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

  • Perform a general assessment to establish the certainty of chickenpox in the contact, the level of exposure, and whether the person fulfils the criteria for immunosuppression. If in doubt, seek specialist advice.
  • Urgently seek specialist advice regarding further management.
  • People who have had a significant exposure to chickenpox and who are immunocompromised should be tested for varicella-zoster antibody, regardless of their history of chickenpox. Test for varicella-zoster immunoglobulin G (IgG) antibodies in primary care if test results can be available within 2 working days of first exposure. If this is not possible, urgently seek specialist advice because testing in secondary care and/or varicella-zoster immunoglobulin prophylaxis may be needed.
Basis for recommendation

This recommendation is based on Department of Health guidance on immunisation against infectious disease: The 'Green Book' [DH, 2006].

  • CKS recommends urgently seeking specialist advice on the management of an immunocompromised person who has been in contact with chickenpox, in view of the potential for severe disease and complications in this group.
  • The Department of Health recommends referral of anyone who fulfils the following criteria for consideration of varicella-zoster immunoglobulin prophylaxis [DH, 2006]:
    • Significant exposure to chickenpox or herpes zoster, and
    • A clinical condition that increases the risk of severe varicella (e.g. immunosuppressed people, neonates, and pregnant women), and
    • No antibodies to varicella-zoster virus.
  • CKS suggests testing for varicella-zoster immunoglobulin G antibodies in primary care if the results can be available within 2 working days of first exposure (to allow time for referral to secondary care if necessary), taking into account the practicalities of testing in a primary care setting and feedback from expert reviewers. However, local arrangements may differ, and it is advisable to contact the local laboratory to determine whether a result will be available within this time.
  • The Department of Health recommends that an immunocompromised person who has a negative antibody status (or for whom results cannot be available within 7 days of exposure) should receive varicella-zoster immunoglobulin, ideally within 7 days of exposure [DH, 2006]. This should be done in a specialist setting.

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