Chickenpox usually begins with:

• Fever
• Tiredness
• Headache
• Loss of appetite

After these initial symptoms, an itchy rash with fluid-filled blisters appears throughout the body. Chickenpox blisters typically start at the chest, back, and face before spreading over the entire body. Blisters turn into scabs in 4-7 days, after other signs of illness.

Chickenpox can cause several health complications. Complications include Group A streptococcal disease (skin and soft tissue infections), encephalitis (swelling of the brain) pneumonia (lung infection), bleeding problems, sepsis (bloodstream infection) and dehydration.

Those who are more likely to have serious complications due to chickenpox are:

• Infants
• Adolescents
• Adults
• Pregnant People
• People with weakened immune systems

If you think you may have these symptoms, talk with your healthcare provider.

• Chickenpox mainly spreads through close contact with an infected person.
• The virus spreads easily through the air when an infected person breathes, talks, coughs, or sneezes.
• A person infected with chickenpox can spread the disease before they have any symptoms.
• This could be up to 2 days before the chickenpox rash appears and up to 7 days after the rash appears.
• It takes about 10 to 21 days after exposure with an infected person for someone to develop chickenpox.

If you think you or your someone in your family may have chickenpox and have not been vaccinated against chickenpox: Stay home and call your doctor and let them know of your concerns.

• Stay away from other individuals or large groups in places such as school, daycare, and waiting rooms, before speaking to your doctor.

If you think you have been exposed to chickenpox:

• Call your doctor immediately to let them know you have may have been exposed to someone with chickenpox.
• Your doctor may be able to determine if you have protection against chickenpox based on your vaccine record or previous lab results.
• Your doctor may also make special arrangements to evaluate you to limit risk to other patients and staff.
• Make sure to wear a facemask that covers your nose and mouth.
• Stay away from places where there are large groups of people who are at higher risk of getting sick, such as schools, hospitals, or childcare. Do not return until your doctor says it is okay to return. This will help make sure that you do not spread chickenpox to others.

• The best way to prevent chickenpox is to get the chickenpox vaccine. Everyone — including children, adolescents, and adults — should get two doses of chickenpox vaccine if they have never had chickenpox or were never vaccinated.
• The chickenpox vaccine is safe and works very well in preventing chickenpox. Two-doses of the vaccine is 92% effective and one-dose is 82% effective at preventing chickenpox. If a vaccinated person does get chickenpox, the symptoms are usually milder with fewer or no blisters, and low or no fever.

There are many places to get the chickenpox vaccine. If you have insurance, talk to your doctor or check with your local pharmacy to see what vaccines are offered. Most health insurances cover the cost of all recommended vaccines for children and adults.

If you are uninsured or underinsured, there are programs available to help cover the cost of vaccines. Children who are 18 years of age or younger are eligible to receive vaccines at no cost through the Vaccines for Children (VFC) Program if they are:

• Eligible for or are enrolled in Medi-Cal
• American Indian or Alaskan Native
• Uninsured (do not have health insurance)
• Underinsured (private health insurance does not cover the full cost of vaccines)

Click to see if your child is eligible to receive VFC vaccines: English | Spanish

Uninsured or underinsured adults can access free or low cost vaccines at select clinics enrolled in the Vaccines for Adults (VFA) program. For more information on who is eligible, read VFA Eligibility Based on Insurance Status. You can use the following resources for more information on locating clinics:

• A list of free and low-cost clinics in Los Angeles County.
• Interactive county map to locate free and low-cost vaccine clinics.
• LACDPH Vaccines website for patients and their families to get more information on vaccines.

You can also dial 2-1-1 for a list of free or low cost vaccine clinics. This includes Vaccines for Children (VFC) provider locations that serve Medi-Cal eligible children and uninsured or underinsured adults. Learn more about specific vaccine information for different age groups:

• Vaccines for Infants and Children (LACDPH)
• Vaccines for Adolescents and Teens (LACDPH)
• Vaccines for Adults (LACDPH)

