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Exposure to varicella-zoster (chickenpox-shingles) virus

Product for post-exposure treatment: varicella-zoster specific immunoglobulin (VZIG)

  • Risk assessment: must be performed by the clinician with responsibility for the patient.
  • Prescription for VZIG: must be signed by clinician with responsibility for the patient.
  • VZIG risk assessment and prescription forms: download forms here
  • VZIG stock and issuing centre: pharmacy at Southampton General Hospital (UHSFT).

Please note: VZIG is issued only when UHS Pharmacy receives both prescription and risk assessment forms (required for VZIG returns to the Deptartment of Health).

Deliver or fax (023 8120 6792) prescription and risk assessment forms to the main dispensary at Southampton General Hospital. If faxed, the original prescription will need to be received by pharmacy within 72 hours.

Out-of-hours, contact on-call pharmacist through switchboard (023 8077 7222).

General information about varicella-zoster virus VZV infection

Primary infection with VZV causes varicella (chickenpox), an acute, infectious disease most commonly seen in children under 10 years old after an incubation period of 10 to 21 (average 14) days. The classic sign of chickenpox is a papular rash that turns into itchy, fluid-filled vesicles that eventually turn into scabs. The rash first appear on the face, chest, and back and then spreads to the rest of the body and may involve the mouth, eyelids and genital area. It usually takes about one week for all the vesicles to become scabs.

Varicella spreads easily from infected people to susceptible individuals through coughing or sneezing. It can also be spread by touching or by breathing in the virus particles that come from chickenpox vesicles. Serious complications from chickenpox include pneumonia, bleeding problems, infection or inflammation of the brain (encephalitis, cerebellar ataxia), bacterial infections of the skin and soft tissues (including group A streptococcal infections), blood stream infections (sepsis).

Once the illness resolves, the virus remains dormant in the dorsal root ganglia. VZV can reactive later in a person’s life and cause a painful, maculopapular rash called herpes-zoster or shingles, which tends to be more prevalent in adults. The rash most commonly appears on the trunk along a thoracic dermatome. Less commonly, the rash can be more widespread and affect three or more dermatomes. This condition is called disseminated zoster. This generally occurs only in people with compromised immune systems. Disseminated zoster can be difficult to distinguish from varicella. Postherpetic neuralgia (PHN) is the most common complication of herpes zoster. It is a persistent pain in the area where the rash once was. PHN is diagnosed in people who have pain that persists after their rash has resolved. Other complications of herpes zoster include ophthalmic involvement (herpes zoster ophthalmicus), bacterial super-infection of the lesions (staphylococcus aureus and group A beta hemolytic streptococcus), cranial and peripheral nerve palsies; visceral involvement, such as CNS vasculopathy, pneumonitis, hepatitis, acute retinal necrosis.

People with active lesions caused by herpes zoster can spread VZV to susceptible people. People who have not had chickenpox can get infected with VZV from someone with herpes zoster. If this happens, they are at risk of developing varicella not herpes zoster. Susceptible people at high risk for severe chickenpox include pregnant women, infants born at less than 28 weeks gestation or who weigh less than 1500 grams (regardless of whether the mother had chickenpox or been vaccinated), neonates born to susceptible mothers, people of all ages who have compromisedor suppressed immune systems.