Shingles and Chickenpox in Aged care

Many years ago I received a call from my best friend, “will y0u come over and check out Emma’s (her daughter) rash” she said, “it’s covering her face and trunk and she has a fever”. So over I head, I walked into the room and it was really obvious Emma had chickenpox. Now here’s the catch, at that stage I’d never had chickenpox, but  14 days later I started to develop a headache and fever and then the rash appeared. Chickenpox as an adult is no fun!

So why write about the risk of chickenpox in aged care, surely it’s a childhood illness and not applicable in the aged care setting. Well as I personally experienced it is possible for non immune adults to catch chickenpox, and in aged care there is a risk of catching chickenpox from our residents who have shingles if we have never had chickenpox.

What is chicken pox (Varicella Zoster)?

Chicken pox is a highly contagious, generally mild illness caused by the Varicella Zoster virus (VZV). It is characterised by a vesicular ash (blisters) which come out for several days and can appear on the trunk, face, scalp and mouth. Other symptoms can include: fever, runny nose, cough and tiredness.

chickenpox-rash-children

When is somebody infectious with Chickenpox?

Chicken pox is infectious from 2 days before the rash appears until all the lesions have crusted over (approximately 5-7 days). Individuals are not contagious during the incubation period (when the illness is brewing),

If you are exposed to someone with Chicken pox in the infectious stage and you are not immune you may develop chicken pox 10 to 21 days after exposure.

Are you immune to chickenpox?

If you have had chickenpox in the past, or have been vaccinated against chickenpox, you are considered immune to chickenpox.

What is Shingles (Herpes Zoster)?

Shingles is a reactivation of the Varicella Zoster virus, and is characterised by a vesicular rash that follows a nerve branch and is often associated with severe pain.

shingles-on-torso

Can you catch Chicken pox from shingles?

Yes,  The virus spreads when a person has direct contact with the active herpes zoster (shingles) lesions. The lesions are infectious until they dry and crust over. People with active herpes zoster lesions should avoid contact with in their household and in occupational settings until their lesions dry and crusted.

How does Chicken pox spread?

Chickenpox is spread by Airborne and Droplet spread – from the respiratory secretions prior to the rash. It is also spread via Indirect Contact by touching respiratory droplets on another person or object or by Direct Contact with the fluid from the vesicle (blister).

What should you do if a resident develops chickenpox/shingles?

  • Isolate the client in their room using airborne + contact precautions for both chickenpox and shingles. Staff caring for the resident only need to use airborne and contact precautions if they are non immune (have never had chickenpox).  Implementing airborne precautions can be really challenging in aged care, as we don’t have the same sort of facilities as a hospital. Normally I would recommend just shutting the residents door and using your additional precautions.). Encourage the resident to stay in their room for the duration of the illness, avoiding communal activities and dining.
  • Hand hygiene
  • Allocate staff who are immune to chickenpox (so staff who have had chickenpox in the past or have been vaccinated against chickenpox) to care for the client (for both chickenpox and shingles)
  • Notify the relatives
  • Discourage children and non-immune relatives from visiting.

What should you do if you develop chickenpox/shingles?

If you develop Chickenpox/Shingles you must take sick leave and inform your nurse manager. You cannot return to work until the vesicles (blisters) have crusted over.

For more information about the Shingles vaccine see: http://www.immune.org.nz/vaccines/zostavax

References:

https://www.cdc.gov/shingles/hcp/clinical-overview.html

http://www.immune.org.nz/resources/comparison-chickenpox-and-shingles

http://www.immune.org.nz/resources/herpes-zoster-shingles

 

 

 

 

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