Chickenpox in Children

Early Herd Immunity against COVID-19: A Dangerous Misconception

Chickenpox in Children | Johns Hopkins Medicine

We have listened with concern to voices erroneously suggesting that herd immunity may “soon slow the spread”1 of COVID-19.

For example, Rush Limbaugh2 recently claimed that “herd immunity has occurred in California.

” As infectious disease epidemiologists, we wish to state clearly that herd immunity against COVID-19 will not be achieved at a population level in 2020, barring a public health catastrophe.

Although more than 2.5 million confirmed cases of COVID-19 have been reported worldwide, studies suggest that (as of early April 2020) no more than 2-4%3–5 of any country’s population has been infected with SARS-CoV-2 (the coronavirus that causes COVID-19).

Even in hotspots New York City that have been hit hardest by the pandemic, initial studies suggest that perhaps 15-21%6,7 of people have been exposed so far. In getting to that level of exposure, more than 17,500 of the 8.

4 million people in New York City (about 1 in every 500 New Yorkers) have died, with the overall death rate in the city suggesting deaths may be undercounted and mortality may be even higher.8

Some have entertained the idea of “controlled voluntary infection,”9 akin to the “chickenpox parties” of the 1980s. However, COVID-19 is 100 times more lethal than the chickenpox. For example, on the Diamond Princess cruise ship, the mortality rate among those infected with SARS-CoV-2 was 1%.

Someone who goes to a “coronavirus party” to get infected would not only be substantially increasing their own chance of dying in the next month, they would also be putting their families and friends at risk. COVID-19 is now the leading cause of death in the United States, killing almost 2,000 Americans every day.

8 Chickenpox never killed more than 150 Americans in a year.9

To reach herd immunity for COVID-19, ly 70% or more of the population would need to be immune. Without a vaccine, over 200 million Americans would have to get infected before we reach this threshold.

Put another way, even if the current pace of the COVID-19 pandemic continues in the United States – with over 25,000 confirmed cases a day – it will be well into 2021 before we reach herd immunity.

If current daily death rates continue, over half a million Americans would be dead from COVID-19 by that time.

As we discuss when and how to phase in re-opening,10 it is important to understand how vulnerable we remain. Increased testing will help us better understand the scope of infection, but it is clear this pandemic is still only beginning to unfold.


  1. McKay H. Will “herd immunity” work against coronavirus? Fox News. Published March 23, 2020. Accessed April 23, 2020.

  2. Two Stories Indicate Coronavirus Herd Immunity. Rush Limbaugh Show. Accessed April 23, 2020.

  3. Flaxman S, Mishra S, Gandy A, et al. Report 13: Estimating the Number of Infections and the Impact of Non-Pharmaceutical Interventions on COVID-19 in 11 European Countries.; 2020. doi:10.25561/77731

  4. Bendavid E, Mulaney B, Sood N, et al. COVID-19 Antibody Seroprevalence in Santa Clara County, California. medRxiv. April 2020:2020.04.14.20062463. doi:10.1101/2020.04.14.20062463

  5. Reuters. Dutch study suggests 3% of the population has coronavirus antibodies. Mail Online. Published April 16, 2020. Accessed April 23, 2020.

  6. ago RR-SW 8 days. Surprising number of pregnant women at NYC hospitals test positive for COVID-19. Accessed April 23, 2020.

  7. Lucking L. Coronavirus antibodies found in 21% of New Yorkers in early testing. MarketWatch. Accessed April 28, 2020.

  8. Katz J, Sanger-Katz M. N.Y.C. Deaths Reach 6 Times the Normal Level, Far More Than Coronavirus Count Suggests. The New York Times. Published April 27, 2020. Accessed April 28, 2020.

  9. How “Chickenpox Parties” Could Turn The Tide Of The Wuhan Virus. Accessed April 23, 2020.



Chickenpox in Children | Johns Hopkins Medicine

Shingles is a common viral infection of the nerve roots that is caused by the varicella-zoster virus (herpes zoster), which is the same virus that causes chickenpox.

About one-third of the population will suffer from shingles pain at some point in their life, with adults over age 50 and people with a weakened immune system at the highest risk of getting shingles. However, children can also get shingles.

What Is Shingles?

After a person has chickenpox, the virus remains inactive in their body. During adulthood, the virus may reactivate, and cause an outbreak of shingles. Though shingles is common, researchers do not know what causes the virus to reactivate.

Once reactivated, the virus travels along a sensory nerve and develops into a painful, localized skin rash or small blisters. The rash occurs in the area of the affected nerve, usually with blisters, or fluid-filled sacs on top of reddish skin. This rash is what we call shingles.

The word “shingles” is from Latin and French words meaning “belt” or “girdle,” because the shingles rash usually appears in a single band on the body.

Most healthy people that develop shingles will experience symptoms for just a few weeks, and the condition is unly to return. In some cases, the symptoms may linger for a few months and can be more severe.

Related: Postherpetic Neuralgia

What Causes Shingles?

Shingles occur when the chickenpox virus reactivates. Anyone who had even a mild case of chickenpox can get shingles, including children. Although the reason for the reactivation of the virus is unclear, some medical professionals believe it may be due to lowered immunity to infections as we age.

Other factors that can increase the risk of developing shingles include:

  • Certain diseases. Conditions that weaken the immune system, such as HIV/AIDS and cancer, can increase the risk of shingles.
  • Cancer treatments. Radiation or chemotherapy can lower the body’s resistance to disease and can trigger shingles.
  • Certain medications. Drugs designed to prevent rejection of transplanted organs can increase the risk of developing shingles — as can prolonged use of steroids, prednisone.
  • Stress and Fatigue. Chronic, daily stress and highly stressful life events can be a risk factor, especially if other factors are present, such as mood disorders or a poor diet, that can negatively affect the immune system.

What are the Symptoms of Shingles?

Two to four days before the shingles rash occurs there may be tingling or local pain in the area. Pain is usually the first sign of shingles. For some, the pain can be intense.

In some cases, and depending on the location of the pain, shingles can be mistaken for problems with the heart, lungs, or kidneys. Furthermore, patients may also experience headaches, fever, dizziness, sensitivity to light, and flu- symptoms without a fever.

And, there are cases where some patients experience shingles pain without ever developing the rash.

As time progresses, tingling, itching, joint pain, swollen glands, and a burning pain often develops. The rash typically appears one to five days after the symptoms begin, starting with small, red spots that form blisters filled with fluid, and then scab over. If the blisters burst from scratching, the skin may scar after the rash subsides.

The shingles skin rash usually heals within two to four weeks; however, some people develop ongoing nerve pain that can last for months or years, a condition called postherpetic neuralgia.

The rash caused by shingles is more painful than itchy, with the pain and rash being the most obvious signs of shingles. The skin rash tends to be isolated to one side of the body, or in a particular location on the body. Shingles most commonly develops in the areas of the chest, stomach, spine, face, and mouth, but can appear other places on the body, even in multiple locations.

Besides the skin, many other organs can be affected by shingles, leading to severe complications. For example, shingles can affect the eyes, brain, heart, lungs, liver, pancreas, joints, intestinal tract, blood vessels, and more. Therefore, it’s very important to immediately seek a doctor’s care when symptoms of shingles first occur.

Stages of Shingles

Shingles tend to develop in stages.

Prodromal stage (before the rash appears)

  • Pain, burning, tickling, tingling, and numbness occurs in the area around the affected nerves several days or weeks before a rash appears. The discomfort usually occurs on the chest or back, but it may occur on the belly, head, face, neck, an arm or a leg.
  • Flu- symptoms (usually without a fever), such as chills, stomachache, or diarrhea, may develop just before, or along with, the start of the rash.
  • Swelling and tenderness of the lymph nodes may occur.

Active stage (rash and blisters appear)

  • A band, strip, or small area of rash appears. It can appear anywhere on the body, but will generally appear on only one side of the body. Blisters will form. The fluid inside the blisters is clear at first but may become cloudy after 3 to 4 days. Some patients may not get a rash, or the rash may be mild.
  • A rash may occur on the forehead, cheek, nose, and around one eye (herpes zoster ophthalmicus), which may threaten eyesight.
  • Pain, described as “piercing needles in the skin,” may occur along with the skin rash.
  • Blisters may break open, ooze, and crust over in about five days. The rash heals in about 2 to 4 weeks, although some scars may remain.

