Chickpox and Pred

I have been on long term high dose pred for some years now and on sunday I came into contact with a lovely little boy who the following day came out with the chicken pox! Now I was told that if I had been in contact with someone who has chicken pox even though I have had it before I should contact my GP. I called and was told by the receptionist not to worry unless I got shingles. So why was I told to contact my GP if I came into contact with chicken pox if you just have to wait until you get shingles.


19 Replies

  • I have been told many times over the years that everytime Sean comes into close contact with chickenpox he must be admitted for 5 days of I.V , think it was anti viral drugs. By some miracle he has never been in contact but Ive been told by RBH pred and Chickenpox is not good combination due to potential side effects. To be honest though I wish Sean had it when younger cos Ive built up a bit of an irrational fear of him catching it.

    Good luck sorting it out, Could you ring RBH and ask their advice?

    Hope you dont get Shingles!!

  • i would push to speak to gp bex and not settle for receptionist advice as arn't you more at risk cause of immune system if on pred and while chickenpox is not nice shingles is nasty.

  • I have had chicken pox so I guess I am immune I don't know if pred and shingles are some nasty combination. Any chance one of our Dr's could give me definitive advise I am not fond of using up GP's valuable time for nothing.


  • not necessarily bex u can get it more than once and if u have had chickenpox the chances are that you are less likely to get spots again (unless it was v mild 1st time) but shingles which are painful to say least.

  • 'any chance a doc can give def advise' ?????

    Are you saying our inane ramblings are not helping ha ha

    Only kidding :-)

  • hi bex,

    i ahve been on long term pred and my little bro's friend got chciken pox and was in contact with him.I ahve managed to get chicken pox twice somehow i dont but when i was on contact with this kid i spoke to the gp and was asked to come in and have an antiviral injection and have a course fo tabletsto take for 5 days. am sorry i cant remember the name of the tablets but there were antiviral things.

    sorry cant be of more help. hope you manage t get some answers.


  • usual antiviral is aciclovir me thinks

  • Hi Bex, I was in a similar position to you earlier this year. I spoke to my GP on the phone about it and she explained that it was unlikely that I would contract chicken pox or shingles as I'd had chicken pox as a child, however I was right to be concerned and aware due to long-term, high-dose pred. My GP assured me that there was no need for medication unless I developed any signs of either chicken pox or shingles, but if I did then they would quickly treat me with IV (I think) immuno globulin, and that may require a few days in hospital. At first I wasn't convinced that I shouldn't have the meds as a precaution anyway, but my GP said I really didn't need it unless I developed symptoms/signs/spots. I didn't contract either chicken pox or shingles and I'm pleased I didn't have the meds, because, quite frankly, I take enough as it is and spend enough time in hospital all ready.

    I hope this helps to alleviate your anxieties.


  • Chickenpox is a funny old virus.

    The primary infection - Varicella zoster, which we call chickenpox - is a respiratory (no, really, it is) virus and can be caught after being in the same room as the index case (the person wot's got it) for 10-15 minutes. 14-21 days later, you then develop a body-wide rash. As your body fights the infection, the virus becomes dormant in the nerve-endings (the sensory dorsal root ganglion, for those of you with a medical bent). Shingles (herpes zoster) can occur when this virus is re-activated, for example in the case of immunosuppression or stress.

    There have been documented cases of people being more at risk of developing shingles after being exposed to chickenpox, although the reason for this isn't clear (theoretically this ""doesn't work""). It is possible, but rare, to get chickenpox twice, particularly if your immune system if below par, and being on corticosteroids would certainly count in this group. The guidance that I'm looking at isn't particularly clear regarding whether people who've already had chickenpox should receive antiviral treatment, but it does cite that it is possible to have more severe herpes zoster (shingles) when on corticosteroids.

    Individuals on corticosteroids who have never had chickenpox and are exposed are advised to have VZIG injections to ""passively immunise"" them against the infection.

    I think the long and short of it may be to talk it through with your doctor and ascertain the local protocols. It seems from the reading I've done that there may be a slightly increased risk of a second chickenpox infection or more severe shingles (though this is rare and not understood), so you may be offered anti-viral tablets.



  • And yes Emily, the usual anti-viral agent it aciclovir - taken five times a day (eek).

  • yes 5 times a day for a week, 5 hours apart, so in the middle of the sodding night. Am very glad that my last dose is due at teatime tomorrow, having had shingles for nearly a week!!!!

    Would definately talk to GP, and if you are to develop chickenpox/shingles get aciclovir quickly (need to start within 72h but asap) because if you get shingles you can get really bad pain for years afterwards - hence I am actually setting my alarm for 4am because I am scared of pain.

    15mins till last dose before bed, so best get off the computer and head in that direction!


  • Cathy's pretty much said it all, but just to add that if you're not sure whether you've had chicken pox, or if you have had it, but only mildly, you can get your antibody levels checked with a blood test.

