Prevention and control of varicella-zoster virus in hospitals
- David J Weber, MD, MPH
David J Weber, MD, MPH
- Professor of Medicine, Pediatrics and Epidemiology
- University of North Carolina Schools of Medicine and Public Health
- William A Rutala, PhD, MPH
William A Rutala, PhD, MPH
- Research Professor of Medicine
- University of North Carolina School of Medicine
Varicella-zoster virus (VZV) infection causes two clinically distinct forms of disease: varicella (chickenpox) and herpes zoster (shingles). Primary VZV infection results in the diffuse vesicular rash of varicella, or chickenpox. Endogenous reactivation of latent VZV typically results in a localized skin infection known as herpes zoster, or shingles. Varicella is generally a mild disease in children, although serious complications can sometimes occur (eg, secondary bacterial skin infections and pneumonia). Complications from VZV infection are more common in neonates, adults, or immunocompromised persons.
Because varicella is highly contagious and may cause serious disease, the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and infectious disease experts have published recommendations regarding the prevention of VZV among health care personnel, isolation of patients with VZV infection, and the management of patients and health care personnel exposed to VZV. Issues specific to infection control and care of exposed health care personnel are discussed below.
The epidemiology and clinical manifestations of VZV have changed significantly since the introduction of the varicella vaccine. These issues, as well as the diagnosis, treatment, and prevention of varicella infection are discussed elsewhere. (See "Epidemiology of varicella-zoster virus infection: Chickenpox" and "Vaccination for the prevention of chickenpox (primary varicella infection)" and "Clinical features of varicella-zoster virus infection: Chickenpox" and "Treatment of varicella (chickenpox) infection" and "Clinical manifestations of varicella-zoster virus infection: Herpes zoster" and "Treatment of herpes zoster in the immunocompetent host".)
IMPORTANCE OF INFECTION CONTROL
Control of VZV is important in health care facilities for the following reasons:
●VZV is highly contagious. This is particularly true of patients who present with varicella, compared to those with zoster, who are generally less infectious.
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- IMPORTANCE OF INFECTION CONTROL
- GENERAL PRINCIPLES OF VIRAL TRANSMISSION
- Incubation period of varicella
- Secondary attack rates of VZV
- NOSOCOMIAL TRANSMISSION
- Transmission from persons with varicella
- Transmission from persons with zoster
- PREVENTION OF VARICELLA AMONG HEALTH CARE PERSONNEL
- Rationale for immunizing susceptible health care personnel
- Establishing susceptibility to infection
- Active immunization of susceptible health care personnel
- - Assessment of immunity after immunization
- - Documentation of varicella immunization
- - Adverse events of vaccination
- INFECTION CONTROL MEASURES
- Isolation precautions for patients with varicella
- Isolation precautions for patients with herpes zoster
- EVALUATION OF EXPOSURE AMONG PERSONNEL
- MANAGEMENT OF EXPOSED PREVIOUSLY VACCINATED HEALTH CARE WORKERS
- MANAGEMENT OF EXPOSED SUSCEPTIBLE HEALTH CARE PERSONNEL
- Work furlough
- Post-exposure prophylaxis
- - Varicella vaccine
- Among health care personnel who are unvaccinated
- Among health care personnel who have received one dose of vaccine
- Rash among exposed health care personnel who received post-exposure vaccine
- - Varicella-zoster immune globulin
- - Antiviral Therapy
- MANAGEMENT OF HEALTH CARE PERSONNEL WITH VZV INFECTION
- Diagnosis of VZV in health care workers
- Work restrictions
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS