The VZV virus, which is spread by airborne droplets, is extremely contagious. The incubation period ranges from 10 to 23 days. One to three weeks after exposure, a rash appears on the torso, face, armpits, upper arms and legs, inside the mouth, and sometimes in the windpipe and bronchial tubes, causing a dry cough.

The rash is made up of small, red, itchy spots that grow into fluid-filled blisters within a few hours. After several days, the blisters dry out and form scabs. New spots usually continue to form over four to seven days. Children usually have only a slight fever, but an adult may experience fever with severe pneumonia and breathing problems. Adults usually have higher fevers, more intense rash, and more complications than children.

The average child will have between 250 and 500 blisters over about five days; the more blisters the child has, the harder the body has to fight to make enough antibodies to destroy the virus. The fight between the virus and the immune system causes fevers, fatigue, and poor appetite. Those who catch the disease from a sibling instead of a classmate usually have a more severe illness, from 300 to 5,000 blisters. This is because the close contact at home causes a much larger amount of virus to enter the system.

The patient is infectious from five days before the rash erupts until all the blisters are completely healed, dried, and scabbed over. This can take from six to 10 days after the rash appears.

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