Postherpetic neuralgia (chronic pain stage)

  • Postherpetic neuralgia (PHN) is the most common complication of shingles. It lasts for at least 30 days and may continue for months or years. Symptoms include:
    • Aching, burning, stabbing pain in the area of the earlier shingles rash.
    • Persistent pain that may linger for years.
    • Extreme sensitivity to touch.
  • The pain associated with PHN most commonly affects the forehead or chest. This pain may make it difficult for the person to eat, sleep, and do daily activities. It may also lead to depression.

Shingles may be confused with other conditions with similar symptoms. The rash from shingles may be mistaken for an infection from herpes simplex virus (HSV), poison oak or ivy, impetigo, or scabies. The pain from PHN can feel  appendicitis, a heart attack, ulcers, or migraine headaches.

How is Shingles Diagnosed?

A diagnosis of shingles is typically a physical exam and history, specifically, if the patient has ever had chickenpox. Also, a tissue scraping or culture of the blisters may help confirm the diagnosis. Shingles can be confused with herpes simplex, dermatitis herpetiformis (a chronic blistering skin condition), impetigo (a bacterial infection of the skin), and skin reactions.

If there is a reason to suspect the rash is shingles, antiviral treatment may begin immediately. Early treatment can help shorten the length of the illness and prevent complications, such as postherpetic neuralgia.

How is Shingles Treated?

There is no cure for shingles, but treatment may shorten the length of illness and prevent complications.

Initial Treatment

As soon as the patient is diagnosed with shingles, the doctor will probably start treatment with antiviral medicines. If treatment begins within the first three days of seeing the shingles rash, there is less chance of complications, such as postherpetic neuralgia.

The most common treatments for shingles include:

  • Antiviral medicines to reduce the pain and the duration of shingles.
  • Over-the-counter pain medicines to help reduce pain during an attack.
  • Topical antibiotics to stop infection of the blisters.
  • Over-the-counter (OTC) antihistamines (e.g., Benadryl) and topical creams (e.g., Lidocaine cream) can help relieve the itching.

In severe cases, the use of corticosteroids, along with antiviral medicines, may help. However, corticosteroids are not often prescribed, since some studies show taking a corticosteroid along with an antiviral medicine doesn’t help any more than just taking an antiviral medicine by itself.

Ongoing Treatment

If pain persists for more than a month after the shingles rash heals, the patient may have postherpetic neuralgia (PHN), the most common complication of shingles. PHN can cause pain for months or years. It affects about 10-15% of people who had shingles.

Lifestyle and Home Remedies

Taking a cold bath or using cool, wet compresses on your blisters may help relieve the itching and pain. And, if possible, reducing stress can be helpful.

What are the Complications of Shingles?

Most patients will suffer from the typical symptoms of shingles. In some cases, shingles can lead to long-term pain or affect internal organs. Not everyone will have complications from shingles; however, some of the complications that can develop include:

  • Postherpetic neuralgia. For some people, shingles pain continues long after the blisters have cleared. This condition is known as postherpetic neuralgia, and it occurs when damaged nerve fibers send confused and exaggerated messages of pain from the skin to the brain.
  • Vision loss. Shingles in or around an eye (ophthalmic shingles) can cause painful eye infections that, in some cases, can cause immediate or delayed vision impairment.
  • Neurological problems. Depending on which nerves are affected, shingles can cause inflammation of the brain (encephalitis), facial paralysis, and hearing or balance problems.
  • Skin infections. If shingles blisters aren’t properly treated, bacterial skin infections may develop.
  • Other organs. Several other organs can be affected by shingles, including the heart, lungs, liver, pancreas, joints, intestinal tract, blood vessels, and more.
  • Ramsay Hunt Syndrome. A complication of shingles infections inside or near the ear can cause weakness of the muscles on the affected side of the face, as well as hearing and balance problems.
  • Pneumonia. Although infrequent, shingles can cause inflammation of the tissue of the lungs, resulting in viral pneumonia. This condition usually improves along with the symptoms on the skin. Some patients may experience fever and persistent breathing problems for weeks after the rash clears.