    I was exposed to it at work about three years back - treated a young man who turned out to have chicken pox meningitis and had spent quite a while each day bending over to him very close to look at the backs of his eyes with an opthalmoscope. I was on high dose steroids at the time and since my mum could not remember whether I had had it or not, Occy Health took a blood test for the antibodies. Luckily it came back showing I had had it and had sufficent antibodies to make me immune, but if I hadn't done, they would have admitted me for IV immunoglobulin (essentially other people's antibodies pooled from the general population of blood donors) to give me passive immunity, and would probably also have given me aciclovir too.

    I think it's worth anyone who is on steroids regularly asking about the antibody test, just so that you have that reassurance that you are immune, prior to having an exposure. If you are not immune, it is possible to be vaccinated, but receiving even the vaccine is not recommended to people on high dose steroids, or people with severe eczema, as it is a live vaccine and can therefore give you chicken pox if you are immunosuppressed. It is of course, as with anything, a risk-benefit analysis and some doctors might still consider giving you the vaccine even if you were on pred if you had never had it and were at high risk of coming into contact, eg if you have small kids. Certainly, if you are not always on high dose pred, but are sometimes, and you are at risk of contact and have never had it, it is worth asking about the vaccine at a time when you are not on pred.

    If you have young kids who have not had it, and are yourself on pred, it is probably also worth considering asking if they can be vaccinated so that they don't get it and pass it to you. Again, though, the live vaccine carries a small risk of developing mild zoster infection, so if they were vaccinated and developed a rash immediately after, they would be infectious to you.

    The main risk to people on pred is that they will get a more severe chicken pox infection - most of the time this is just in the form of a particularly nasty rash, which is usually unpleasant but nothing more, although it can be dangerous if you have a lot of open sores and you get a secondary bacterial infection - you can get septic really quickly, and if you have a lot of open sores you can also lose fluids and salts to a dangerous level, sort of like with burns.

    The really nasty bit is that people who get chicken pox when immunosuppressed are also more at risk of chicken pox meningitis, encephalitis (brain infection) and pneumonitis (lung infection) - I have treated patients with all of these and they are really really not nice (so I was panicking rather when I found out my meningitis patient had chicken pox meningitis and I had been rather heavily exposed!) The good news is that they do tend to respond to anti-viral therapy once they have been diagnosed, but they are very unpleasant and potentially dangerous.

    Shingles is less dangerous, as it usually only involves reactivation of the infection in one small portion of the skin (the portion supplied by one nerve) but it is very unpleasant and painful, and can result in nerve pain in the area for some time afterwards. It is not as infectious as chicken pox, as it is not transmitted by respiratory transmission (ie the virus is just contained within the fluid of the vesicles, rather than exhaled from the lungs as it is in chicken pox). It is possible, though, if you haven't had chicken pox, to catch it from someone with shingles, if you have direct contact with the rash, and more specifically with the fluid from the vesicles.

    I don't think there is anything anyone can particularly do to avoid shingles, it is a risk to anyone who has had chicken pox, due to reactivation of the virus, and I believe about 50% of people who have had chicken pox will get shingles at some point. It is not generally 'caught', as Cathy says, although incidents have been described (I tend to think that the cases described were co-incidence - as Cathy says, it doesn't make medical 'sense' otherwise!). Reactivation tends to occur at times when the immune system is low, such as when recovering from another illness or when on the dreaded pred. The only thing you can really do is to be very aware of the symptoms, if you have had chicken pox and are on pred, so that you can go to your doctor and get treatment (aciclovir again) at the earliest opportunity.

    It starts with general feelings of malaise for 2 - 3 days, with headache and often a mild fever, then pain in one particular area of the body - often intense burning or tingling pain. Then a blistering rash appears in the area affected - this is usually a localised and discrete area (the area supplied by one nerve, a dermatome - see for a picture of the dermatomes). It doesn't usually cross the midline. The rash usually lasts 2 - 4 weeks, but will usually clear up faster if you get treatment promptly. You should be particularly keen to get treatment if you are on steroids, or are immunosuppressed for any other reason, or it is affecting the ophthalmic division of the facial nerve, ie the area over the eye - if it does affect this area, your doctor may want to send you to see an ophthalmologist to make sure there is no likelihood of damage to your cornea.

    Remember if you have shingles you are still mildly infectious to others (although less so than with the pox) so you should stay away from others on pred or otherwise immunosuppressed (eg HIV, chemotherapy) and from pregnant women.

    Anyway, that is virtually everything I know about chicken pox (apart from some rather esoteric genetic stuff, but I don't think I'll bore you all with that!). I like virology - can you tell?!

    Bex, I hope you don't succumb to the dreaded pox, but if you do, don't panic, most of the time it responds well to the treatment and is not nearly as dangerous as you might think. Just keep a close eye on things and make sure you seek help quickly both initially and again if things deteriorate.

    I'm just glad I did have it as a child after all!

