Recommendations for Postexposure Prophylaxis of Varicella Infection

1. Recommendations for Postexposure Prophylaxis of Varicella Infection Mona Marin, MD Centers for Disease Control and Prevention Blood Products Advisory Committee Meeting July 21, 2005

2. Postexposure Prophylaxis of Varicella • Vaccination • Varicella zoster immune globulin (VZIG)

3. Vaccination as Postexposure Prophylaxis • Healthy susceptible persons aged ≥12 months • Within 3-5 days postexposure

4. Outline VZIG Recommendations • General indications for the use of VZIG • Advisory Committee on Immunization Practices (ACIP) recommendations • American Academy of Pediatrics (AAP), Committee on Infectious Diseases additional recommendations (Red Book) • Other recommendations

5. General Indications for the Use of VZIG

6. Indications for the Use of VZIG • The decision to administer VZIG to a person exposed to varicella-zoster virus (VZV) should be based on whether: • The patient is susceptible • The exposure is likely to result in infection • The patient is at greater risk for complications than the general population

7. Varicella Seroprevalence in Americans Aged ≥6 Years, NHANES III, 1988-1994* Source: Kilgore et al, J Med Virol, 2003

8. Types of Exposure to VZV for Which VZIG is Indicated for Susceptible Persons • Household: residing in the same household • Playmate: face-to-face indoor play • Opinions differ about duration: 5 min, 1 hr • Hospital • Varicella: in same 2- to 4-bed room or adjacent beds in a large ward, face-to face • Herpes zoster: intimate contact (touching or hugging) • Newborn: onset of varicella in the mother ≤5 days before or within 48 h after delivery

9. ACIP Recommendations

10. Use of VZIG for Postexposure Prophylaxis • Persons aged <13 years • Immunocompromised children • Primary and acquired immunodeficiency disorders • Neoplastic diseases • Immunosupressive treatment • Neonates whose mothers become infected with varicella 5 days before and 2 days after delivery • Neonates exposed postnatally - premature infants • Hospitalized • <28 weeks’ gestation or weigh ≤1,000 g

11. Use of VZIG for Postexposure Prophylaxis • Persons aged ≥13 years • Immunocompromised adolescents and adults • Healthy adolescents and adults - on an individual basis • Pregnant women • Hospital personnel

12. AAP – Additional Recommendations for Special Situations

13. Patients on High-dose IGIV • Patients receiving monthly high-dose IGIV (≥400 mg/kg) are likely to be protected and probably do not require VZIG if the last dose of IGIV was given 3 weeks or less before exposure

14. Patients with a Bleeding Diathesis • Use of VZIG for patients with a bleeding diathesis should be avoided, if possible. IGIV would be an acceptable alternative in this situation.

15. Healthy Adults • VZIG can be given to healthy susceptible adults after exposure to varicella, but VZIG is not recommended routinely. A 7-day course of Acyclovir may be given to susceptible adults beginning 7 to 9 days after varicella exposure if vaccine is contraindicated or more than 72 hours elapsed from the time of exposure.

16. Other Recommendations

17. Recipients of Stem Cell Transplant • Postexposure prophylaxis with valacyclovir or acyclovir (between days 3-28 postexposure) be considered in addition to VZIG for all VZV-seronegative recipients of hematopoietic stem cell transplant* *Source: Weinstock et al, Infect Contr & Hosp Epidemiol, 2004

18. Thank You