Managing Persons at Risk for Severe Varicella

Varicella Zoster Immune Globulin

Prevention for Susceptible Persons Who Cannot Receive Varicella Vaccine

For persons exposed to others with varicella or disseminated shingles (defined as appearance of lesions outside the primary or adjacent dermatomes), varicella zoster immune globulin can prevent varicella from developing or lessen the severity of the disease It is only recommended for people at high risk for severe varicella who are not eligible to get the vaccine. Such persons include

• newborns whose mothers have varicella from 5 days before to 2 days after delivery
• premature babies exposed to varicella in their first month of life, specifically:
  • premature infants born at ≥28 weeks of gestation who are exposed during the neonatal period and whose mothers do not have evidence of immunity
  • Premature infants born at <28 weeks of gestation or who weigh ≤1,000 grams at birth and were exposed during the neonatal period regardless of maternal immunity
• children with leukemia or lymphoma who have not been vaccinated
• people with cellular immune-deficiencies or other immune system problems
• people on medications, such as high-dose systemic steroids that suppress the immune system
• pregnant women without evidence of immunity to varicella

Varicella zoster immune globulin should be given as soon as possible but no later than 96 hours after exposure to VZV.

The current licensed product for use in the United States is VariZIG™. For more information, see the Morbidity and Mortality Weekly Report article on A New Product (VariZIG™) for Postexposure Prophylaxis of Varicella Available Under an Investigational New Drug Application Expanded Access Protocol.

Acyclovir Treatment

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
• pregnant women with serious, viral-mediated complications (e.g., pneumonia); however, routine use of oral acyclovir in pregnant women is not recommended because of risks and benefits to the fetus and mother are unknown
• 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.

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