    Take care all,

    Em H

  • Can children still carry chicken pox back to you if they have had it I have had chicken pox twice so is it likely i could still get shingles


  • Been to DR this morning, I hate early appointments cos I am still recovering from the night and I had to explain the rather convoluted story with less than enough breath! Anyway after the ""are you sure you are OK"" she did a blood test but as I had really bad chicken pox as child everyone (she went to consult) thinks the odds of getting it again are remote. As to shingles if I get any signs they will treat it right away.


  • Tracy,

    Your children are unlikely to be able to carry chicken pox and pass it to others if they have had it already, although it's not out of the question. Certainly, if you've had it twice yourself, you should hopefully have sufficient antibodies to prevent you from catching it again.

    As for shingles, though, you will not *catch* it from anyone (at least, it's very very rare), but you are still at risk, having had chicken pox in the past - as shingles is caused by reactivation of the infection in someone who has had chicken pox in the past. You would be particularly susceptible if you are immunosuppressed in any way such as being on steroids. There is nothing much you can do to remove the risk - the only thing you can do is be vigilant for the early signs as I have described below and get treatment early if you are striken by it.

    Hope this helps

    Em H

  • Hi All

    Sorry to add another question!!!!

    My 3 year-old son has asthma - not on long term pred but tends to have to have it for 5-7 days a month throughout winter. He hasn't had chicken pox but bearing in mind his age and constant exposure to bug infested children (him included) it's only a matter of time!!!

    Last year he was exposed to CP and had to be admitted to hospital due to asthma - we were isolated due to this - as he was a risk to other patients - he was given pred - it wasn't until we got home and i started looking up asthma on web that i realised that having pred and contracting CP was a problem - hospital never mentioned it even though he was on his 5 course in as many months (sorry for ramble) anyway to my question.

    Does taking pred in short doses (3 - 5 days) about 1/2 times a month for winter months suppress the immunity? Or am I getting stressed over nothing. I can't get Ollie vacinacted as it isn't licenced for children under 12 (i think - maybe 9) in this country unless they live with immunity suppressed people.

    Ollie's asthma has been well controlled over summer months so no worries - but now that he's at pre-school and cold mornigns and evenigns are here - he's ill - one week as pre-school and colder weather and he has cold/cough /chest infection and on 10 puffs salbutamol 4 hourly and 20 mg pred (hopefully it won't be like last year when he was ill and in/out of hospital until spring) - soon it will be the CP season so i'm getting stressed about the implications of taking pred and exposure!!!!!

    Thanks in advance for any advice/ answers.


  • Hi Claire,

    It is a difficult issue and I do sympathise with your worries. As you experienced, doctors will usually still give pred to someone having an exacerabation of asthma even if they have had a recent chicken pox exposure, as the real risk of their asthma not being treated outweighs the hypothetical risk that they will get chicken pox - and the potential complications of getting chicken pox whilst on pred *can* be treated, especially if the child is in hospital and being closely monitored, and the chicken pox is therefore picked up quickly.

    In terms of the regular courses of pred - I have no particular references to back this up, but the frequency of courses you are describing would, I think, probably not cause significant immune system suppression in between courses.

    It would still be a potential problem if he was exposed to chicken pox whilst actually on pred. The only thing you can really do is to be vigilant to the signs and symptoms of chicken pox, so that you catch it early, seek medical attention quickly if he is exposed while on pred, even if he doesn't have symptoms, and make sure all his friends' parents understand the importance of letting you know if their kids have the pox.

    It might still be worth discussing the vaccination - it probably wouldn't be used in such a young child, as it is a live vaccine and therefore does have slightly more risks, but the fact that it is not licensed doesn't necessarily mean that it can't be given. Many doctors, particularly specialists/consultants, would consider giving medication outside of its licensed recommendations if the benefit was seen to be great enough.

    I hope this helps; I would recommend though that you discuss your concerns with your doctor too.

    Take care

    Em H

  • I have often wondered about chickenpox and long term pred. I have been on 40mg of pred since feb and often come into contact with children with chicken pox through work, I am a paediatric nurse. Have been told that i should be ok, occ health have said this. But is it ok or am I at risk?

    Carolyn xx

  • Carolyn,

    If you have not had chicken pox, or have had it only mildly and don't have sufficient antibodies, you are at risk of contracting it and of getting a worse form due to being on pred. Could it be that Occy Health have your old health records or blood test results and that they know you are immune - perhaps that is why they are saying you aren't at risk?

    If you haven't had it, you can be immunised, but most people would not do this whilst you are on pred, as it is a live vaccine and might give you mild chicken pox, which would be worse if on pred.

    If you come into contact with it, you can have passive immunisation with iv immunoglobulin (antibodies) to help to stop you getting it - the effect lasts a few weeks.

    If you contract it, you can have treatment with aciclovir to shorten the duration of infection and likelihood of serious complications.

    Hope this helps


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