What can be done to protect a patient without evidence of immunity who is exposed to varicella and is at high risk for severe disease and complications?

ACIP recommends administration of varicella zoster immune globulin (VariZIG, Saol Therapeutics) to certain people up to 10 days following exposure to varicella or herpes zoster. People for whom VariZIG is recommended are those without evidence of immunity to varicella who are at high risk of severe disease and complications of varicella illness and are ineligible for varicella vaccination. VariZIG given up to 10 days after an exposure can modify or prevent clinical varicella disease. See the varicella zoster immune globulin section below, and www.cdc.gov/mmwr/pdf/wk/mm6228.pdf, pages 574–6, for more information on this topic.

Patients recommended by ACIP to receive VariZIG include:

• Immunocompromised patients without evidence of immunity
• Newborn infants whose mothers have signs and symptoms of varicella around the time of delivery (i.e., 5 days before to 2 days after)
• Hospitalized premature infants born at 28 weeks (or more) of gestation whose mothers do not have evidence of immunity to varicella
• Hospitalized premature infants born at less than 28 weeks of gestation or who weigh 1,000 grams or less at birth, regardless of their mothers’ evidence of immunity to varicella
• Pregnant people without evidence of immunity

If a susceptible person exposed to varicella or zoster is age 12 months or older, and has no contraindications to varicella vaccination, varicella vaccine can prevent or reduce the severity of infection when administered as post-exposure prophylaxis (PEP) as soon as possible, within 5 days after exposure. There is no evidence that vaccination after infection increases the risk of vaccine-associated adverse reactions. If the patient’s exposure does not result in infection, vaccination can protect against future exposures. See the MMWR for details: www.cdc.gov/mmwr/preview/mmwrhtml/rr5604a1.htm.