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Chickenpox - Management
How should I assess someone who has had contact with chickenpox?

  • For all people with a history of exposure to chickenpox, establish whether:
    • The diagnosis of chickenpox in the contact is certain.
    • The exposure was significant enough to put the person at risk of infection.
    • The person has had chickenpox in the past.
    • The person is at increased risk of complications of chickenpox (e.g. pregnant women, immunocompromised people, neonates).
  • For management of a person who has been exposed to shingles, see the CKS topics on Post-herpetic neuralgia and Shingles.
Clarification / Additional information
  • Significant exposure takes into account [DH, 2006]:
    • The type of varicella-zoster infection in the index case. The risk of acquiring infection from an immunocompetent person who does not have exposed zoster lesions is unlikely. Exposure is significant if the person has had contact with:
      • Chickenpox.
      • Disseminated zoster.
      • Immunocompetent people with exposed lesions (e.g. ophthalmic zoster).
      • Immunosuppressed people with localized zoster on any part of the body (because this group may have increased viral shedding).
    • The timing of exposure in relation to the rash onset in the index case. Exposure is significant if the person was in contact with:
      • Chickenpox — between 48 hours before onset of rash to crusting of lesions.
      • Disseminated zoster — from 48 hours before onset of rash to crusting of lesions.
      • Localized zoster — day of onset of rash until crusting of lesions.
    • Closeness of contact. Exposure is significant if:
      • Maternal/neonatal contact.
      • Continuous home contact.
      • Contact in the same room (e.g. house or classroom, or 2- to 4-bed hospital bay) for 15 minutes or more, or contact on large open wards (particularly paediatric wards).
      • Face-to-face contact (e.g. having a conversation).
  • People who are immunosuppressed include [DH, 2006]:
    • Those being treated for malignant disease with immunosuppressive chemotherapy or generalized radiotherapy, or those who have received this within the past 6 months.
    • Those who have received an organ transplant and are currently receiving immunosuppressive treatment.
    • Those who have received a bone marrow transplant and are still considered to be immunosuppressed (including those within 12 months of finishing all immunosuppressive treatment, or longer for those who have developed graft-versus-host disease).
    • Those receiving high-dose systemic steroids (until at least 3 months after treatment has stopped). For children, this includes those who have taken prednisolone, 2 mg/kg per day for at least 1 week or 1 mg/kg per day for 1 month (or equivalent doses). For adults, an equivalent dose is harder to define, but immunosuppression should be considered in those who have taken around 40 mg of prednisolone daily for more than 1 week.
    • Those receiving immunosuppressive drugs alone (e.g. azathioprine, ciclosporin, methotrexate, cyclophosphamide, leflunomide, cytokine inhibitors), or in combination with lower doses of steroids, for at least 6 months after treatment.
    • Those with primary immunodeficiency (e.g. severe combined immune deficiency syndromes, Wiskott–Aldrich syndrome).
    • Those who are immunosuppressed because of HIV infection.
  • Always seek specialist advice regarding the management of someone who is, or may be, immunocompromised.
Basis for recommendation
  • This recommendation is based on Department of Health guidance on immunisation against infectious disease: The 'Green Book' [DH, 2006].
  • Post-exposure management aims to protect people at high risk of developing varicella and people who may transmit infection to those at high risk (e.g. healthcare workers) [DH, 2006].

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