Preventing VZV Transmission in Healthcare Settings

Infection control measures depend on whether the patient with herpes zoster is immunocompetent or immunocompromised. Healthcare professionals should also determine if 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 are based on patient's immune status and rash localization.

Work restriction guidance

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 (page 43) of ACIP's recommendations.

As noted in this guidance:

• For localized herpes zoster in an immunocompetent person:
  • Cover lesions and restrict from the care of high-risk patients (e.g., 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 them from duty until all lesions are dry and scabbed.
• For disseminated herpes zoster or localized herpes zoster in an immunocompromised person until the disseminated infection is ruled out:
  • Exclude from duty until all lesions are dry and scabbed.

With evidence of immunity

Healthcare personnel who have one or more documented doses 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 8th day after the first exposure through the 21st 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.

With no evidence of immunity

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 8th day after the first exposure through the 21st day after the last exposure.
• Should be furloughed or temporarily reassigned to locations remote from patient-care areas from the 8th day after the first exposure through the 21st day after the last exposure.
• Should receive post-exposure vaccination per 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 8th day after the first exposure through the 28th day after the last exposure.