春天孩儿脸，一天变三变。换季时节，乍暖还寒，正是呼吸道感染高发季节。水痘是由水痘-带状疱疹病毒引起的常见传染病，多见于儿童。大多数病例发生于冬春两季时，常见于学校内传播。治疗原则主要是缓解症状，抗生素治疗无效。水痘的传染性很强，在水痘疫苗出现以前，超过90%的人群在15岁以前会感染水痘。 如今水痘的发生率大为降低，是应该归功于水痘疫苗的功劳，减少了孩子感染水痘的机会。
Chickenpox is common childhood infectious disease caused by the varicella-zoster virus. Most cases occur during the winter and spring and most likely due to school contact. It cannot be treated with antibiotics. Treatment is usually to relieve the symptoms. Before the vaccine became available, more than 90 percent of people had the infection by the time they were 15 years old. It is much less now, thanks to the varicella vaccine which can protect kid from the infection and greatly reduce their chance of getting chickenpox.
水痘的症状和体征
发烧和皮疹是水痘主要的症状，皮疹出现前可出现低热，咽痛，疲乏倦怠，哭闹不安，胃纳减退等前驱症状。
1.皮疹什么时候出现？---水痘的皮疹很痒，通常在前驱症状后一天出现。
2.皮疹是什么样子的？---皮疹在最开始的时候是一些小的红色斑疹或高出皮面的小丘疹，看上去像小痘痘或虫咬的小包。接着皮疹发展成薄壁而饱满充满液体的小水疱，随后水疱破溃，干燥结痂。新的皮疹在之后的数天内陆续分批出现，演变成丘疹和水疱疹。
水痘皮疹的特征性表现是“四世同堂”，就是在疾病高峰期可以看到斑疹、丘疹、疱疹和结痂在同一时间同时存在。水痘的皮疹常先出现在前胸，后背，脸并逐渐发展到身体其他部位，包括头皮， 口腔， 四肢及外生殖器部位。
在有湿疹的孩子中，水痘的皮疹可能相对严重些或分布更为广泛。相对大年龄的孩子或成人，年幼的儿童发生水痘时会相对症状轻一些，水疱疹也会少些。
3. 皮疹会持续多久？--- 在第一个疹子出现后的4天内，新的丘疹和水疱疹会相继分批出现。大多数平时健康的人会在第6天左右水疱疹全都结痂，之后的一周到两周内痂皮脱落。
Signs And Symptoms
Fever and a rash are the most common signs of chickenpox. It often starts with a mild fever and usually include sore throat, feeling tired, irritable, and loss of appetite.
1. When does the rash appear? ---The chickenpox rash is itchy and usually first appears one day after the above symptoms begin.
2.What does the rash look like? ---At first, the rash starts out as a clusters of small red rash or bumps that look like pimples or insect bites. These later develop into thin-wall blisters full of fluid and then pop which finally dry up, crust and become dry and brown scabs. New clusters of rash, bumps and blisters continue to appear for a few days.
A hallmark of chickenpox is that all stages (red bumps, blisters, and scabs) can appear on the body at the same time. The rash tend to developed on the chest, back, or face, and can spreads to almost everywhere else on the body, including the scalp, mouth, limbs, and genitals.
The rash may be more extensive or severe in kids who have eczema. Young kids tend to have a mild illness with fewer blisters than older children or adults.
3. How long does the rash last? — New bumps and blisters can develop throughout the body for about 4 days following the first rash. By day six, the blisters have completely scabbed over in most healthy people. It may take a week or two for the scabs to fall off.
水痘是怎么传染的
水痘的传染性极强，罹患水痘的患者为主要传染源。从出疹前一到两天直到皮疹全部结痂整个病程都具有传染性。可以通过呼吸道咳嗽以及喷嚏的飞沫传播，也可以通过直接接触水痘患者传播（比如疱疹的疱液）。虽然儿童和任何年龄的成年人都可以罹患水痘， 但一般常见于儿童。在第一次接触到水痘病毒的以后的2周左右出现皮疹等症状，大多数人会在10到21天以内。
How Is It Spread?
Chickenpox is highly contagious. Children with chickenpox are infectious even one to two days before the rash show up until the last blisters have dried up. It can be spread by either having direct contact with the person who has chickenpox, from breathing in fluid droplets in the air when they cough and sneezing, or by touching the area of chickenpox rash (ie the liquid from the blisters). Children and adults of any age can get chickenpox but it is more common in children. After first being exposed to the varicella virus, the rash usually appears about 2 weeks later, from 10 to 21 days in most cases.
水痘会有并发症吗？
水痘是一个良性的自限性的疾病，在极少数的病人中，可能出现并发症，包括有细菌性的皮肤感染，肺炎和脑炎， 特别是在小婴儿，成年人，及有免疫受损的人群中。
Chickenpox Complications
Chickenpox is usually a benign and self-limiting condition. In rare cases, complications can happen including bacteria skin infections, pneumonia and encephalitis, especially in infant, adults and people with compromised immune systems.
水痘的治疗措施有哪些？
水痘是病毒感染，不能用抗生素治疗，大多数孩子会感觉不舒服5到7天左右。
1.治疗主要是针对缓解发热和皮疹的瘙痒症状
发热：可以使用对乙酰氨基酚 （泰诺林，必理通）退热。要注意的是水痘的孩子不能给予阿司匹林退热，防止发生会引起大脑和肝脏损害的瑞氏综合症。
瘙痒：可以使用抗组胺药物缓解水痘皮疹的瘙痒， 比如开瑞坦，仙特敏，苯海拉明。同时也可以使用炉甘石洗剂外用止痒。避免搔抓，否则会有继发皮肤细菌感染以及留下疤痕的风险。
口腔疱疹：患儿可能因为口腔疱疹的疼痛而进食减少，所以要鼓励孩子摄入足够的液体来帮助预防脱水及控制发热。
Chickenpox Treatment
Chickenpox is a virus and it cannot be treated with antibiotics. Most children with chickenpox are unwell for about five to seven days.
