CHICKENPOX / SHINGLES

From person to person
Chickenpox is known as "Windpocken" (wind pox) in German and the clue is in the name: the pathogens can be carried long distances "by the wind"; in other words, it is an airborne disease. In most cases, the virus is absorbed by breathing in minuscule droplets of saliva that are spread in the air by sufferers through breathing, coughing, sneezing or speaking. Almost all contact between an unprotected person and a chickenpox sufferer leads to infection. The fluid in the blisters is particularly infectious, if they burst. This means that the virus can get onto a sufferer's hands if they scratch the rash or scabs and then be passed on from hand to hand. The virus is easily transferred from hands to the mucous membranes of the mouth or nose.

Unlike chickenpox, shingles is not caused by contact with chickenpox or shingles sufferers, but by the reactivation of the dormant virus in the body. Shingles is also less infectious. The virus is not spread by droplet infection expelled into the air by breathing, coughing, sneezing or speaking. Only the fluid in shingles spots is infectious. This means that the main channel of infection is smear infection, particularly through hands. People who have never had chickenpox and have not been vaccinated against it can become infected with the varicella-zoster virus through contact with shingles spots and develop chickenpox in the first instance.

Through contaminated objects
The virus can remain infectious outside the body for several hours or even a few days. It may be transmitted, for instance, by touching door handles, handrails, taps or toys with germs on them.

During pregnancy and in newborns
Very occasionally, the disease can be transmitted to the unborn child through the bloodstream during pregnancy if the mother develops chickenpox in the first six months of the pregnancy. If, however, a pregnant woman goes down with chickenpox shortly before or after giving birth, there is a considerable risk of infection for the newborn.

There is no danger to the unborn child if a mother develops shingles, however.

Chickenpox most commonly occurs in early childhood, mostly in children under the age of 10 attending kindergarten or school. Unprotected teens and adults are also at risk of infection, however, and chickenpox is often more severe in adults. People who have had the disease and recovered are usually immune to chickenpox for life, but anybody who has had chickenpox can develop shingles. Shingles most commonly affects people over the age of 50 or those with a compromised immune system.

• During the acute phase of the illness, sufferers should stay at home while they recover and avoid contact with people suffering from immune deficiencies.
• In chickenpox, only the symptoms are usually treated. This includes careful skin care with baths and medication to soothe the itching. Skin care also helps to avoid bacterial skin infections.
• Antibiotics are ineffective against diseases caused by viruses. They may be used if complications caused by bacteria occur.
• Shingles is generally treated with careful skin care and additionally prescribed anti-viral medicines.
• Please notify the practice team before visiting your doctor's surgery with a suspected case of chickenpox, so that they can take the necessary protective measures.
• The regulations of the German Infectious Disease Protection Act apply to chickenpox. Children and adults who have been diagnosed with chickenpox or are suspected of having the disease may not visit or work in any public institutions such as schools or kindergartens. This also applies to people who do not have sufficient protection against chickenpox if a case or suspected case of chickenpox has occurred in their household. Sufferers must inform the public institution of the disease. Public institutions may be visited as soon as sufferers are no longer contagious.
• Unprotected pregnant women or people with a compromised immune system who come into contact with sufferers should immediately notify their doctor.

Vaccination against chickenpox
The German Standing Committee on Vaccination (STIKO) recommends vaccination against chickenpox.

• For children, it is recommended that immunisation protection be built up in two stages. The first vaccination should be administered at the age of 11 to 14 months and the second at the age of 15 to 23 months.

• Unvaccinated children and young people and those who have been vaccinated only once should catch up on the missing vaccinations as soon as possible.

• Unvaccinated adults who have never suffered from chickenpox are advised to seek a two-stage vaccination if:
  • they work in healthcare or are about to start work in public institutions for pre-school children,
  • they are women hoping to have children,
  • they are to undergo any treatment that lowers resistance,
  • they are waiting for an organ transplant,
  • they suffer from severe neurodermatitis,

and persons in contact with the last three.

People who have had contact with chickenpox sufferers and are not protected can, in some circumstances, still be vaccinated. Find out more from your local health authority.

Vaccination against shingles
The German Standing Committee on Immunisation (STIKO) recommends vaccination against shingles with an inactivated vaccine for:

• all people over the age of 60,
• people over the age of 50 whose immune systems have been weakened by illness or medical treatment,
• people over the age of 50 with underlying conditions such as diabetes, rheumatoid arthritis, chronic inflammatory bowel disease, chronic obstructive pulmonary disease or asthma.

The vaccination consists of two doses to be taken between two and six months apart.

Your local health authority can provide further advice. As chickenpox is a notifiable disease, you will also find information there on the current situation and a great deal of experience dealing with the illness.

You can find additional (specialist) information on the website of the Robert Koch-Institut (www.rki.de/varizellen).

Further information about infection protection through vaccination is available on the website of the Bundeszentrale fiir gesundheitliche Aufklarung (www.impfen-info.de).