trials with these three organizations. He is also an author of a paper cited in this topic. RJ declares that she has no competing interests. AW is a member of the Data and Safety Monitoring Board (DSMB) for a Merck study of a candidate VZV vaccine.
Peer reviewers
Chad M. Hivnor, Major, USAF, MC, FS
Chief
Outpatient & Pediatric Dermatology
59th Medical Wing/ SGOMD
Lackland Air Force Base
San Antonio
TX
Disclosures
CMH declares that he has no competing interests.
References
Key articles
Marin M, Güris D, Chaves SS, et al; Centers for Disease Control and Prevention. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007 Jun 22;56(RR-4):1-40.Full text Abstract
Royal College of Obstetricians and Gynaecologists. Chickenpox in pregnancy (Green-top guideline no. 13). January 2015 [internet publication].Full text
American Academy of Pediatrics. Varicella-zoster virus infections. In: Kimberlin DW, ed. Red book 2021-2024: report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021; 831-43.Full text
Pergam SA, Limaye AP, AST Infectious Diseases Community of Practice. Varicella zoster virus in solid organ transplantation: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019 Sep;33(9):e13622. Abstract
Centers for Disease Control and Prevention. Chickenpox (varicella). For healthcare professionals. Oct 2022 [internet publication].Full text
Centers for Disease Control and Prevention. Updated recommendations for use of VariZIG - United States, 2013. MMWR Morb Mortal Wkly Rep. 2013 Jul 19;62(28):574-6.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Smallpox
- Herpes zoster infection (shingles)
- Herpes simplex virus (HSV) infection
More DifferentialsGuidelines
- Recommended child and adolescent immunization schedules for ages 18 years or younger, United States, 2024
- Varicella (chickenpox)
More GuidelinesPatient information
Chickenpox
Chickenpox vaccine
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