Managing People at Risk for Severe Varicella
Varicella Zoster Immune Globulin
Prevention for Susceptible Persons Who Cannot Receive Varicella Vaccine
For people exposed to varicella or herpes zoster who cannot receive varicella vaccine, varicella zoster immune globulin can prevent varicella from developing or lessen the severity of the disease. It is only recommended for people who cannot receive the vaccine and 1) who lack evidence of immunity to varicella, 2) whose exposure is likely to result in infection, and 3) are at high risk for severe varicella.
Persons at risk of severe varicella include—
- immunocompromised patients without evidence of immunity to varicella, such as—
- children with leukemia or lymphoma who have not been vaccinated
- people on medications that suppress the immune system, such as high-dose systemic steroids or chemotherapeutic agents
- people with cellular immune-deficiencies or other immune system problems
- newborns whose mothers have varicella from 5 days before to 2 days after delivery
- premature exposed babies exposed to varicella or herpes zoster, specifically—
- hospitalized premature infants born at ≥28 weeks of gestation whose mothers do not have evidence of immunity
- hospitalized premature infants born at <28 weeks of gestation or who weigh ≤1,000 grams at birth regardless of their mothers’ varicella immunity status
- pregnant women without evidence of immunity to varicella
The varicella zoster immune globulin product licensed for use in the United States is VariZIG™. VariZIG should be given as soon as possible after exposure to varicella-zoster virus (VZV) and within 10 days of exposure. For more information, see the Morbidity and Mortality Weekly Report article on Updated Recommendations for Use of VariZIG — United States, 2013.
American Academy of Pediatrics (AAP) recommends that certain groups at increased risk for moderate to severe varicella be considered for oral acyclovir treatment. These high risk groups include
- healthy, persons older than 12 years of age
- persons with chronic cutaneous or pulmonary disorders
- persons receiving long-term salicylate therapy
- persons receiving short, intermittent, or aerosolized courses of corticosteroids
Some health care providers may elect to use oral acyclovir for secondary cases within a household.
For maximum benefit, oral acyclovir therapy should be given within the first 24 hours after the varicella rash starts.
Oral acyclovir therapy is not recommended by the Advisory Committee on Immunization Practices or AAP for use in otherwise healthy children experiencing typical varicella without complications.
Acyclovir is a category B drug based on US Food and Drug Adminstration (FDA) Drug Risk Classification in pregnancy. Some experts recommend oral acyclovir or valacyclovir for pregnant women with varicella, especially during the second and third trimesters. Intravenous acyclovir is recommended for the pregnant patient with serious complications of varicella.
Images and logos on this website which are trademarked/copyrighted or used with permission of the trademark/copyright or logo holder are not in the public domain. These images and logos have been licensed for or used with permission in the materials provided on this website. The materials in the form presented on this website may be used without seeking further permission. Any other use of trademarked/copyrighted images or logos requires permission from the trademark/copyright holder...more
This graphic notice means that you are leaving an HHS Web site. For more information, please see the Exit Notification and Disclaimer policy.