Is It Possible to Avoid Shingles?

Most people get shingles only once, but it is possible to get it two or more times.

Anyone who has had chickenpox can get shingles later in life. There is a shingles vaccine that may help prevent shingles, or make it less painful. The vaccine (Zostavax) is recommended for adults ages 60 and older, even if they’ve previous had shingles.

For children and adults who never had chickenpox, there is a vaccine (Varicella) that can help avoid getting the virus that causes both chickenpox and shingles.

For anyone who has never had chickenpox and has not received the chickenpox vaccine, it is best to avoid contact with people who have shingles or chickenpox. Fluid from shingles blisters is contagious and can cause chickenpox, but not shingles.

Novus Spine & Pain Center

Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating shingles pain. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.

To schedule an appointment, please contact us online, request a call back, or call our office at 863-583-4445.

Shingles Resources

Shingles (WebMD)
Shingles (Mayo Clinic)
Shingles (Johns Hopkins)
Shingles (Wikipedia)
How Shingles Can Affect Your Body (


Chickenpox in Children

Chickenpox in Children | Johns Hopkins Medicine

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Chickenpox is a highly infectious disease that usually occurs during childhood. By adulthood, more than 90% of Americans have had chickenpox. Since the mid-1990s, most children have been vaccinated against the infection.

The disease is caused by the varicella-zoster virus (VZV), a form of the herpes virus. Transmission occurs from person-to-person by direct contact or through the air by coughing or sneezing.

Until 1995, chickenpox infection was a common occurrence, and almost everyone had been infected by the time he or she reached adulthood.

However, the introduction of the chickenpox vaccine in 1995 has caused a decline in the incidence of chickenpox in all ages, particularly in children ages 1 through 4 years.

The varicella vaccine can help prevent this disease, and 2 doses of the vaccine are recommended for children, adolescents, and adults who are not already immune to chickenpox (have already had the disease).

What are the symptoms of chickenpox?

Symptoms are usually mild among children, but may be life threatening to healthy infants, children, and adults, and people with impaired immune systems. The following are the most common symptoms of chickenpox. However, each child may experience symptoms differently. Symptoms may include:

  • Fatigue and irritability 1 to 2 days before the rash begins
  • Itchy, red rash that progresses to tiny, fluid-filled blisters on the trunk, face, scalp, under the armpits, on the upper arms and legs, and inside the mouth
  • Fever
  • Feeling ill
  • Decreased appetite
  • Muscle and/or joint pain
  • Cough or runny nose

The symptoms of chickenpox may resemble other skin problems or medical conditions. If a person who has been vaccinated against the disease is exposed, then he or she may still get a milder illness with a limited and less severe rash and mild or no fever. Always consult your child's doctor for a diagnosis.

How is chickenpox spread?

Once infected, chickenpox may take 10 to 21 days to develop. Chickenpox is contagious for 1 to 2 days before the appearance of the rash and until the blisters have dried and become scabs.

The blisters usually dry and become scabs within 4 to 5 days of the onset of the rash, but there are usually several new crops of blisters developing during this time period.

Children should stay home and away from other children until all of the blisters have scabbed over.

Family members who have never had chickenpox have a 90% chance of becoming infected when another family member in the household is infected.

How is chickenpox diagnosed?

Chickenpox is usually diagnosed a complete medical history and physical exam of your child. The rash of chickenpox is unique, and usually a diagnosis can be made from a physical exam.

What is the treatment for chickenpox?

Specific treatment for chickenpox will be determined by your child's doctor :

  • Your child's age, overall health, and medical history
  • Extent of the condition
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Treatment for chickenpox may include:

  • Acetaminophen for fever (Do not give aspirin)
  • Antibiotics for treating bacterial infections that may develop (antibiotics do not treat the chickenpox infection)
  • Calamine lotion (to relieve itching)
  • Antiviral drugs (for severe cases)
  • Rest
  • Increased fluid intake (to prevent dehydration)
  • Cool baths with baking soda (to relieve itching)

Children should not scratch the blisters, as this could lead to secondary bacterial infections. Keep your child's fingernails short to decrease the lihood of scratching.

