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Chickenpox in the Child Care Setting

Chickenpox is a very contagious disease caused by the varicella zoster virus. Most children in the United States experience chickenpox before they are school-aged. A vaccine against chickenpox is now available. Although chickenpox is not a serious disease for most children, those whose immune systems are impaired (e.g., newborns and persons who are on chemotherapy for cancer, have AIDS, or take steroids like cortisone or prednisone) may experience severe disease, or even death. Chickenpox can also cause more severe health problems in pregnant women, causing stillbirths or birth defects, and can be spread to their babies during childbirth. Occasionally chickenpox can cause serious, life-threatening illnesses, such as encephalitis or pneumonia, especially in adults. In the past, some children who had chickenpox and were given aspirin developed Reye's Syndrome, which affects the liver and brain and results in the abrupt onset of seizures and, in some cases, death. For this and other reasons, aspirin should not be given to any child.

Chickenpox usually begins as an itchy rash of small red bumps on the scalp that spreads to the stomach or back before spreading to the face. However, this pattern can vary from person to person. It is believed to be spread person-to-person when a susceptible person is exposed to respiratory tract secretions (i.e., those produced by coughing or running noses) or directly to fluid from the open sores of an infected person. The disease is so contagious in its early stages that an exposed person who is not immune to the virus has a 70% to 80% chance of contracting the disease.

After infection, the virus stays in the body for life. Although people cannot get chickenpox twice, the same virus causes “shingles” or herpes zoster. An adult with shingles can spread the virus to someone, adult or child, who has not had chickenpox and the susceptible person can develop chickenpox. However, persons who have had chickenpox previously and are exposed outside child care are unlikely to bring the infection to child care unless they become ill.

If an adult or child develops chickenpox in the child care setting: Temporarily exclude the sick child or adult from the center. Allow the person to return 6 days after the rash begins or when all chickenpox blisters have formed scabs. (Local public health laws vary on the length of exclusion; consult your local health department.) Notify all staff members and parents that a case of chickenpox has occurred. Urge anyone who you know has an impaired immune system or who might be pregnant to consult a physician about the need for special preventive treatment. Contact the local health department to determine additional preventive measures. In some areas, child care providers are required to report known or suspected cases of chickenpox.

If a case of shingles occurs in the child care setting, the infected person should cover any lesions. If that is not possible, the person should be excluded from the child care setting until the lesions crust over.

Note: This information is not intended to take the place of your state's or locality's child care regulations and laws. In every case, the laws and regulations of the city, county, and state in which the child care facility is located must be carefully followed even if they differ from these recommendations.

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