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Preventing Varicella in Health Care Settings

Nosocomial Transmission of VZV

Nosocomial transmission of varicella-zoster virus (VZV) is well-recognized and can be life threatening to certain groups of patients. Reports of nosocomial transmission are relatively uncommon in the United States since introduction of varicella vaccine.

Patients, health care providers, and visitors with varicella or herpes zoster can spread VZV to susceptible patients and health care providers in hospitals, long-term-care facilities, and other healthcare settings. These transmissions have been attributed to delays in the diagnosis or reporting of varicella and zoster and failures to implement control measures promptly.

Although all susceptible patients in health care settings are at risk for severe varicella and complications, certain patients without evidence of immunity are at increased risk:

  • pregnant women
  • premature infants born to susceptible mothers
  • infants born at less than 28 weeks gestation or who weigh ≤1000 grams regardless of maternal immune status
  • immunocompromised persons (including those who are undergoing immunosuppressive therapy, have malignant disease, or are immunodeficient)


Management of Patients with Varicella

  • Follow standard precautions plus airborne precautions (negative air-flow rooms) and contact precautions until lesions are dry and crusted
  • If negative air-flow rooms are not available, patients with varicella should be isolated in closed rooms with no contact with persons without evidence of immunity
  • Patients with varicella should be cared for by staff with evidence of immunity

For more information, see management of patients with herpes zoster and management of healthcare personnel.

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