Immunity from chickenpox

Most people who have had chickenpox will be immune to the disease for the rest of their lives. However, the virus remains dormant in nerve tissue and may reactivate, resulting in herpes zoster (shingles) later in life. Rarely, a secondary case of chickenpox does occur. Blood tests can confirm immunity to chickenpox in people who are unsure if they have had the disease.

What complications are commonly associated with chickenpox?

Complications can occur from chickenpox. Those most susceptible to severe cases of chickenpox are infants, adults, pregnant women, and people with impaired immune systems.

Unborn babies may also be infected if the mother has not had chickenpox prior to pregnancy. Even healthy children may develop complications for chickenpox, most commonly serious skin infections.

Complications of chickenpox may include:

  • Secondary bacterial infections
  • Pneumonia
  • Encephalitis (inflammation of the brain)
  • Cerebellar ataxia (defective muscular coordination)
  • Transverse myelitis (inflammation along the spinal cord)
  • Reye syndrome (a serious condition that may affect all major systems or organs)
  • Death


A Ticking Timebomb : Johns Hopkins Center for Innovative Medicine

Chickenpox in Children | Johns Hopkins Medicine

Ticks are evil. Deer ticks are even worse: little dots of evil, the size of a freckle. They spread Lyme disease, and what can happen next sounds a horror movie.

But first, the ticks: They are the minuscule vectors that transmit Lyme disease. But really what they transmit are corkscrew-shaped bacteria called spirochetes. (Their official name is Borrelia burgdorferia; the disease is also known as Lyme borreliosis.

) Spirochetes are real lowlifes in the disease world; another devastating disease they cause is syphillis. Although deer get the blame for the epidemic of Lyme disease that has hit the East Coast particularly hard, they’re just a truckstop for the ticks; a place to grab a quick meal.

“Deer are immune to Lyme disease, but they are an important food source for the ticks that transmit it,” says John Aucott, M.D., an infectious diseases specialist and renowned expert on Lyme Disease, and the founding physician of the Lyme Disease Clinical Research Center.

No, the real source, or reservoir, for these nasty spirochetes are rodents such as the white-footed mouse.

So let’s say you’ve been bitten by a deer tick. Most ly, you never noticed it.

You may not even know you’ve been bitten unless you happen to see a telltale, bullseye-shaped rash, called Erythemia migrans – which may or may not show up after the tick sucks your blood and in return gives you the gift that keeps on giving. You may not get sick right away, either.

If you do, you might mistake what’s happening as the flu. With symptoms a headache, low-grade fever and chills, fatigue, swollen glands, achiness, and a stiff neck, who could blame you? If you’re lucky, you take antibiotics, and you get better.

If you’re not lucky, you may or may not take antibiotics, you may or may not feel better, but you won’t truly be better. Instead, the disease will get worse, as the spirochetes burrow further into your body.

“Lyme disease is a heck of a lot more complicated than many people realize, because it’s got a lot of variables,” says Aucott. “ syphillis, it’s got multiple stages; so there’s early Lyme disease, the period within weeks after the tick bite. That’s primarily a skin infection with the rash.

Then in the two- to six-week range, the spirochete disseminates and the illness changes forms,” as the infection moves outward from the bite; these are the flu symptoms.

“In some people, the disseminated bacteria end up in organs the heart, or in the nervous system – so the symptoms could look heart trouble or meningitis. It’s kind of a moving target with all these different manifestations, depending on how far the disease has progressed.”

You may not even know you’ve been bitten unless you happen to see a telltale, bullseye-shaped rash – which may or may not show up after the tick sucks your blood and in return gives you the gift that keeps on giving.

Basically, at every stage, even the rash, Lyme disease has the potential to be misdiagnosed; especially if nobody connects what’s happening to the bite of a pencil point-sized tick.

“Then in the third stage, which may be six months or even years later, you can get arthritis,” says Aucott. “So you have all these seemingly disparate illnesses that don’t appear to be related, but they’re all due to the different phases of the bacteria.

” Treatment varies, depending on how widely the infection has spread. “The earlier you treat it, the easier it is to treat.

If you catch it early with the rash, which is what you want to do, it’s much easier to treat than if it’s already disseminated and the patient has had heart or nervous system involvement or joint problems. It gets harder and harder to treat.”

