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 usually turn into scabs in five to seven days, after other signs of illness.

Chickenpox can cause several health complications. Complications include skin and soft tissue infections, swelling of the brain (encephalitis), lung infection (pneumonia), bleeding problems, bloodstream infections (sepsis) 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 or someone in your family may have symptoms or have been exposed to chickenpox, talk to your doctor.

Chickenpox mainly spreads through close contact with an infected person.

• It spreads through the air when an infected person breathes, talks, coughs, or sneezes.
• It takes about 10 to 21 days after being around an infected person for someone to develop chickenpox.

A person with chickenpox can spread the disease up to 2 days before the chickenpox rash appears and up to 7 days after the rash appears.

If you are confirmed to have chickenpox, you should stay at home away from other people until all your blisters have scabbed over. This will help you make sure that you do not spread chickenpox to others.

If you think you or your someone in your family may have chickenpox because you or they have symptoms and have not been vaccinated against chickenpox:

• Stay home and call your doctor right away and let them know of your concerns.
• 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. If your doctor tells you to come in for testing, make sure to wear a facemask that covers your nose and mouth.
• Stay away from other people or where there are large groups of people who are at higher risk of getting sick, such as schools, daycare, and hospital or urgent care waiting rooms, before talking to your doctor. This will help you make sure that you do not spread chickenpox to others.

If you think you have been exposed to someone with chickenpox:

• Call your doctor right away to let them know you 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. If your doctor tells you to come in for testing, make sure to wear a facemask that covers your nose and mouth.

If your doctor tells you that you have chickenpox, you should stay at home away from other people until all your blisters have turned into scabs. This prevents spreading the virus 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 two types of chickenpox vaccines:

• Varicella vaccine (VAR) for people who are 12 months old and older.
• Measles-mumps-rubella-varicella vaccine (MMRV) for people who are 12 months to 12 years old.

If you have insurance:

• Talk to your doctor or check with your local pharmacy to see what vaccines they offer.
• Most health insurance plans cover the cost of recommended vaccines for children and adults.

If you are uninsured or underinsured:

• Programs are available to help cover the cost of vaccines.
• Children 18 years or younger may 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)
• Adults who are uninsured or underinsured may be able to get free or low-cost vaccines at clinics enrolled in the Vaccines for Adults (VFA) program. For more information on who is eligible, read VFA Eligibility Based on Insurance Status.

Locating Vaccine Clinics:

• A list of free and low-cost clinics in Los Angeles County.
• Interactive county map to locate free and low-cost vaccine clinics.
• Call 1-833-540-0473 (Public Health InfoLine) 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.

• Chickenpox (Varicella) Frequently Asked Questions (LAC DPH):
  • English | Español | 简体中文 | 繁體中文 | 한국어
• Immunization Schedules: Birth to 6 Years Old | 7 to 18 Years Old | 19 Years and Older (AAP & AAFP)
• What You Need to Know: VAR Vaccine | MMRV Vaccine (Immunize.org)
• Varicella (Chickenpox): Questions and Answers (Immunize.org)
• Chickenpox (Varicella) in Children: Symptoms, Treatment & Prevention (AAP)
• Chickenpox (Varicella) (History of Vaccines)
• Paying for Vaccines (LAC DPH)

• Chickenpox (varicella) 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 people and immunocompromised people.
• 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 an isolation room is not available, 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.

Consultation with VPDC is required before sending specimens to the Public Health Laboratory. Follow the Check List for Managing Patients Suspected of Having Varicella for specific instructions.

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

• People 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. The sooner VariZIG® can be administered, the more effective it will be.

• 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.

The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend that persons who do not have evidence of immunity to varicella should get vaccinated. Varicella vaccines are safe and highly effective to protect against chickenpox. In immunocompetent people, one dose of a varicella-containing vaccine is 82% effective against varicella and 2 doses are 92% effective.

VAR and MMRV Vaccine Recommendations for Children and Adults

*VARIVAX® is contraindicated for use in pregnant persons.
**ProQuad® is only licensed for use in children 12 months through 12 years of age. It may be given at the same time as other vaccines. ProQuad® is associated with a higher risk for fever and febrile seizures in children 12-23 months of age.

Administration Data: California healthcare providers are required to report data on all valid immunizations that they administer to their patients into the California Immunization Registry (CAIR) within 2 weeks of administration per AB 1797.

Administration Errors: Healthcare providers are strongly recommended to report all vaccine administration errors to the Institute for Safe Medication Practices.

Adverse Events: Healthcare providers are required to report any adverse event on the reportable events list to the Vaccine Adverse Event Reporting System (VAERS) per HR 5546.

Storage and Handling: For general recommendations and guidance access the Vaccine Storage and Handling Job Aids.

• Check List: Managing Patients Suspected of Having Varicella (LAC DPH)
• Varicella (Chickenpox) B73 (LAC DPH)
• Varicella Quicksheet (CDPH)
• Immunization Schedules: Birth to 18 Years (AAP) | 19 Years and Older (AAFP) | CA Healthcare Personnel (CDPH)
• Vaccine Information Statements (Immunize.org): MMRV | VAR
• LAC PHL Varicella Test Request Form – PCR and IgG (LAC DPH)
• Measles, Mumps, Rubella, and Varicella Vaccine (MMRV) (CDPH)
• Los Angeles Health Alert Network (LAHAN) (LAC DPH)