Chickenpox is a communicable disease that is highly contagious, caused by the varicella-zoster virus (VZV infection). On the other hand, herpes infection is caused due to herpes simplex virus type 1 (HSV-1 or human herpes virus 1).
HSV-1 and VZV both belong to the herpes virus family, Herpesviridae.
Following a primary infection, HSV 1 reactivation results in herpes labialis, also known as cold sores (fever blisters). Whereas in the case of chicken pox, primary infection causes varicella, following which the latent virus reactivates decades later to produce herpes zoster (shingles).
The similarity between both viruses is that following a primary infection, both establish a latent infection in the neuronal cells in the human peripheral ganglia.
About Herpes Virus
Six common herpes viruses affect humans:
- Varicella zoster virus (VZV) causes chickenpox, usually during childhood, but it can affect teenagers and adults as well.
- Herpes zoster virus reactivates later to cause Shingles.
- Herpes Simplex virus 1 causes cold sores that can be transmitted during oral sex; hence, it is a sexually transmitted infection, also known as oral herpes.
- Herpes simplex virus 2 causes genital herpes and is usually limited to the genital region. HSV-2 is a sexually transmitted infection similar to HSV-1.
- Epstein-Barr virus (EBV) causes mononucleosis, which causes extreme fatigue and weakness.
- Cytomegalovirus (CMV) is very rare in healthy individuals but can cause serious complications in individuals with suppressed immune systems or a weakened immune system, for example, in HIV-affected individuals.
About Varicella zoster virus (VZV infection)
Varicella zoster virus is a member of the herpes family. VZV causes chickenpox primarily (acute infection) and shingles after latency (VZV reactivation). Although the same virus causes both, the conditions are very different and may present differently.
Chickenpox is a very common childhood illness and usually occurs in children. It can also occur in later stages.
Chickenpox is a highly contagious disease and is infectious. A contagious disease causes the virus to spread from one person to the other either by air or droplet nuclei. It is mainly through close contact with someone who has chickenpox.
The average incubation period for varicella is 14 to 16 days after exposure to varicella-zoster virus. The period of communicability is 1 to 3 days before to 4 to 5 days after the rash appears.
The rash appears as a dew drop on a rose petal. Centripetal distribution of the rash. It typically starts on the chest, back, and face and then spreads over the body. Pleomorphic rash occurs; this means that all the stages of rash are present at one time. There is inflammation present around the vesicles.
The virus affects the flexor surfaces involving the axilla.
The classic symptoms are:
- Itchy, fluid-filled blisters, which eventually turn into scabs, over 4-7 days.
- Loss of appetite
People who have been vaccinated can still get the disease, although the symptoms may be milder, with few or no blisters. They may present with just red spots.
Usually, chickenpox is not a serious condition, but in some cases, it can be.
- Pregnant women in the 1st trimester of pregnancy (first 3 months) are at risk, and so is the fetus.
- People with a weakened immune system (HIV/AIDS or cancer)
- Infants may develop chickenpox, which is not always fatal in immune-compromised infants
The serious complications are:
- Streptococcal or bacterial infections.
- Pneumonia or lung infections
- Encephalitis, swelling of the brain, or infection of the brain.
- Hemorrhagic complications.
Death is a very rare complication now. In the past, when the varicella vaccine was not introduced, a lot of deaths would occur as a complication.
Evaluation and Diagnosis
The diagnosis is usually done on the basis of signs and symptoms. Confirmation is done by examining the fluid within the vesicles, scraping lesions that have not crusted, or by blood.
Other tests include Polymerase Chain Reaction (PCR), Tzanck Test, and direct fluorescent antibody test. These tests are usually done just for confirmation and to rule out smallpox. Symptoms are enough for diagnosis since they are classic and typically seen only in infected individuals with chickenpox.
Treatment and Management
Treatment usually involves only symptomatic relief and isolation. Since the mode of transmission is contact, infected individuals are advised to stay at home and in isolation for at least 7 days after the rash appears.
