Chicken problems again?


We had Bird Flu and apparently sporadic cases are still coming to light in Cambodia and Vietnam.  With Bird Flu on the rise again in Cambodia, will it fly across the Mekong and infect Thailand?  Of course it will, and probably has done already.  But since the world statistics from Bird Flu (A/H5N1) has only been 564 cases over eight years, you are more likely to be run over on the road (especially during Songkran).

However, there is another “chicken” disease, Chicken pox!  Actually, chicken pox (AKA Varicella) is not really caused by chickens, nor even carried by them.  Chicken pox is a common disease caused by the varicella zoster virus which is a member of the herpes virus family.  It is very contagious and all communities experience epidemics.

A few years back there was a real outbreak in Thailand, with 22,833 patients with the complaint between January and May.  This nasty condition never actually leaves the community, lying quiet for a while and then attacking in epidemic proportions.  Make no mistake about this one, it is a most aggressive disease that sweeps through schools and institutions and while generally a disease of children, it can attack adults too with devastating results.

The varicella zoster virus is known for the characteristic chickenpox lesions.  These come out very quickly after an initial period of vague symptoms such as fever and aches in muscles and joints.  The lesions (vesicles) are very superficial on the skin and grow like a mini-Vesuvius, burst and then crust over.  That cycle of events takes around four days, but new crops of vesicles come up in waves in the first three or four days, so you can have some vesicles growing bigger while earlier ones are drying up and crusting over.

The vesicles generally come out on the trunk and face first, but can spread to all over the body and even inside the mouth and on the tongue.  Now while scarring is always a worry for the Mums of this world, there are far worse effects from this little virus.  There is a distinct possibility of an encephalitis in older children and adults can actually develop a varicella pneumonia.  Pregnant women who get chickenpox also run the risk of infecting the unborn child, and this can run as high as 10 percent.  Very often, especially if the child scratches the lesions, there can be an added infection by an opportunistic bacterium on top of the viral lesions, so you get a double problem.

So what do you do when chickenpox is doing the rounds?  The first thing is to keep away from those who have the disease.  It is highly contagious and is spread by inhalation of micro droplets in the air, or by direct contact with weeping vesicles.  In a family, this means that little Johnny gets his own towel that no-one else must use and a bed-time kiss is strictly forbidden.

Calomine lotion does help with itchy and weeping vesicles and trim the fingernails in young children to lessen the chances of scratching.  With very little ones, I even suggest putting their hands in socks, just as you do with little babies.

If the temperature is raised (more than 37.5 Celsius) then a little paracetamol will help (but not aspirin as this drug should not be used with children), and if there is the “super-infection” by a bacterium it will be necessary for your doctor to prescribe an appropriate antibiotic.

The other important duty that you have as a parent, is do not send little Johnny back to school until the very last vesicle has dried up.  This is generally around a week to ten days, but is so important in trying to stop the epidemic.

The other nasty part of this virus is that it lies dormant in your system and can strike back many years later as Shingles, or as we medico’s call it, Herpes Zoster.  No, chickenpox is not fun, and to those of you who are struggling with it right now, you have my sympathies.

However, we do have a varicella vaccine these days, and vaccination is recommended from about 12 months of age.  Like all vaccination programs, this will radically reduce the impact of epidemics.