Chickenpox (varicella) is often harmless in healthy children, but once infected it can lead to shingles (herpes zoster) later in life. From 2023, the combined MMRV vaccination is recommended for all children aged 9 and 12 months. A catch-up vaccination is recommended between the ages of 13 months and 39 years.
Pathogen and transmission
Chickenpox (varicella) is a highly contagious disease caused by the varicella zoster virus (VZV). VZV can also case shingles later in life. The virus is easily transmitted from person to person through the air in respiratory droplets. The blister fluid of a chickenpox rash or shingles is also infectious. Chickenpox usually occurs in childhood as an unpleasant but generally mild and harmless disease. An infected person is already contagious two days before the rash develops and until the final blisters have formed scabs.
Infection with VZV usually confers life-long immunity to chickenpox, but the viruses remain in the body and may eventually cause shingles later in life.
Clinical picture
Chickenpox (Varicella)
Mild fever and tiredness develop two to three weeks after infection, followed by a rash that is often itchy. The little red spots develop into pustules and blisters that ultimately dry out and form scabs that drop off.
People usually catch chickenpox only once in their lifetime.
However, complications such as bacterial skin infections can occasionally occur. Serious complications such as pneumonia, encephalitis and meningitis are rare. If the disease does not develop until adulthood, the risk of complications is higher than in children. Newborns, people with a compromised immune system, pregnant women (pneumonia) and their unborn children (high risk of malformation) are at particular risk.
Shingles (Herpes zoster)
After a person has had chickenpox, the virus remains unnoticed in the body (in the dorsal nerve ganglia) for the rest of their life. The virus can be reactivated, particularly at an advanced age and in immunocompromised people, in the form of shingles (herpes zoster). In this condition a rash and blisters form in a defined area on one side of the body. Various complications can occur: The rash is occasionally accompanied by severe, persistent pain (“Post-herpetic neuralgia”) and, in 10-20 percent of cases, one eye is affected by the rash (risk of blindness).
Treatment for chickenpox or shingles is usually limited to symptomatic relief. In some cases, a virostatic drug (which inhibits the development of the virus) may be used.
Occurrence and frequency
Varicella zoster viruses occur throughout the world.
Chickenpox occurs year-round in Switzerland. Practically the entire adult population (98 percent) has antibodies to the virus, i.e. most people had chickenpox during their childhood.
Of those who do not catch chickenpox until they are 16 or older, every year, approx. 50 need to be hospitalised for complications, and roughly 20 in every 100,000 of the over-16s die of the disease, i.e. approx. 10 to 20 times more commonly than in children.
About one third of all people who were infected with VZV, will eventually develop shingles later in life.
Prevention/vaccination
As of 2023, vaccination against varicella (chickenpox) with two doses is recommended as a routine vaccination for all infants aged 9 and 12 months. It should preferably be given with a combined, quadrivalent MMRV vaccine that protects against four diseases: Measles, Mumps, Rubella and Varicella.
Due to the elevated risk of complications in adults, VZV infection should be prevented in anyone who has no immunity yet. A catch-up vaccination against chickenpox / varicella (or MMRV) is therefore recommended for all children, adolescents and adults aged 13 months to 39 years (i.e. up to their 40th birthday) who have not yet contracted varicella and who have not yet received a total of two vaccine doses. The vaccination requires two doses at least four weeks apart. If there is uncertainty about a previous chickenpox infection, the IgG antibodies can be determined to clarify the immune status.
From January 2023, the costs of vaccination against chickenpox for children, adolescents and adults aged up to 39 years (i.e. up to their 40th birthday) are covered by the compulsory health insurance (basic insurance). This includes the recommended basic vaccination and/or the catch-up vaccination with varicella monovalent vaccines or combined MMRV vaccines.
Immunisation against herpes zoster (shingles) with the adjuvanted subunit-vaccine (Shingrix®) is recommended in Switzerland since 2022. This applies to healthy persons aged 65 and over and for patients with an immunodeficiency aged 50 and over or with severe immunodeficiency aged 18 and over. Two doses are required, at least two months apart. For patients with immunodeficiency, an interval of four weeks might be considered on an individual basis. Vaccination with the subunit vaccine is reimbursed by the compulsory health insurance from February 2022.
The previous 2017 recommendations for the attenuated live vaccine (Zostavax®) now only apply to people aged 65 to 79 years without immunodeficiency who prefer the live vaccine over the subunit vaccine. Vaccination with the live vaccine is not reimbursed by the compulsory health insurance.
Documents
EMP_211117_EKIF FOPH_Analytic Frame SHINGRIX_final (PDF, 1 MB, 18.11.2021)Evaluation of the Federal Commission for Vaccination (FCV)
Version: November 2021
Last modification 14.04.2024
Contact
Federal Office of Public Health FOPH
Division Communicable diseases
Schwarzenburgstrasse 157
3003
Bern
Switzerland
Tel.
+41 58 463 87 06