• Chickenpox (Varicella) Frequently Asked Questions (FAQs): English | translations pending
• About Chickenpox (Varicella) (CDC)
• Chickenpox Vaccination: What Everyone Should Know (CDC)
• Chickenpox Vaccine Information Statement (CDC)
• Child and Adolescent Vaccine Assessment Tool (CDC)
• MMRV Vaccine (Measles, Mumps, Rubella, and Varicella) Vaccine Information Sheet (CDC)
• Paying for Vaccines (LACDPH)
• The Adult Vaccine Assessment Tool (CDC)
• U.S. Chickenpox Vaccination Program (CDC)
• Vaccine Facts (LACDPH)
• Vaccine Safety (CDC)

• Chickenpox is characterized by a generalized, pruritic rash which progresses rapidly from macular to papular to vesicular lesions before crusting. Lesions develop in crops, and therefore, lesions in all stages of development can be present at the same time. Rash typically appears on the chest, back and face, and then spreads to the rest of the body.
• Chickenpox rash in vaccinated patients can appear as maculopapular rather than vesicular. This presentation is becoming increasingly common with the introduction of childhood vaccinations for varicella.
• The incubation period for chickenpox can range from 10 to 21 days. A prodrome of fever and malaise can occur 1 to 2 days before rash onset, especially in adults. Symptoms can appear mild in otherwise healthy children, but certain individuals are at higher risk for complications including infants, adolescents, adults, pregnant persons and immunocompromised individuals.
• Chickenpox is transmitted through droplets or airborne spread of vesicle fluid or by secretions of the respiratory tract. Scabbed lesions are not infectious. A person with chickenpox is considered contagious 1 to 2 days before rash onset until all lesions have crusted.

• Patients with signs or symptoms of varicella should be isolated from other patients prior to or as soon as possible after entry into the facility.
• Patients with suspected chickenpox should wear a well-fitted medical mask or respirator and be placed in an airborne infection isolation room if one is available. If this cannot take place, escort masked patient away from other patients directly to a private room for evaluation and specimen collection.

Regardless of prior immunity status, all healthcare staff entering the same room as the patient should use respiratory protection consistent with airborne infection control precautions.

• Laboratory confirmation is important for suspected chickenpox cases. Healthcare providers should obtain a swab of vesicular fluid for PCR testing or in the absence vesicular lesions, scrapings of maculopapular lesions.
• Testing of IgM serology is not recommended but can indicate an acute varicella infection along with chickenpox symptoms.

• Varicella vaccine is safe and highly effective to protect against chickenpox.
• In immunocompetent individuals, one dose of a varicella-containing vaccine is 82% effective against varicella, 2 doses are 92% effective.
• For more information on vaccines, see Advisory Committee on Immunization Practices (ACIP) Recommendations for Varicella Vaccines.
• Healthcare personnel should have documented evidence of immunity against varicella.
• Please report any vaccine related adverse events to Vaccine Adverse Event Reporting System (VAERS).

Varicella Vaccines	Number of Doses	Age		Recommended Age	Dose and Route
		1st Dose	2nd Dose
Varivax ® (Merck)	2	12-15 Months	4-6 Years At least 3 months after the 1st dose	12 months	0.5mL Intramuscular (IM) or Subcutaneous (SQ)
		13+ Years	At least 4 weeks after the 1st dose
ProQuad ® 1 (Merck) Measles, Mumps, Rubella & Varicella	2	12-47 Months	4-6 Years Or at least 3 months after the 1st dose	12 months to 12 years	SQ

¹ Associated with a higher risk for fever and febrile seizures in children 12-23 months of age.

• Individuals who do not have evidence of immunity should be vaccinated with varicella – containing vaccine within 3-5 days of exposure to chickenpox.
• Certain high-risk groups, including immunocompromised children, pregnant women, and infants can be offered varicella-zoster immune globulin (VariZIG) within 10 days of exposure to prevent chickenpox from developing or lessen its severity.

• Oral acyclovir or valacyclovir is recommended as a treatment to certain groups, including:
• Healthy people over 12 years old
• People with chronic cutaneous or pulmonary disorders
• People receiving long-term salicylate therapy
• People receiving short, intermittent or aerosolized courses of corticosteroids
• Secondary cases within a household
• Oral acyclovir or valacyclovir should be given within the first 24 hours after a rash starts.
• Treatment is not recommended for otherwise healthy children who are experiencing varicella without complications.

• Chickenpox B73
• CDPH Varicella Quicksheet
• Check List: Managing Patients Suspected of Having Varicella
• Centers For Disease Control and Prevention (CDC) Measles Trainings
• You Call the Shots
• The Pink Book Webinar Series