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Varicella Vaccine
Recommendations for Postexposure Prophylaxis of Varicella of Persons at High Risk for Severe Disease

Clinical questions and answers 

Questions and links to answers:

1. What is recommended for postexposure prophylaxis following varicella exposures among persons at high risk for severe disease?
2. What are the indications for VZIG use?
3. When should VZIG be administered?
4. What is the recommended dosage?
5. How can I obtain VZIG for a patient in need?
6. Is there a shortage of VZIG?

Go to other pages of related questions:

• Q&As from Providers
• Health care workers related
• Storage and handling
• Who should get vaccinated
• Pregnancy related
• Varicella disease specific

1. What is recommended for postexposure prophylaxis following varicella exposures among persons at high risk for severe disease?

Varicella zoster immune globulin (VZIG) is recommended for postexposure prophylaxis for persons at high risk for severe disease and complications.

2. What are the indications for VZIG use?

The Advisory Committee on Immunization Practices and the American Academy of Pediatrics (AAP) indicate that the decision to administer VZIG to a person exposed to varicella-zoster virus (VZV) should be based on whether a) the patient is susceptible (either by having a negative history of varicella or by lacking documentation of vaccination), b) the exposure is likely to result in infection, and c) the patient is at greater risk for severe disease and complications than the general population. (http://www.cdc.gov/mmwr/preview/mmwrhtml/00042990.htm).

Several types of exposure can place susceptible persons at risk for varicella. Direct contact exposure is defined as greater than 1 hour of direct contact with an infectious person while indoors; substantial exposure for hospital contacts consists of sharing the same hospital room with an infectious patient or prolonged, direct, face-to-face contact with an infectious person (e.g., health-care workers). Brief contacts with an infectious person (e.g., contact with x-ray technicians or housekeeping personnel) are less likely to result in VZV transmission than are more prolonged contacts.

Persons at greater risk for severe varicella and for whom VZIG is recommended include:

Persons aged <13 years

• Immunocompromised children - including children who have primary and acquired immunodeficiency disorders, neoplatic diseases, and are receiving immunosuppresive treatment. ACIP recommends that, to ensure protection against severe disease, immunocompromised persons receiving regular IGIV should be administered VZIG if exposed to wild-type VZV.

• Neonates whose mothers have signs and symptoms of varicella within 5 days before to 2 days after delivery

• Neonates exposed postnatally, specifically premature infants born to susceptible mothers because their immune system may be compromised. These infants should be considered at risk for as long as they are hospitalized. Premature infants who are < 28 weeks’ gestation or who weigh < or = 1,000 g at birth who are exposed to VZV should receive VZIG regardless of maternal history. VZIG is not recommended for healthy, full-term infants who are exposed postnatally, even if their mothers have no history of varicella infection (with the exception of those neonates mentioned in the previous bullet).

Persons aged > or =13 years

• Immunocompromised adolescents and adults

• Healthy adolescents and adults: For susceptible, healthy adolescents or adults, although varicella is more severe than in healthy children, the decision to administer VZIG should be made on an individual basis. The objective of using VZIG among healthy adolescents and adults is to modify, rather than to prevent, illness with the hope of inducing lifetime immunity. For this group, vaccination within 3-5 days of exposure also is beneficial in preventing/modifying varicella.

• Pregnant women

• Hospital personnel

3. When should VZIG be administered?

VZIG treatment is expected to be most effective when it is initiated within 96 hours after exposure. Treatment after 96 hours is of uncertain value.

4. What is the recommended dosage?

The recommended dose is 125 U/10kg (22 lbs) of body weight, up to a maximum of 625 U. VZIG should be administered intramuscularly as directed by the manufacturer.

5. How can I obtain VZIG for a patient in need?

VZIG can be obtained from the sole authorized US distributor, FFF Enterprise (Temecula, CA). VZIG can be ordered from FFF Enterprises, at 1-800-843-7477 or via the Internet at www.fffenterprises.com. FFF Enterprises delivers VZIG on an as needed basis (e.g., when there is an identified exposed person for whom VZIG is indicated). Under normal circumstances, the distributor delivers the vaccine within 24 hours of request. Currently, VZIG is available only in 625-U vials. Pediatric VZIG (125-U vial) are no longer available and clinicians should use the appropriate volume from the 625-U vial when VZIG is indicated.

Additional information on VZIG use can be found in the 1996 ACIP recommendations for prevention of varicella (MMWR 1996;45:20-24; http://www.cdc.gov/mmwr/preview/mmwrhtml/00042990.htm).

6. Is there a shortage of VZIG?

No. The sole producer of VZIG in the United States has ceased production of VZIG. However, there is sufficient supply of 625-U vials of VZIG at the moment, and can be obtained from FFF Enterprises. (http://www.fda.gov/cber/infosheets/mphvzig092005.htm).

 

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This page last modified on September 26, 2005