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Much maligned ailment
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Summer brings in its wake diseases too, like chicken pox. DR HARI MOHAN talks to several doctors in the city to bring you a clearer picture of the disease and what you must do, should it visit you
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It's hot, hot, hot and just the right time for unwelcome visitors. Like chicken pox. It starts with a runny nose, headache and mild fever and when the skin erupts with tiny blisters after a couple of days, then the name chicken pox is whispered.
Pox is a word with a bit of dread attached to it. Old timers well remember its more vicious cousin, small pox, which today is symbolised by probably the pockmarked face of an Om Puri.
Thanks to universal vaccination the scourge has been successively removed from the earth, with only samples of the virus probably in secret American and Russian labs.
The complications are more in adults than in children
The lesions could be secondarily infected by bacteria when it becomes painful and pus fills it. Encephalitis (brain tissue infection), Pneumonia rarely hepatitis, are some of the complications which are more frequent in persons with lowered immunity like those with AIDS, leukaemia and diabetes. Chicken pox is a self limiting disease, that is, the body fights it with its own immune mechanism and it ends naturally, unless there are complications. For a long time the treatment was symptomatic till the day the wonder drug Acyclovir came into vogue. This antiviral drug is the drug of choice today for chicken pox. Acyclovir does not completely put an abrupt end to the course of the disease but it reduces its severity and troublesome symptoms and minimises complications. For this to be most effective it has to be given at the time of formation of the blisters as it prevents viral replication. It has no prophylactic or preventive function. There is also a skin preparation available but oral tablets are more effective. The advent of this wonder drug has created a real difference in the outcome of the disease. Homeopathy boosts the immunity of the patient in order to fight the disease, says Dr.R.V.Padiyar, an experienced homeopath of Cochin West. It has around five drugs for chicken pox which are chosen according to the individual and his symptoms. It has no role to play in the prevention of the disease and in the event of any complications arising the patient should be referred to the appropriate speciality. Modern medicine found an answer for immunity when the chicken pox vaccine came into being. Though not being given as an universal vaccine it can be given for possible contacts in the family and it will definitely help in prevention or reducing the severity of the infection. The vaccine is a bit expensive and cannot be given for certain people like pregnant women.
It has been available in India for the past five years.
According to Dr.Roy Isaac Jacob, paediatrician of Fort Kochi, before the age of twelve a single dose is given and after 12 years two doses at 6 weeks interval are given.Immunoglobins like gammaglobin and varicella zoster immunoglobin can also be given for contacts in the event of the vaccine being contraindicated .
The vaccine is 70 to 90 per cent effective in preventing the disease and 95 per cent effective in decreasing the severity of the disease and in avoiding complications. The adverse effects due to the vaccine itself is quite rare and out of the first 11 million doses given, very infrequently ( 2.8 per 1,00,000 doses given ) did complications arise.
The vaccine can be given within 3 to 5 days after exposure to the disease to reduce its severity. Generally an attack gives lifelong immunity but Dr.Roy has seen instances of a child with a mild rash getting a second attack after some time.
Acyclovir can be effectively used in children too, a minimum period of 2 weeks of staying away from school is needed for the child so that the infection is contained.
Chicken pox is more common in children than adults.
Dr. L.George paediatrician, cautions on the use of aspirin in children and specially with chicken pox as a dreaded complication called Reyes syndrome can arise.
Chicken pox cannot be dismissed lightly, says Dr.Sujeeth Vasudevan, leading physician of Ernakulam, who goes on to describe that once upon a time in the US, they used to have chicken pox parties where those who had the infection used to mingle with those who were yet to get it and were sure of getting it because of the party.
There are no rigid food restrictions but it is better to have a bland non spicy diet with less oil, plenty of water and fruits and adequate rest, he advises.
The chicken pox virus at times hibernates in the body to recur later as Herpes Zoster which is a painful neurodermatological condition. Acyclovir does wonders here too.
Usually herpes zoster attacks are seen after the fifth decade .
One should be aware that rarely encephalitis manifested by headache and vomiting, and cerebellitis by giddiness can occur as complications of chicken pox, warns neurologist Dr.Somnath, of Krisna Nursing home Ernakulam.
Dr.Naresh Padiyar, dermatologist in Cochin West opines that skin lesions could get infected and cause painful eruptions which has to be treated with adequate antibiotics. He says that once the scab covers the vesicle the infectivity dwindles and the child can go back to school and adult back to work safely.
This is an eyeopener to many school authorities who insist that the scabs should disappear before the child attends school. There is no rigid time frame for taking a bath which is almost a ritual after any eruptive disorder. Once the general condition is improved and there is no fever a bath will give great relief.
Dr.Rajan Payapally, virologist, says Acyclovir is a wonder drug which has dramatically reduced the severity of chicken pox, though people have unnecessary reservations that by suppressing vesicle eruption it will lie submerged to spring back again which is nothing but a misconception.
Chicken pox vaccine is also totally safe and effective he adds .
So the next time chicken pox visits you, lie back and enjoy the rest with nourishing food and plenty of fluids and Acyclovir prescribed by your family physician and you can almost have a party.
What's it, really?
In truth chicken pox is caused by the varicella zoster virus (viruses are microscopic organisms which replicate fast in the host and cause infections )
The virus is found in abundance in infected vesicles and in the oral and nasal secretions of the person with chicken pox and spreads through inhalation of droplets of saliva, nasal discharge, or from vesicles by contact, hence highly contagious it spreads like wildfire specially in closed environments like schools etc.
It starts with fever, body pain and shivering, at times loss of appetite ,headache ,which lasts for around 24 hrs and then the rash develops.
It is symmetrical first appearing in the trunk and later spreads to arms and legs. Initially they are hard macules then get filled up into fluid filled vesicles, finally drying up as crusts called scabs, all these lesions being infective.
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