Basically, at every stage, Lyme disease has the potential to be misdiagnosed; especially if nobody connects what’s happening to the bite of a pencil point-sized tick.

But it’s still treatable. Sharon Akers, who runs the Edward St.

John Foundation, a philanthropic organization that has helped support Aucott’s work since 2010, has seen many people – friends, coworkers, family members – who were misdiagnosed, whose symptoms kept getting worse, people who became discouraged and thought this nightmare would never end – find hope and get better under Aucott’s care. She recalls one young lady, whom she and Edward St. John referred to Aucott after seeing her at a crab feast, walking “ she was drunk. Her gait was horrific,” Akers recalls. “It turned out that she was also having chronic headaches and dizziness.” Aucott diagnosed the Lyme disease, figured out that the girl’s first exposure had been years earlier, and began to treat the bacteria and address the neurological impairment. “She still has a little residual damage, but now she is totally functional and back in school.”

With Lyme disease, the big question is, “is it really gone?” When symptoms improve, sometimes all the spirochetes have been killed, but not always.

Instead, what’s happening may be the disease equivalent of that deceptive calm at the end of a creepy movie; just when you think it’s safe to go back in the water, it’s not.

Worse, Lyme disease can seem to shape-shift, to present with a whole new constellation of symptoms.

Eight years ago, Aucott, along with Antony Rosen, M.D., head of the Division of Rheumatology, and immunologist Mark Solosky, Ph.D., officially started a clinical research program. “We decided it was the perfect opportunity to put together a classic translational research program,” says Aucott, “one that bridges patients and the laboratory.”

The focus of Aucott’s research is “this whole phenomenon we call post-treatment Lyme disease syndrome” (PTLDS). “Patients call it chronic Lyme disease, but we’ve tried to get away from that,” because it’s not entirely accurate.

“It’s a distinct part of Lyme disease that happens in a subset of patients who, when treated with antibiotics, don’t fully recover their health. That’s the controversial part of Lyme disease, because it’s much harder to get a handle on.

” For example, some of the key symptoms – fatigue, pain, and inability to think clearly, or other cognitive issues – are not-very-specific pegs that could fit the description of many illnesses. “Some people think it’s really nebulous,” Aucott adds, “and to some extent, they’re right. Because there is not real blood test for PTLDS.

Patients know they aren’t getting better, but until there’s a blood test to confirm that you have PTLDS, it’s going to be very hard to separate those symptoms from those of other syndromes fibromyalgia or chronic fatigue.”

Aucott and Solosky are actively looking for biomarkers – telltale molecular signs that say, “this person still has Lyme disease.” Right now, there’s a test that can show that someone has antibodies to Lyme disease, but that’s about all it shows. “The test shows exposure, and exposure is not the same as active infection,” says Aucott.

“For instance, I have antibodies to chicken pox because I had it when I was a kid, but it doesn’t mean I have chicken pox today. Those antibodies have a memory, and they stay in your system for years or decades.

But the presence of antibodies doesn’t mean someone is actively sick from the infection; it just means your immune system has been exposed to it sometime in the past.” Another issue: Even if the antibodies show up, it doesn’t necessarily mean that someone’s fatigue is due to Lyme disease. It could be something else. Still other issues: The antibodies can sometimes go away.

“It’s not predictable what they’re going to do.” Also: “You can get it more than once, because there are different strains. You’re not protected; I’ve had patients who have gotten it two or three times.”

With Lyme disease, the big question is, “is it really gone?” When symptoms improve, what’s happening may be the disease equivalent of that deceptive calm at the end of a creepy movie; just when you think it’s safe to go back in the water, it’s not.

In highly sophisticated detective work, Aucott and Solosky are studying patients using proteomics – the study of ultra-specific proteins, which are footprints in the blood. “What makes our study very unique is that we have the patients at the time of their initial diagnosis, when they have the rash, before they even get antibiotics,” says Aucott.

“Then we follow them for seven visits,” taking blood samples each time. “So we can follow these proteomic shifts” – the trail of the footprints – “just you would in a patient who’s having a heart attack, except our time scale isn’t a matter of hours, but many months.

” The goal is to find changes over time that can lead to a test that says, “This person still has active Lyme disease,” or “the disease is not active in this person.”