Topical calamine lotions are prescribed to relieve pruritus (itching). Daily cleansing is done to avoid infections. Aspirin is to be avoided since it can cause Reye syndrome. (systemic damage but targets majorly the liver and brain). In adults, antiviral drugs like acyclovir or valacyclovir are advised after 24 to 48 hours of rash onset.
Chickenpox is very common, and it is believed that every individual has contact with the infection once in their lifetime. Although it is a common childhood illness, there are certain measures to be taken to prevent the spread of infection.
- Avoid contact with the infected individual.
- Immunization practices.
There are 2 vaccines for chickenpox: varicella vaccine and MMRV vaccine. The latter protects children from measles, mumps, rubella, and chickenpox.
Two doses of the vaccine are 90% effective at prevention. Most individuals who get the vaccination do not get chickenpox or get a milder version of the disease.
The reactivation of the dormant varicella-zoster virus causes shingles. The few factors that promote reactivation are fatigue, stress, illness, immune system-suppressing drugs, and radiation therapy.
The rash is also known as herpes zoster. It is more common in an age of more than 50 and people who have had chickenpox earlier in life.
- Pain along the course of the nerve where the virus resides, mostly in thoracic and lumbar areas or any other part of the body.
- Itching and burning sensation in the skin.
- Group of small blisters, linear in pattern. The appearance and disappearance pattern is the same as chickenpox lesions.
- Pain persists even after weeks, months, or years after the rash heals.
- Hypo or hyperpigmentation of skin.
The incubation period of shingles is 2 to 3 weeks and usually 14-16 days. Shingles can be transmitted only by contact with fluid from the rash or blisters. Airborne transmission is not a concern in shingles-infected individuals.
Prevention of transmission
Shingles-infected individuals can transmit the VZV infection to anyone who has not been vaccinated against varicella. If infected, they will develop chickenpox and not shingles rash.
Anyone with shingles can spread the infection from the time of onset of the skin lesion until all lesions are scabbed and healed.
- Keep the rash covered.
- Practice hand hygiene, that is, wash hands frequently and with soap or a chemical disinfectant.
- Avoid contact with people who have not had chickenpox in the past.
Treatment and Management
Oral antiviral drugs can be started within the first 72 hours of symptoms to reduce pain and promote healing. Pain relievers and lotions similar to chickenpox can be used to help with partial relief of symptoms.
The easiest way to prevent the infection is to be isolated and avoid contact with uninfected individuals.
Apart from that, there are two Shingles vaccines available:
- Zostavax is given as a single dose to individuals aged 60 or above.
- Shingrix is given in two doses, separated 2-6 months to individuals of age 50 or above. It is preferred over Zostavax, according to the Centers for Disease Control and Prevention (CDC)
About Herpes Simplex Virus
It is a common sexually transmitted infection that causes painful blisters or ulcers. It spreads due to skin-to-skin contact and is incurable.
Herpes Simplex virus can be either type 1 or type 2. Type 1 HSV is usually transmitted due to oral sexual contact; hence, it is also termed oral herpes or cold sores. It can also cause genital herpes and is commonly seen in adults. Type 2 HSV is usually transmitted by sexual contact and can cause genital herpes.
The symptoms can be managed and treated, but the disease has no cure.
The symptoms are either absent or very mild.
- Painful, recurring blisters or ulcers.
- Fever, body aches, swollen lymph nodes.
Oral herpes symptoms include cold sores and open sores in or around the mouth and lips. Genital herpes symptoms include bumps, blisters, open sores around the genitals or anus.
Treatment and Management
Medicines are used to treat the symptoms and recurrent episodes of herpes. Antiviral medicines like acyclovir, famciclovir, and valacyclovir are given. Paracetamol, naproxen, or ibuprofen is prescribed to deal with pain related to sores. HSV lives inside nerve cells and alternates between being active and inactive.
Although both herpes and chickenpox are caused by viruses from the same family, they are different in nature. The varicella-zoster virus causes chickenpox, whereas herpes is caused due to herpes simplex virus. Herpes zoster is a latent infection of chickenpox. Chickenpox is curable and can be prevented by administering vaccination, whereas herpes is incurable.