Primary Prevention — Measures taken to prevent the occurrence of the disease in a naïve

person.

 The VZV vaccine is the routinely used method of primary prophylaxis. Though it’s

not included in the EPI, the VZV vaccine is routinely administered to children in

Egypt at the age of 12-15 months with the second dose at 4-6 year before entering

school.

 It is a live-attenuated vaccine which can be given in 2 forms. Either a monovalent

vaccine — which is more common or a combination MMRV vaccine. The vaccine is

administered either IM or subcutaneous depending on the available preparation.

 The vaccine is given ideally in 2 doses. The first provides and immunity of around 80-

85% wihile the second provides 95% immunity.

 It is mandatory for people in direct contact with immune deficient patoents, HCW,

and household contacts.

 Given that it’s a live-attenuated vaccine it is contraindicated in:

o Neonates

o Pregnant women

o Immunocompromised individuals or those receiving high dose immune

suppressants.

 The VZV vaccine is also CI in patients with a HX of hypersensitivity to the vaccine

itself or a component of the vaccine.

 Studies have also shown cross-hypersensitivity between the VZV vaccine and

neomycin and gelatin.

 Special Populations and Primary Prevention:

o High-risk Transplant patients: Studies on patients with end stage liver and

renal disease have shown that the vaccine is safe in transplant patients and is
 effective prior to transplantation. It is however not recommended for use in

patients with a hematopoietic cell transplantation.

 Geel A, Zuidema W, van Gelder T, van Doornum G, Weimar W.

Successful vaccination against varicella zoster virus prior to kidney
transplantation. Transplant Proc. 2005; 37:952–953. [PubMed:
15848586]
 Furth SL, Hogg RJ, Tarver J, Moulton LH, Chan C, Fivush BA.
Varicella vaccination in children with chronic renal failure. A report of
the Southwest Pediatric Nephrology Study Group. Pediatr Nephrol.
2003; 18:33–38. [PubMed: 12488988]
 Broyer M, Tete MJ, Guest G, Gagnadoux MF, Rouzioux C. Varicella
and zoster in children after kidney transplantation: long-term results of
vaccination. Pediatrics. 1997; 99:35–39. [PubMed: 8989334]
 Kano H, Mizuta K, Sakakihara Y, Kato H, Miki Y, Shibuya N, Saito
M, et al. Efficacy and safety of immunization for pre- and post- liver
transplant children. Transplantation. 2002; 74:543–550. [PubMed:
12352917]
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919834/pdf/nihms-
208518.pdf
o Patients with Leukaemia or Lymphoma: VZV vaccine is not recommended for

leukemic patients. The vaccine can be considered in patients with lymphoma

who have been in remission without chemo for at least 3 months. Antiviral

therapy is preferred.

o Patients with other malignancies: Patients in remission, off chemotherapy for

3 months.

o Neonates born to mothers infected with VZ during the pregnancy: VZV Ig

given to neonates who’s mother’s developed a VZV infection 5 days pre-

delivery and 2 days post-delivery to avoid the risk of disseminated varicella.

ONLY IF THE MOTHER HAS NO HISTORY OF VZV INFECTION OR

POSITIVE ANTIBODY SCREENING.

Secondary Prevention — Prevention in an Exposed individual.

 Susceptible Populations: — Individuals who have no documented history of VZV and

a high risk exposure e.g.

o HCW
 o Occupational exposure to children e.g. teachers

o Military recruits

 Should receive the VZV vaccine provided there are no CIs that prevent them from

doing so.

 Immunisation is ideally given within 72 hours of exposure but can be given up to 120

hours post exposure. Effectiveness is >90% when giving within 3 days and 70% at 5

days.

 Isolaion d and contact precautions should be taken if a non-immunized person is

exposed starting from day 10 to day 21.

 For high risk patients who cannot take the vaccine e.g. Immunocomp patients.VZIG

or antiviral therapy are used.

 Patients eligible for the varicella vaccine should have the immunisation delayed by 5

months after administration of VariZIG

 Patients receiving VariZIG should be isolated from days 10 to

28 post-exposure.
 VariZIG vs VZIG?.

 Clinical experience suggests that aciclovir or valaciclovir from days 3 to 22 post-exposure may

be a reasonable alternative for prophylaxis if varicella-specific immunoglobulin is not available in

immunocompromised patients