Treatment and Prevention of Chickenpox Spread in the Office Environment

by: dr. Ariska Sinaga, Sp.PD

Chickenpox, or known as cacapox in Indonesian, is an infectious disease caused by the Varicella Zoster Virus (VZV). This virus is also the cause of herpes zoster (shingles). When first infected with VZV, the symptoms that appear are chickenpox. After recovery, this virus remains in the body in a dormant state in the nervous system. When the immune system decreases, this virus can reactivate and cause herpes zoster (shingles).

Varicella is very contagious and usually occurs in children, but adults can also be infected, especially if they have never been infected before or have not been vaccinated.

How Varicella Virus Spreads:

• Through airborne droplets: The virus can spread when an infected person coughs, sneezes, or talks. The virus particles can be inhaled by others who are within about 1 meter.
• Direct contact with skin lesions: The virus can spread through fluid that comes out of blisters. Once the blisters dry up and form scabs, they are usually no longer contagious.
• Through contaminated objects: The virus can survive on surfaces such as towels or clothing. If someone touches these objects and then touches their face or mouth, the virus can enter the body. However, this transmission is rare because the virus dies quickly outside the body.
• Perinatal transmission: Pregnant women who are infected with varicella can transmit the virus to their fetus through the placenta.

Signs and Symptoms of Varicella:

1. Early symptoms: Usually appear 1-2 days before skin lesions appear, such as fever, fatigue, loss of appetite, body aches, and headache.
2. Typical rash: Skin lesions begin as small red spots on the face, chest, abdomen, and back, then spread to the rest of the body. These red spots develop into blisters filled with clear fluid, which then crust over. The rash can be very itchy and may appear on the scalp, mouth, or genital area.
3. Additional symptoms: Swollen lymph nodes and pus in blisters that are scratched or infected.
4. Complications: Complications can occur in adults, infants, or individuals with weakened immune systems, such as pneumonia, encephalitis, or secondary skin infections from scratching.

Period of Infection

Varicella is contagious 1-2 days before the rash appears, when symptoms first appear. The virus stops being contagious once all the blisters have dried up and become scabs, usually about 5-7 days after the rash first appears.

Varicella Treatment

Most cases of varicella will heal on their own within 1-2 weeks. Some treatments that can be done include:

1. Home isolation: Infected employees should isolate themselves for 7-10 days until the skin lesions dry up.
2. Fever treatment: Medicines such as paracetamol can be used to reduce fever. Avoid aspirin as it can cause Reye's Syndrome.
3. Reducing itching: Use calamine lotion or take a warm bath mixed with colloidal oatmeal or baking soda. Trim nails to prevent scratching.
4. Antihistamine drugs: Medicines such as cetirizine or loratadine can be used to reduce itching.
5. Antivirals (acyclovir): Given to high-risk individuals, such as those who have not received the varicella vaccine, pregnant women, or individuals with weakened immune systems. Antivirals are most effective if given within 24-48 hours of the onset of skin lesions.

Prevention of Varicella Spread in the Office Environment:

1. Varicella Vaccination:
   • The varicella vaccine is highly effective in preventing the disease, with an effectiveness of 80-90%. It is a live, attenuated vaccine containing live viruses to stimulate immunity without causing disease.
   • In adults, the vaccine is given in two doses 4-8 weeks apart.
   • The World Health Organization (WHO) and CDC recommend vaccination for those who have not received the vaccine or have been infected with varicella, as well as for those who work in places with a high risk of exposure to varicella (such as hospitals, schools, or laboratories), and women of childbearing age.
2. Isolation of Employees Infected with Varicella:
   • Infected employees should isolate themselves at home until all skin lesions have dried and crusted over, which usually takes about 7-10 days.
3. Clean and Healthy Living Behavior in the Office:
   • Wash your hands properly using 6 steps, and the office must provide handwashing facilities with soap and running water and alcohol-based hand sanitizer.
   • Disinfect frequently touched surfaces such as keyboards, doorknobs, elevator buttons, tables, and so on.
   • Tissues and masks are recommended for employees who are coughing or sneezing to reduce the spread of airborne droplets.
   • Educate employees to consume healthy, nutritious foods and exercise regularly to maintain health and immunity.
4. Employee Education Regarding Signs, Symptoms, and Transmission of Varicella:
   • Employees should be informed about the early symptoms of varicella, such as fever, fatigue, and a rash that develops into blisters. Information about how it is transmitted through airborne droplets, direct contact with blister fluid, or contaminated surfaces should also be provided.
5. Monitoring and Rapid Response to Varicella Cases in the Office:
   • Conduct data collection and monitoring of employees at risk, especially those who have not been infected or vaccinated. Report cases of varicella to management or local health facilities for treatment.

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