1. Treatment is about ease the symptoms of fever and itching
Fever: acetaminophen (Tylenol,Panadol,) can be used for fever. Children with chickenpox should not be given aspirin for fever or pain to avoid the Reye syndrome which can cause severe brain and liver damage.
Itching: antihistamine medications can be taken for itching, such as Claritin, Zyrtec and Benadryl. Calamine lotion may also be topical used to help with itching. Avoid scratching the skin to because it can cause a skin infection and increase the chances of developing a scar.
Blisters in the mouth may cause pain and thus appetite will decreased. Encourage children to drink enough to help preventing dehydration and controlling the fever.
2.抗病毒治疗
对于有发生重症水痘危险的人群，比如成人，12岁以上未接种水痘疫苗的儿童，有免疫受损的儿童，可以在病程早期使用抗病毒药物 （比如阿昔洛韦，伐昔洛韦）以帮助抵抗水痘病毒感染。
2. Antivirus medication
For people who are at risk of developing a more serious illness, such as adults, children older than 12 who are unvaccinated, children who have compromised immune systems, antivirus medication can be used (ie. acyclovir or valacyclovir) to help shorten or fight varicella infection if it is started in the early stage of the infection.
3.隔离和接触防护
水痘的传染性很强，从出疹前一到两天直到皮疹全部结痂整个病程都具有传染性。如果孩子罹患水痘，应该及时报告学校。水痘患儿应该停课在家隔离休息，不能去学校或者幼儿园上课，并且要与其他的儿童和成人隔离，直至最后一个疱疹结痂为止。已经干燥结痂的痂疹是没有传染性的。绝大多数以前得过水痘的人不会再次感染。
3. Isolation and contact precautions
Chickenpox is very contagious as early as one to two days before the rash show up until all the lesions crusted. You should report to the school if your child gets chickenpox. Children with chickenpox should not go to school or kindergarten and should be away from other children and adults until the last blister has dried. A dry blister scab is not infectious. Most people cannot get chicken pox again if they have already had it.
水痘疫苗接种
接种水痘疫苗被公认为是最有效的预防水痘的方法。让我们一起看看水痘疫苗在儿童和成人中的应用吧！
儿童： 目前在国内的免疫接种计划中，水痘疫苗属于自费的二类疫苗，自1995年起在上海市12月龄以上的儿童中推荐开始使用。2005年以后适龄儿童接种率逐渐提高，目前水痘疫苗是上海接种率最高的自费疫苗，接种率已经达到93%。推荐进行2剂接种以获得完全理想的免疫效果。美国的免疫接种计划从2007年开始推行水痘疫苗两剂接种计划，分别是12到15月龄接种第一剂，然后4到6岁加强免疫一剂。
接种水痘疫苗可以给予非常有效的预防和保护，保护率达90%。如果接种后没有获得完全免疫的儿童在接触水痘病毒后可能会发生水痘，但是通常会比较轻，没有发热，皮疹较少，恢复较快。另外，如果在预防接种前已经感染过水痘则不需进行接种。
成人：如果过去感染过水痘，则对水痘有终身免疫，不需预防接种。目前推荐对水痘没有免疫力的成人接种水痘疫苗，特别是有感染水痘风险的以及接触有重症水痘风险的人群，包括有：
●医疗工作者
●密切接触有免疫受损的人群（包括接受器官移植者及艾滋病患者）
●幼儿教师
●日托机构工作人员
●在大学，军事基地，劳教机构中的易感的青年人
●国际旅行者
●处于生育期的女性。但是，已经怀孕了或者近期准备怀孕的不应该接种水痘疫苗。
如果是易感人群，但不清楚之前是否有过水痘感染，可以先做血液检查明确是否有水痘病毒抗体。
Chickenpox Vaccination
For children: A chickenpox vaccination is recommended for children aged 12 months as part of their vaccination schedule inChina. Two doses of the vaccine is recommended to be fully vaccinated. InUnited States, a chickenpox vaccination is recommended for children aged 12 through 15 months of age and a booster dose at 4 to 6 years of age.
The chickenpox vaccine is very effective and protects against infection in 90 percent of those who are vaccinated. Vaccinated kids do not develop full protection from the vaccine may get chickenpox after exposure. However, it is milder and usually no fever and cause a less severe rash with quicker recoveries. The vaccine is not needed if a child is infected with chickenpox before being vaccinated.
For adults
People who had chickenpox in the past have immunity against chickenpox lifelong.
It is recommended adults who do not have immunity to chickenpox to have vaccination, especially those who are at risk of exposure to chickenpox and those who are in contact with people who are at risk for severe chickenpox infection. This includes:
●Healthcare workers
●Those who are in close contact with people with a compromised immune system (this includes transplant recipients and people with HIV)
●Teachers of young children
●Daycare employees
●Susceptible young adults in colleges, military bases, or correctional facilities
●International travelers
●Women of childbearing age; however, women who are pregnant or plan to become pregnant soon should not receive the varicella vaccine.
If you are at risk for chickenpox but are unsure whether you have had the infection, you can have a blood test to check for immunity to varicella.
澳大利亚墨尔本大学医学院
儿科博士百汇医疗（中国）儿科医师
蒋本然