The real Holy Grail, Aucott continues, “would be if we can find a pattern that identifies people who are destined not to recover completely, the people who are going to need further intervention because they’re destined to go on to PTLDS.

In medicine, we to treat people, but then we also to repeat their test and show that they’re cured. in cancer, you repeat the CT scan, or in a heart attack, you repeat the EKG.

But in Lyme disease, there’s nothing to repeat, nothing to show that the person has recovered.”

Still other things to think about: When someone with Lyme disease doesn’t get better, is it because the antibiotics didn’t kill every last bacteria and a few remain dormant? “That’s one hypothesis.

Or maybe the infection triggered an autoimmune disease; there’s good precedent for that, as in rheumatoid arthritis.

Or maybe it’s a combination of the two; maybe most of the infection is gone, but that little bit triggers an ongoing inflammation.”

Hopkins is the first academic medical center to “formally embrace the challenge of doing research on these chronically ill patients that nobody seems to understand,” Aucott states. “I’m really proud of Johns Hopkins for being willing to tackle this.”



Chickenpox in Children | Johns Hopkins Medicine

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Chickenpox is a common childhood disease. It causes an itchy, blistering rash and is easily spread to others.

Until the varicella vaccine was licensed in 1995, chickenpox infection was very common. Almost everyone had been infected as a child. Now a vaccine is available to prevent chickenpox. Two doses of the vaccine are recommended for children, teens, and nonimmune adults.

What causes chickenpox?

The disease is caused by the varicella-zoster virus. It is easily passed from person-to-person by direct contact or through the air by coughing or sneezing.

Who is at risk for chickenpox?

Any child or adult who has never had chickenpox or been vaccinated against it is at risk for getting the disease.

Chickenpox is passed from person-to-person by direct contact or through the air by coughing and sneezing. It can also be spread by being exposed to the fluid from the blistering rash. Once exposed, symptoms usually appear within a couple of weeks. But it may take as few as 10 and as many as 21 days for the chickenpox to develop.

Chickenpox is contagious for 1 to 2 days before the rash starts and until the blisters have all dried and become scabs. The blisters usually dry and become scabs within 5 to 7 days of the onset of the rash.

Children should stay home and away from other children until all of the blisters have scabbed over.

It is important that people who are infected avoid those with weak immune systems, such as those with organ transplants, HIV, or those getting cancer treatment.

Family members who have never had chickenpox have a high chance of becoming infected when another family member in the house is infected. The illness is often more severe in adults compared to children.

Most people who have had chickenpox will be immune to the disease for the rest of their lives. However, the virus remains inactive in nerve tissue and may reactivate later in life causing shingles. Very rarely, a second case of chickenpox does happen. Blood tests can confirm immunity to chickenpox in people who are unsure if they have had the disease.

How is chickenpox treated?

Specific treatment for chickenpox will be determined by your healthcare provider :

  • Your overall health and medical history
  • Extent of the condition
  • Your tolerance for specific medicines, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Treatment for chickenpox may include:

  • Acetaminophen (to reduce fever). Children with chickenpox should NEVER be given aspirin. 
  • Skin lotion (to relieve itchiness)
  • Antiviral drugs (for severe cases)
  • Bed rest
  • Drinking plenty of fluids (to prevent dehydration)
  • Cool baths with baking soda (to relieve itching)

Children should not scratch the blisters because it could lead to secondary bacterial infections. Keep fingernails short to decrease the lihood of scratching.

What are the complications of chickenpox?

Complications can happen from chickenpox. They are more common in adults and people with weak immune systems. Complications may include:

  • Secondary bacterial infections
  • Pneumonia (lung infections)
  • Encephalitis (inflammation of the brain)
  • Cerebellar ataxia (defective muscular coordination)
  • Transverse myelitis (inflammation along the spinal cord)
  • Reye syndrome. This is a serious condition marked by a group of symptoms that may affect all major systems or organs. Do not give aspirin to children with chickenpox. It increases the risk for Reye syndrome.
  • Death

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, call your healthcare provider. You should tell your provider as quickly as possible if you get these symptoms:

