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Chickenpox - Management
How should I manage a healthy person who has been in contact with chickenpox?

  • Perform a general assessment to establish the person's risk of chickenpox on the basis of their history of chickenpox, the certainty of chickenpox in the contact, and the level of exposure.
  • If the person's exposure to chickenpox is not significant, or if they have a history of chickenpox, or if they are known to be immune to chickenpox, reassure. People with a definite history of chickenpox or herpes zoster can be considered to be protected.
  • If the person is not immune, advise them that they may develop chickenpox.
  • Healthcare workers:
    • Healthcare workers with significant exposure to the varicella-zoster virus who have been vaccinated or have a definite history of chickenpox or zoster can continue working (as they are considered protected), but should be advised to contact their occupational health department before patient contact if they feel unwell or develop a rash.
    • Unvaccinated healthcare workers with a negative or uncertain history of chickenpox or herpes zoster should be serologically tested. Consider routine testing for healthcare workers born and raised overseas, for whom a history of chickenpox is a less reliable indicator of immunity.
      • If there is no definite history of varicella-zoster virus infection but a varicella-zoster virus antibody test is positive, consider the person to be immune.
      • Non-immune healthcare workers should be advised to avoid contact with high-risk patients for 8–21 days after their contact with chickenpox, and to report to their occupational health department before patient contact if they feel unwell or develop a fever or rash.
      • If a healthcare worker has no varicella-zoster antibody, varicella vaccine should be offered to reduce the risk of exposing patients to varicella-zoster virus in the future.
Clarification / Additional information
  • The definition of a healthcare worker includes people who work in hospitals and general practice who have contact with patients. Examples include [DH, 2006]:
    • Medical and nursing staff.
    • Ward cleaners.
    • Catering staff.
    • Ambulance staff.
    • Receptionists in general practice.
Basis for recommendation
  • This recommendation is pragmatic advice, taking into account guidance from the Department of Health guidance on immunisation against infectious disease [DH, 2006] and guidelines on chickenpox in pregnancy from the Royal College of Obstetricians and Gynaecologists [RCOG, 2007].

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