Preventing Varicella-Zoster Virus (VZV) Transmission from Herpes Zoster in Healthcare Settings

Management of Patients with Herpes Zoster

Infection control measures depend on whether the patient with herpes zoster is immunocompetent or immunocompromised and whether the rash is localized or disseminated (appearance of lesions outside the primary or adjacent dermatomes).

In all cases, follow standard infection control precautions. Use the table below to determine if any additional infection control precautions are required.

Infection control precautions based on patient’s immune status and rash localization

Management of Healthcare Personnel with Herpes Zoster

Guidance for work restrictions for healthcare personnel exposed to or infected with certain vaccine-preventable diseases and conditions, including herpes zoster, are summarized in Table 5 of Immunization of health-care personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP). As noted in this guidance:

• For localized herpes zoster in an immunocompetent person
  • Cover lesions and restrict from care of high-risk patients (i.e., patients who are susceptible to varicella and at increased risk for complications of varicella, including neonates, pregnant women, and immunocompromised persons of any age) until all lesions are dry and scabbed.
  • If lesions cannot be completely covered, exclude from duty until all lesions are dry and scabbed.
• For disseminated herpes zoster or localized herpes zoster in an immunocompromised person until disseminated infection is ruled out: exclude from duty until all lesions are dry and scabbed.

Management of Healthcare Personnel Exposed to Someone with Herpes Zoster

Healthcare personnel who have one or more documented dose(s) of varicella vaccine or other evidence of immunity to varicella

• Do not need post-exposure prophylaxis
• Do not need work restrictions.
• Should ensure they are up to date with two documented doses of varicella vaccine.
  • If they have only one documented dose of varicella vaccine, they should receive the second dose within 3 to 5 days after exposure, as long as 4 weeks have elapsed since the first dose.
• Should self-monitor, or have the employee health program or an infection control nurse monitor, from the 8^th day after the first exposure through the 21^st day after the last exposure and immediately report any fever, headache, skin lesions, or systemic symptoms.
  • If symptoms occur, immediately remove healthcare personnel from patient care, place them on sick leave, and provide them with antiviral medication.

Healthcare personnel who are not vaccinated or do not have other evidence of immunity to varicella

• Are considered susceptible to VZV infection.
• Are potentially infectious from the 8^th day after the first exposure through the 21^st day after the last exposure.
• Should be furloughed or temporarily reassigned to locations remote from patient-care areas from the 8^th day after the first exposure through the 21^st day after the last exposure.
• Should receive post-exposure vaccination in accordance with ACIP and CDC recommendations.
  • Should be vaccinated within 3 to 5 days of exposure to rash.
  • Vaccination 6 or more days after exposure is still indicated because it induces protection against subsequent exposures if the current exposure did not cause infection.
• Should receive varicella zoster immune globulin if they are at risk for severe disease and varicella vaccination is contraindicated (e.g., pregnant healthcare personnel).
  • If varicella zoster immune globulin is administered as post-exposure prophylaxis, exclude from work from the 8^th day after the first exposure through the 28^th day after the last exposure.

Recommendations for healthcare institutions to prevent varicella and nosocomial spread

• Have documented evidence of varicella immunity for all healthcare personnel readily available at the healthcare personnel’s work location.
• Alert healthcare personnel without evidence of immunity to varicella about the risks of possible infection and offer those without evidence of immunity two doses of varicella vaccine, administered 4 to 8 weeks apart, when they begin employment.
• Establish protocols and recommendations for screening and vaccinating healthcare personnel and for managing healthcare personnel after exposures in the workplace.

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