  • A fever that lasts longer than 4 days or goes above 102°F (38.8°C)
  • The rash becomes more red or warm and tender, and has pus
  • A change in mental status, such as confusion or extreme sleepiness
  • Having problems walking
  • Stiff neck
  • Having problems with breathing or a frequent cough
  • Frequent vomiting

Key points about chickenpox

  • Chickenpox is a common childhood illness. It is easily spread to others.
  • There is a vaccine available to prevent chickenpox.
  • Symptoms are usually mild in children. They may be life-threatening to adults and people of any age with weak immune systems.
  • The rash of chickenpox is unique and the diagnosis can usually be made on the appearance of the rash and a history of exposure.
  • Treatment helps reduce fever and itchiness of rash. Children with chickenpox should NEVER be given aspirin.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.


Hopkins Researchers Develop New Quick Tool To Sort Out Insect Bites In Children

Chickenpox in Children | Johns Hopkins Medicine

Children afflicted with insect-bite rashes are often misdiagnosed or referred for extensive and costly tests, but a new, easy-to-remember set of guidelines developed at the Johns Hopkins Children's Center should help.

Called SCRATCH, the letters form a memorable acronym for symmetry, cluster, Rover, age, target/time, confused, household). It is a guide to the symptoms and features that help pediatricians and others to recognize the source of a rash.

Insect-bite skin rashes mimic the symptoms of a variety of conditions, ranging from fungal infections, scabies, allergies and environmental contacts, to HIV-associated dermatoses. Reactions to a bite are often delayed, making it difficult to trace exposure.

“SCRATCH could spare many children and their parents from going through invasive-not to mention expensive-procedures if pediatricians recognize the problem early on,” says Raquel Hernandez, M.D., a third-year resident at the Children's Center and lead author of the article, published in the July online edition of Pediatrics.

Hernandez and co-author Bernard Cohen, M.D.

, head of dermatology at the Children's Center, developed SCRATCH by examining a month's worth of patient records from visits to the Children's Center dermatology clinic.

They found that the majority of children who were eventually diagnosed with an insect-bite rash had undergone extensive lab tests and skin biopsies before they were referred to Hopkins.

The most common misdiagnosis was scabies, a skin infection caused by a parasite that produces red, itchy lesions. Many of the children were treated repeatedly for scabies.

“These guidelines are really intended to make pediatricians consider insect-bite hypersensitivity as a diagnosis and think twice before referring a child for a skin biopsy or another invasive procedure,” Cohen says.
Using the tool is straightforward, Cohen adds. If the rash fits the SCRATCH criteria, it's ly bug-borne.

S for Symmetry
Erruptions are usually symmetric and appear on exposed parts of the body, such as face, neck, arms, legs. Younger children may have rashes on their scalps. Diaper areas, palms and soles are not affected. The trunk is rarely affected. By contrast, scabies causes rashes on palms, soles and between toes and fingers.

C for Clusters
Lesions appear in “meal clusters,” described as breakfast, lunch and dinner. The linear or triangular clusters are typical of bedbug bites, but also appear in bites caused by fleas.

R for Rover Not Required
Presence of pets in the household is not a criterion for diagnosis because a bite might occur outside of the home.

A for Age Specific
The condition is most prevalent in children between the ages of 2 and 10.

T for Target Lesions and Time
Target-shaped lesions – named so for their resemblance to the bull's eye on a target — are typical of insect-bite hypersensitivity.

Time indicates the chronic/recurrent nature of the eruptions. Many patients may have delayed reactions and may not experience flareups until months or years after the intial exposure.

Most children develop full immunity by age 10 and no longer have recurrent rashes.

C for Confusion
Parents often express confusion and disbelief at the suggestion that there might be fleas or bedbugs in their homes. “One of the primary criteria is that if the parents don't believe me, I am probably right,” Cohen says.

H for Household with Single Family Member Affected
Un conditions that have similar symptoms, such as scabies and atopic dermatitis, insect-bite rashes often appear in a single member in a family.

“Common sense might tell us that fleas and mosquitoes would affect other members of the family, but we must keep in mind that these rashes develop in children who have hypersensitivity that others do not have,” Hernandez said.

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Materials provided by Johns Hopkins Medical Institutions. Note: Content may be edited for style and length.