Post-exposure prophylaxis against varicella-zoster virus infection
- Mary A Albrecht, MD
Mary A Albrecht, MD
- Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
Varicella-zoster virus (VZV) is one of eight herpesviruses known to cause human infection and is found worldwide. Primary infection with VZV causes chickenpox, with fever and a characteristic vesicular rash. Although varicella is usually a mild, self-limited illness, it can be associated with complications, such as pneumonia, hepatitis, encephalitis, and secondary bacterial infection. Complicated infection can lead to morbidity and mortality, particularly among immunocompromised hosts and pregnant women.
This topic will address the use of active immunization (varicella vaccine) and passive immunization (VariZIG) and other interventions for post-exposure prophylaxis in nonimmune individuals. The efficacy and safety of the varicella vaccine for routine immunization in children and adults are discussed elsewhere. (See "Vaccination for the prevention chickenpox (primary varicella infection)".)
Post-exposure prophylaxis for neonates, pregnant women, bone marrow transplant recipients, and health care workers is discussed elsewhere. (See "Varicella-zoster infection in the newborn" and "Varicella-zoster virus infection in pregnancy" and "Prevention and control of varicella-zoster virus in hospitals" and "Immunizations in hematopoietic cell transplant candidates and recipients".)
The clinical manifestations and management of varicella are discussed separately. (See "Clinical features of varicella-zoster virus infection: Chickenpox" and "Varicella-zoster infection in the newborn" and "Treatment of varicella (chickenpox) infection".)
VZV infection causes two clinically distinct forms of disease: varicella (chickenpox) and herpes zoster (shingles).
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- GENERAL BACKGROUND
- Person to person
- Mother to child
- INCUBATION PERIOD
- ASSESSMENT OF RISK OF INFECTION
- Determining susceptibility
- Types of exposure
- Role of serologic testing
- TYPES OF POSTEXPOSURE PROPHYLAXIS
- Who is eligible for varicella vaccine?
- Which patients require passive immunoprophylaxis?
- EFFICACY OF IMMUNIZATION DURING OUTBREAKS
- VARICELLA VACCINE ADMINISTRATION
- Available formulations
- Adverse events
- Testing for seroconversion
- PASSIVE IMMUNIZATION
- General background
- Historical perspective
- - Zoster immune globulin
- - Varicella-zoster immune globulin
- - Clinical data
- - Indications
- - Time interval from exposure
- - How to administer
- Intravenous immune globulin (IVIG)
- Monitoring for infection
- ACYCLOVIR FOR POSTEXPOSURE PROPHYLAXIS
- Healthy children and adults
- Immunocompromised hosts
- Pregnant females
- WHAT TO DO WHEN PROPHYLAXIS FAILS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS