The first sign of this highly infectious disease, caused by the varicella-zoster virus, may be a few small ' tear drop spots', usually on the scalp or trunk. Rapidly spreading itchy red papules and blisters may then cover the rest of the body. Some may be febrile, unwell and have diarrhoea and/or vomiting. The incubation period after contact with a case is 10 to 21 days and knowledge of this helps in diagnosis. The patient is infectious for up to two days before the rash appears. Children should be kept away from school for five days after onset of the rash. The rash dries and clears over the next one to two weeks. There are few complications in healthy children other than secondary infection of the lesions, and residual scars that are more likely if the lesions have been scratched. Adults, pregnant women and the immunocompromised are at greater risk of viral pneumonia, encephalitis or Guillain-Barré syndrome. Life-long immunity to chickenpox follows the infection but the virus lies dormant in the body and may sometimes undergo reactivation later, causing shingles.
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