The Hawaiʻi Department of Health (DOH) is reporting the expansion of a community outbreak of chickenpox (varicella) on Kauaʻi to 10 cases, linked to four schools, raising concerns that the disease will continue to spread.

The DOH Disease Investigation Branch (DIB) urges families and schools to take proactive steps to limit the spread of chickenpox on Kauaʻi.

Last week, five cases were reported linked to Kīlauea Elementary School. Five additional cases were reported from three other schools: Hanalei Elementary School, Kauaʻi Christian Academy and Island School. All the cases involve children under the age of 18. One case was partially vaccinated with one dose and had milder illness; the other nine were unvaccinated.

Community members who have not previously been infected with or fully vaccinated against chickenpox are at risk of infection, but can protect themselves and others by getting chickenpox vaccine now. Some individuals cannot be vaccinated and may be at risk of severe disease if exposed and they are not already immune — especially pregnant women, newborns and those with medical conditions that weaken their immune system. These individuals or their caregivers should seek medical advice to learn about other medications they can take for protection.

Many schools on Kauaʻi have low vaccination rates among students. Because of the potential for spread, the DOH strongly recommends the following precautions for those who may be at risk:

• Get the varicella vaccine: Two doses will provide nearly 100% immunity, or significantly reduce severity of symptoms.
  • Normal doses: For children, one dose at age 12-15 months, the second at age 4-6 years.
  • During an outbreak: An accelerated schedule is recommended for eligible adults and children ages 1 and older. Allow at least a month between the first and second dose.
  • Groups at highest risk of severe disease: Non-immune adolescents, adults, pregnant women and those with medical conditions that weaken their immune system. Infants are also at high risk, but not eligible for vaccine until a year old, so household members of infants younger than one year should check their immune status and get vaccinated if not already immune.
• If you can’t get the vaccine for medical reasons, talk to your doctor immediately: If you are not protected against chickenpox (did not previously have infection or vaccination), seek medical advice about the best options for protection. Especially vulnerable are pregnant women, newborns and those with weakened immune systems.
• Stay home: If showing any signs of infection (red rash, blisters), isolate at home until all rash blisters form scabs (usually five to seven days). This will reduce the risk of spreading the disease. Early signs one to two days before the rash can include fever, loss of appetite, headache, or tiredness. When in doubt, stay home and avoid exposing others.
• No “chickenpox parties”: Trying to achieve immunity through deliberate exposure to chickenpox can cause unnecessary suffering by the child, increase the child’s lifetime risk of shingles, and make someone in vulnerable health who gets exposed seriously ill. Two doses of vaccine provide lifelong protection for most people and reduce the risk of contracting shingles