By Rachel Nall MSN CRNA

Reviewed by Cameron White, MD, MPH

Many people think of chickenpox as a childhood disease, but adults can get it, too.

In a healthy person, the varicella-zoster — or chickenpox — virus usually causes mild symptoms. However, in adults with chronic medical issues, especially those with weakened immune systems, more severe symptoms are possible.

The chickenpox vaccine has helped reduce the number of people who get the virus each year, but chickenpox can still develop in people of all ages.

In this article, we describe how to recognize and treat chickenpox in adults and look into whether adults can get the vaccine.

Symptoms

An adult with chickenpox may first experience common symptoms of a viral illness. These include:

• body aches
• fatigue
• a cough
• a fever
• a sore throat

Later, a person may notice a rash with tell-tale chickenpox lesions. Doctors call these itchy, fluid-filled blisters “vesicles.”

Chickenpox blisters usually first develop on the chest, back, or face. They can then spread to other areas, including the eyelids, genitals, and the inside of the mouth.

The blisters typically start to scab over 1 week after they appear, according to the Centers for Disease Control and Prevention (CDC). It is common to have lesions in different stages at the same time. For example, a person may have vesicles, pustules, and scabbed-over lesions.

Some adults who have received the chickenpox vaccine still experience mild symptoms. Doctors call this “breakthrough chickenpox.” In this case, a person may have a few chickenpox lesions and viral illness symptoms.

Some people still develop the full range of chickenpox symptoms after receiving the vaccination.

Treatments

Usually, doctors recommend supportive treatments for the symptoms of chickenpox until a person’s immune system stops the virus from replicating.

A doctor may prescribe the medication acyclovir (Zovirax) to reduce the duration and severity of symptoms. Acyclovir reduces the rate that the chickenpox virus multiplies within the body.

Doctors do not tend to recommend antiviral treatment for otherwise healthy children with chickenpox, but they can prescribe it for adults.

A person should take acyclovir as soon as they notice symptoms, for it to be most effective.

An article in the journal BMJ Clinical Evidence reports that adults who had taken acyclovir within 24 hours of noticing a chickenpox rash experienced less severe symptoms and symptoms that lasted a shorter time, compared with people who had not taken acyclovir.

However, not all adults with chickenpox need to take this medication. The body should naturally fight the virus, which should resolve over time.

Pregnant women, seniors, and adults with weakened immune systems — possibly as a result of HIV or cancer — should take acyclovir for chickenpox to reduce the risk of complications.

The following at-home treatment methods can help reduce itching and discomfort:

• Calamine lotion: Try applying this to itchy vesicles that have scabbed over, not to open lesions.
• Cool baths: Adding baking soda, colloidal oatmeal, or uncooked, unflavored oatmeal can help relieve symptoms. Colloidal oatmeal products are available for purchase online.
• Over-the-counter pain relievers: Medications such as acetaminophen (Tylenol) are available to purchase in drugstores or online, and they can help reduce any fever or body aches.
• Do not give children with chickenpox aspirin, because it increases the risk of a severe condition called Reye’s syndrome.

Complications

Rarely, chickenpox can cause severe complications, and it can even be fatal.

In the United States, adults with chickenpox are over four times more likely to die from the disease than children who have it, according to an article in the journal BMJ Clinical Evidence. An estimated 31 out of 100,000 adults with chickenpox die from the condition.

The most common complication that can be fatal is varicella pneumonia. This causes symptoms such as shortness of breath, a fever, a cough, chest pain, and low oxygen saturation.

According to an article in the Journal of Investigative Medicine: High Impact Case Reports, around 5–15% of adults with chickenpox have some respiratory symptoms.

Other potentially serious chickenpox complications can include:

• bacterial skin infections
• dehydration
• brain inflammation, called encephalitis
• severe bleeding
• severe infection in the bloodstream, called sepsis

Some people with chickenpox require hospitalization. They may need extra oxygen to help them breathe or antibiotics to treat bacterial skin or bloodstream infections.

Anyone with concerns about chickenpox complications should speak with a doctor about preventive measures and treatments. A doctor can also advise about getting a chickenpox vaccination.

Causes and risk factors

The chickenpox virus can travel in many ways. It can spread through respiratory droplets, when a person sneezes, for example, or through to contact with blisters. This is why the virus is so contagious.

Any adult who is not immune and who comes in contact with an infected person is at risk.

Even when a person no longer has chickenpox symptoms, the virus remains in their system. It can reactivate later and cause shingles.

Shingles is a painful condition that can cause itchy, burning lesions. A person who has never had chickenpox can get shingles by coming into contact with shingles lesions.

Stages

After a person has been exposed to the chickenpox virus, it takes several days for symptoms to develop. Below, we describe how the virus gets into the body and causes symptoms:

Initial exposure

Chickenpox can travel via respiratory droplets or through direct contact with an infected person’s saliva, tears, or fluid from a chickenpox blister.

A person with the infection can spread the virus as early as 2 days before they develop chickenpox lesions.

Incubation period

After the virus has been in the body for about 4–6 days, it begins to replicate in the lymph nodes.

The average incubation period before a person develops symptoms is 14–16 days.

Primary illness

A person typically starts to develop symptoms of a viral illness about 14–16 days after their initial exposure to the chickenpox virus.

These symptoms tend to include fatigue, a runny nose, and a cough.

Secondary infection

Several days after a person first experiences symptoms of a viral illness, the virus disseminates through the body via the blood vessels, leading to chickenpox blisters.

According to an article in the Journal of Investigative Medicine: High Impact Case Reports, most people start to see chickenpox blisters on their skin 10–21 days after the virus entered their bodies.

Usually, a person cannot pass on the infection once their lesions have crusted over and they no longer have a fever.

Vaccine

Chickenpox rates have reduced among all age groups because of the chickenpox vaccine.

Doctors usually give the vaccine in two doses. A child typically receives the first vaccine when they are 12–15 months old and the second at 4–6 years of age.

One vaccine, called ProQuad, contains vaccinations for measles, mumps, rubella, and chickenpox. Adults and children ages 12 years and older usually receive a chickenpox vaccine called Varivax, which only prevents chickenpox.

Adults can receive a chickenpox vaccine if they have never had chickenpox or if they were not vaccinated as children.

The CDC recommend the vaccine for the following adults, in particular:

• childcare workers, such as teachers
• college students
• females of childbearing age
• healthcare workers
• international travelers
• military personnel
• nursing home residents and workers
• others who care for people with weakened immune systems

Doctors do not usually recommend that pregnant women get the chickenpox vaccine. This is because the vaccine contains live viruses that can affect pregnancy.

If a pregnant woman has a high risk of chickenpox but has never gotten it, the doctor may inject a medication that can help protect her immune system against chickenpox.

Also, a person can get the chickenpox vaccine if they have never had chickenpox but were recently exposed to it. The CDC recommend vaccination 3–5 days after exposure to chickenpox.

Outlook

Because of the chickenpox vaccine, the condition is now highly preventable. Most adults can get the chickenpox vaccine.

If a person has chickenpox, taking acyclovir, supportive treatments, or both can help reduce the symptoms.

Anyone who thinks that they may have chickenpox should consult a doctor, who can also address any other concerns about the virus.