Dr Julius Parker: Chicken Pox and a broken hip

Q Our youngest child, aged six, has just come through chicken pox but, seven days after the event, there is no sign of marks on her siblings. Her two eldest siblings, however, (13 and 10) have had flu-like symptoms, and vomiting, intermittently for the last few days. Could they be fighting off chicken pox, or is it likely they have some other illness, like a prequel to flu? There is an outbreak of measles in the area, but they have all been vaccinated, and the eldest (13) had his booster last year. Also, is there any chance of them escaping from chicken pox, although none of them have had it as children? Two other siblings share the same bedroom as the youngest, although she is fully recovered now.

A Chicken pox is highly infectious; the secondary infection rate from a household contact can be up to 90%. This means your other children are very likely to catch chicken pox. You will know by the time you read this, but a short illness with fever and general malaise can precede the development of the typical rash. The incubation period can be between one to three weeks and people with chicken pox remain infectious until all the blisters are crusted and dry. Of course, some people don’t get chicken pox even when everyone around them does. This might be luck, but a more likely explanation is they have already had it, and are immune when exposed again. Some cases of chicken pox, especially in young children, are very mild and if no or only one or two blisters occur the illness may not be recognised by parents for what it is. One British study showed almost 90% of adults who reported no history of chicken pox were antibody positive, meaning they’d been infected in the past.

Antibody testing isn’t routinely needed, but if your older children have been in contact with cases of chicken pox in the past and not developed a rash this time the most likely explanation is they’ve already had the illness. This is good news, as chicken pox tends to be a more unpleasant illness in adults.

Q My mother has been in hospital for several weeks recovering from a broken hip. I visit every day and have been using the gel antibacterial hand sanitisers religiously. But recently my knuckles have started to flake and crack. Is there a good alternative sanitiser available for sensitive skins?

A I hope your mother’s recovery is going well and that by now she’s been able to return home. As you say, antibacterial hand sanitisers are extensively used in hospitals to reduce the risk of cross-infection. Most of the products used contain at least 60% alcohol, which used in a hand rub is very effective at killing bacteria and viruses present on the skin. Alcohol does tend to strip away the protective oily layer on the outer skin, so regular usage can cause skin dryness and irritation. It is also possible to become sensitised to one of a number of chemicals used in such gels, and this is more likely if you have a background of eczema or skin allergic reactions in the past.

From what you describe I suspect the regular use of an over-the-counter moisturiser during the day would be sufficient to settle your skin. Hopefully if your mother’s recovered you would not now be visiting hospital.

Non-alcohol hand sanitisers are available, using other bacteriocidal chemicals, and some manufacturers have developed products which contain moisturising creams. These tend to be for personal use and so are unlikely to be routinely available in hospital, but may be acceptable as an alternative. You could discuss this with your pharmacist and the ward sister at your mother’s hospital.