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School Nurse Guide to Chickenpox

Y’all ever get a call from a mamma, “I’m keeping Little Kyle home because he has the chickenpox?” I love those calls. No, actually that was a lie; I don’t like those calls. The first thing I do is wonder, who in that classroom is not vaccinated…then…who in my school is not vaccinated. I actually know this information and can put my finger on it rather quickly. Then…well…now what? Right?

Let’s do some talking about chickenpox. Let’s talk about these things:

About Chickenpox.

How is Chickenpox Spread?

What do we School Nurses do?

Secondary Bacterial Infection.

To Exclude or Not to Exclude?

More About the Vaccine.


What Is Chickenpox?

Chickenpox is caused by a virus called varicella-zoster (VZV). After exposure, there is a whopping 10-20 days (usually about 15 days) before symptoms develop. TWO WEEKS from exposure to pox and itching…and oh…don’t they itch.

I remember having chickenpox as a child. Mamma had set up a playdate with a kid who was covered in little mosquito bites (God has forgiven my mother…I’m still working on it (na, I love mamma…it’s all good)). That playdate was during the summer months. Mamma would say, “Stop scratching! Don’t pick the scabs! You’ll get pox marks! (pox scars)” There was no vaccine for us poor souls back in the 70s (the vaccine didn’t come out until 1995 (The chickenpox vaccine was added to the childhood immunization schedule in 1995. The booster dose was added in 2006)).

How Does Chickenpox Spread?

Though chickenpox is “seen” as a bunch of tiny (some are not-so-tiny) red spots and blisters all over the body’s skin (a big-bad rash), the varicella-zoster virus is spread by someone coughing or sneezing and “blowing” the virus into the air. What’s crazy is: this virus can live after the sputum has dried and the virus can piggy-back onto dust particles (Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide (American Academy of Pediatrics). Then they float around getting “sucked in” by this child and that child (or me and you).

My first inclination would be to look at the child’s classroom roster and see who’s not vaccinated. Though that would be the first thought, the virus can travel on those dust particles into this room and to that room. This free-loading, dust ridding virus rides the wind currents caused by air vents, open windows, opening and closing doors, or just the wind break from folks walking up and down the halls of your school. So, consider the whole school “the classroom.”

Wanna know something grosser than viruses from slobber? Viruses from drippy sores. Yes, the virus can leak from inside the blisters as they break open during scratching or just losing integrity. The drippy stuff dries and then finds a cool dust-bunny to float all around on until…

Though the incubation period is kinda long (two weeks or so), the most contagious period is when the rash is spreading on the body. But, most of the time, the child’s illness is not noticed until…you guessed it…until the rash is starting to spread.

The “whew!” moment comes when the child’s blisters and red spots are all dried up an there are no new blisters that are forming (Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide (American Academy of Pediatrics)

What do we School Nurses do?

  1. I’ll clarify later, but the first and foremost intervention is to exclude the child from school. They must be excluded until the rash is all crusted over (that’s pretty gross…skin crust…ewwwe).
  2. You will report the infection to the health department. Yep, give a call to the nice folks at your local and trusted health department.
  3. Promote awesome hand-washing (sign up for Nurse Kevin’s Awesome Newsletter and you’ll get an awesome hand-washing PowerPoint Presentation that will get the kinders snapping their fingers and the seniors saying, “Oh Please!”).
  4. Air out the room by opening the windows. Just opening the door won’t work too well. You want the piggy-backing, dust-riding virus to go OUTSIDE. Open the windows, put a fan in the windows blowing to the outside and crack the door slightly to form a suction: Bring Clean Hall Air into the room and blow Bad Room Air out through the windows
  5. Though you’ll want to notify ALL staff and parents/guardians (no vaccine is 100% effective) of the infection (with privacy maintained for the infected), you will want to specifically notify folks that have not been vaccinated.
  6. Be sure to follow your district’s policy…period. And also follow your nursey senses.

Secondary Bacterial Infection.

When I worked hospice, we had a gentleman develop a pretty nasty case of shingles. The doctor first started the patient on antivirals. Later the patient started a round of antibiotics. Why? Because the sores on the skin became infected and likely due to the open sores that were caused by the virus. To put it simply: The Virus caused the sores with the opportunistic bacteria infected the sores.

There have been children who have developed bacterial sepsis associated with chickenpox. Some children have died and not because of the virus but because of the secondary group A streptococcal septicaemia.

To Exclude or Not to Exclude?

Yes, certainly, by all means and amen. Like the great Captain Picard said, “Make it so Number One.” You, the school nurse being “Number One.” Hey, at least he didn’t say, “Number One, I order you to go take a Number Two.” (A little Beavis and Butthead humor…not that I watched them…I just absorbed the humor by means of osmosis when my little knucklehead brother would watch).

More About the Vaccine.

First of all, here’s a copy of the VACCINE INFORMATION STATEMENT

The CDC Suggests: 

Children 12 months through 12 years of age should get 2 doses of chickenpox vaccine, usually:

  • First dose: 12 through 15 months of age
  • Second dose: 4 through 6 years of age

People 13 years of age or older who didn’t get the vaccine when they were younger, and have never had chickenpox, should get 2 doses at least 28 days apart.

FYI: If you see “MMRV” on the child’s vaccination record, that is BOTH the MMR vaccine and the varicella vaccine all mixed up into one.

Before 1995, when the vaccine was incorporated into the required group of vaccines, there were about 4 million cases of chickenpox per year. Each year about 10,600 hospitalizations and around 100 to 150 people died due to complications. A single dose of the vaccine reduces risk of chickenpox between 70-90%, and two doses reduce the risk even more.

A final word

Don’t give a child aspirin if they have the chickenpox…or the flu…or hand, foot, and mouth disease or…to be safe, at anytime. Acetaminophen and Ibuprofen work just fine most of the time. There’s a condition called Reye’s Syndrome. Reye’s syndrome is a rare condition but is super serious and affects children and teenagers recovering from viral infections who take aspirin. The exact cause of Reye’s syndrome is unknown.

Salicylates are a major ingredient in aspirin. Consider other medications that are not aspirin: What about pepto-bismol? It has salicylic acid as an ingredient. What about Oil of Wintergreen? Did you know that Wintergreen Oil is 96-99% methyl salicylate? Consider that Wintergreen is a common flavoring in gum, mints, and candies as well as smokeless tobacco.

And In Case any of you are wondering about poor old Nurse Kevin and his “elective” chickenpox exposure. I recovered. I am doing well today…and yes…I still love mamma.

May All Your Splinters Be Shallow,

Nurse Kevin


Nurse Kevin
Nurse Kevin is a school nurse who takes care of school children in Southwestern Idaho. Nurse Kevin authors content for many different websites including,,,,,

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