1.   Often, scratching the skin because it is itchy results in secondary infection.

2.   The recent report by Connolly et al of diarrhoea and malabsorption being more severe in the presence of detectable secondary infections supports this hypothesis.

3.   Nevertheless, in severe cases, pulmonary oedema and emphysema may occur and the lung surface may be studded with purulent areas of secondary infection.

4.   Secondary bacterial infection may complicate the signs.

5.   The only really effective means of reducing the incidence of secondary infections in the elderly is by vaccination, usually done in autumn.

6.   Although most people recover from chicken pox uneventfully or with a few minor scars, a small percentage suffer secondary bacterial infections of the lesions and more serious complications.

7.   And many antibiotics on which we have relied to surmount secondary infections have become ineffective on account of their overuse for minor illnesses.

8.   Antibiotics are even appropriate for the infirm elderly with flu and colds, or chronic heart, asthma and diabetic patients who also are more susceptible to secondary infections.

9.   Antiseptic and soothing lotions may relieve pain and itching of the bites, but any secondary infections shoud be treated with an appropriate antibiotic.

10.   About a third of the victims die, mainly from blood loss, low blood pressure, cardiovascular collapse and secondary infections.