: Infectious chicken pox My 21 year old son has chicken pox and has been home for a few days now. The spots are just starting to crust over. I work with elderly people but have had chicken pox as a child - should I carry on

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You can continue to work as long as you take the usual common-sense precautions: wear clean clothes and wash your hands.

While varicella is one of the most contagious viruses we know of, the primary route of spread is droplets expressed when an infected person coughs or sneezes. It can also be spread by touching virus from varicella lesions. The virus is believed to have a "short" survival time in the environment (pinning down exactly how short is harder, but this should still be comforting.)

Labile outside host cell. It survives in the external environment for a few hours and occasionally for a day or two.1

As regards your son,

A person with varicella is contagious from 1-2 days before rash onset until the lesions have crusted.2

Your son is no longer contagious, and if you've had chicken pox, you are not contagious unless you develop breakthrough varicella, which is not as rare as people might think.

Approximately 15-20% of 1-dose vaccinated persons may develop varicella if exposed to VZV.3

People with breakthrough varicella are contagious. Breakthrough varicella is usually milder than first infections, and the rash is usually maculopapular (little red bumps) rather than the typical blistery lesions.

One study ...found that persons with mild breakthrough varicella (< 50 lesions) were one third as contagious as unvaccinated persons with varicella. However, persons with breakthrough varicella with 50 or more lesions can be just as contagious as unvaccinated persons.3

The take-home message here is you're fine as long as you don't have breakthrough varicella yourself, wash your hands before entering the building, and aren't rubbing your patients with your son's shirt.

As an aside, most of your patients have already had chicken pox; that's why they can get shingles. If they were so immune-compromised that your son's illness could affect them, they would probably break out with shingles before you could carry it to them.

1 VARICELLA-ZOSTER VIRUS, Section IV
2 Chickenpox (Varicella)
3 Slide set: Overview of VZV Disease & Vaccination for Healthcare Professionals available by clicking on link in 2