Significant exposure:

• Household: residing in the same household

• Playmate: face to face indoor play 5 minutes (some experts use 1 hour)
• Hospital:
– Varicella: In same 2- to 4-bed room or adjacent beds in a large ward, face-to-face contact with an
infectious staff member or patient, or visit by a person deemed contagious
– Zoster: Intimate contact (e.g., touching or hugging) with a person deemed contagious
• Newborn infant

No Yes

Does the patient have evidence of immunity to varicella based on one

or more of the following:
• Receipt of 2 varicella vaccine doses
• Laboratory evidence of immunity or laboratory confirmation of prior wild-type
disease
• Diagnosis of varicella or zoster by a health care provider
• Verification of history of varicella or zoster by health care provider

Yes No

Healthy person • Immunocompromised child

• Pregnant woman
• Newborn infant whose mother had
onset of chickenpox within 5 days
12 months 12 months before delivery or within 48 hours
of age of age after delivery; varicella-zoster
immune globulin or IGIV is not
indicated if the mother has zoster
• Hospitalized preterm infant (28 wk or
more of gestation) whose mother
lacks evidence of immunity against
varicella
• Hospitalized preterm infant less than
28 wk of gestation or birth weight
1000 g or less, regardless of
maternal immunity

Within 5 days of exposure Within 10 days of exposure

No Yes No Yes

If no prior dose of varicella Can varicella-

vaccine received, administer zoster immune
monovalent varicella vaccine globulin be
unless contraindicated administered
within 10 days of
exposure?

No Yes

No prophylaxis No prophylaxis No prophylaxis IGIV, Varicella-zoster immune

400 globulin, intramuscularly,
mg/kg 125 units/ 10 kg body
weight (62.5 units if 2 kg),
up to a maximum of 625
IGIV, Immune globulin intravenous units (i.e., 5 vials)

Reprinted with permission from American Academy of Pediatrics. Herpes simplex. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds.
Reprinted with permission from American Academy of Pediatrics. Varicella-zoster infection. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds.
Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2018:877.
Red Book: 2018-2021 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2018.
Item
Item C263: Exposures toofvaricella-zoster
C68: Management virus: evaluationvirus.
exposures to varicella-zoster and management.

C-64 Critique(s) 68 2021 PREP Self-Assessment: Critiques and Images

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