varicella zoster post exposure isolation

  • isolate 8-21 days
  • IVIG only if immunocompromised
  • give vaccine within 5 days

Health care personnel who are not vaccinated or do not have other evidence of immunity to varicella are considered susceptible to varicella-zoster virus infection and are potentially infectious from days 8 to 21 after exposure. Because of their risk of being infectious even before clinical manifestations of infection may occur, the recommendation is that they be removed from patient-care areas from the 8th day after the first exposure through the 21st day after the last exposure.

IgM antibody testing at day 5 would only indicate acute infection and would not reveal whether a person had immunity based on a prior infection. The present guidance for postexposure management does not include decisions based on acute immunity.

Varicella-zoster immune globulin is recommended for persons in whom varicella vaccination is contraindicated (eg, pregnant health care personnel) and people at risk for severe disease. This at-risk population includes people who are immunocompromised without evidence of immunity to varicella (eg, leukemia or lymphoma, medications that suppress the immune system, cellular immune deficiencies) and pregnant women without evidence of immunity to varicella. This male nurse does not fit into any of those categories and should, therefore, receive vaccination instead of immune globulin.

The Advisory Committee on Immunization Practices recommends that people who have been exposed to varicella or herpes zoster but who do not have evidence of immunity are eligible to receive varicella vaccine. Ideally, the vaccine should be administered within 3 to 5 days after the person is exposed because this may prevent varicella or make it less severe. Even if it has been more than 5 days since the initial exposure, the vaccine should still be offered because this will provide protection against varicella if a person is exposed again in the future.1234

Footnotes

  1. SEEK Questionnaires ↩

  2. Gershon AA, Breuer J, Cohen JI, et al. Varicella zoster virus infection. Nat Rev Dis Primers. 2015;1:15016. PubMed ↩

  3. Lachiewicz AM, Srinivas ML. Varicella-zoster virus post-exposure management and prophylaxis: a review. Prev Med Rep. 2019;16:101016. PubMed ↩

  4. Newman AM, Jhaveri R. Myths and misconceptions: varicella-zoster virus exposure, infection risks, complications, and treatments. Clin Ther. 2019;41(9):1816-1822. PubMed ↩