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CHICKEN POX - VERICELLA

Chicken Pox

Shingles

Overview:

Chickenpox is a highly contagious disease caused by the varicella zoster virus (VZV). Shingles is a reactivation of Chicken Pox (Varicella). The virus remains dormant in the nerve roots of the body. The virus travels along the nerve roots, causing pain (neuralgia) in areas supplied by the nerve. 

 

Mode of Transmission:

Airborne or direct contact with virus particles from the fluid filled vesicles.

 

Examples of Transmission:

Varicella is highly contagious and spreads from person-to-person through respiratory droplets after a person coughs or sneezes, and from breathing or direct contact from touching virus particles from within the fluid filled vesicles. A person with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs. 

Shingles is only infectious when lesions are open. Shingles is not infectious prior to the development of lesions or after the lesions have crusted over – even if neuralgia persists

 

Prevention: 

Vaccination 

 

Precautions:

Universal precautions, and airborne precautions.

 

Signs and Symptoms: 

Chickenpox symptoms begin 10-21 days after exposure to the virus and include:

Fever, Malaise, Rash consisting of reddish fluid-filled blisters (vesicles); the rash is usually itchy.

Shingles presents with blisters in the distribution of a sensory nerve so it is usually only on one hemisphere of the body. It can be very painful; pain can persist even after the rash has resolved. The pain which can range from mild itching to severe pain is followed usually within 5 days by swelling or redness of the skin and clusters of clear vesicles. 

 

Complications:

People who are more likely to suffer severe complications from chickenpox are infants, adolescents, adults, and those who have weak immune systems due to illness or medication. These complications include:

 • Bacterial infections, including necrotizing fascitis • Bleeding problems • Pneumonia • Encephalitis • Death

 

Exposure Determination:

A significant airborne exposure is a combination of a subject (source) showing signs/symptoms of a suspected airborne illness plus an activity that would place you at risk of droplet or airborne exposure.

  • Source of Exposure: Any aerosolized exhalation, sputum, or saliva, either by source coughing, spitting, breathing; any pulmonary (lung) secretions either brought forth by patient (source) or by suctioning while you were not wearing appropriate barrier protection. 

  • High Risk Activities: The following activate the gag/cough reflex. Manual suctioning of naso-pharyngeal airway. Insertion of nasogastric tube and/or intubation.

 

Other factors to consider:

Transport time, proximity to the source, ventilation, and PPE used 

 

General Post Exposure Treatment: 

  • If they are not immune- they should receive the vaccination as soon as possible within 120 hours after exposure and be placed off work beginning 8 days after first exposure until 21 days after last exposure, regardless of post-exposure vaccination. If they have not developed the chickenpox, they may then return to regular duty. If they do develop the chickenpox, then he/she may not return to work until all lesions are crusted and dried.

  • If they are not immune, have a medical contraindication to vaccination and are at high risk for severe disease and complications (immunocompromised patients or pregnant women) they should receive varicella zoster immune globulin as soon as possible within 96 hours. They then need to be placed off work beginning 8 days after the first exposure until 28 days after last exposure.

  • If they have been previously vaccinated, instruct them to report any fever, headache, skin lesions, and systemic symptoms from day 10 to day 21 after exposure. They should be placed off duty if symptoms occur.

  • Treatment for varicella is primarily aimed at relieving the symptoms.

 

Acetaminophen can be given to control fever and muscle aches while itching can be eased with a cool bath or the application of calamine lotion. Antihistamines can be used to control severe itching, which is important to prevent scratching of lesions. The use of an antiviral drug called Acyclovir has been shown to shorten the period of new lesion formation. This results in fewer lesions and more rapid healing. To be effective, it must be given within a week of exposure. Acyclovir is more likely to be prescribed to those with a higher risk of complications.

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2 PM Plan of Action: 

Fill out appropriate Exposure paperwork and get evaluated at Occupational Medical Center. Notify the DICO for tracking.

 

2 AM Plan of Action:

Shower and wash clothing.  Evaluation at the Occupational Medical Center can wait until morning if needed.  Notify the DICO for tracking in the morning.

 

Paperwork Required: 

  1. OC Public Health Communicable Disease Exposure Form (policy 330.96) with Fire incident number on top. Should be faxed while still in the hospital Fax: (714) 564-4050 (outbreaks, hospitalizations and deaths only) Must be reported within 1 working day per policy.

 

OC Public Health Communicable Disease Exposure Form:

  1. The City “Report of Employee Injury” form

  2. Medical Service Order- RM -67 (when medical care is required)

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