Varicella Zoster can be severe and life-threatening in immunocompromised patients. Passive immunization with antibody to varicella zoster proteins can help prevent infection in those with a significant exposure to a patient with active chickenpox or zoster and with a significant risk for severe infection.


Formulations for immune prophylaxis:

(1) ZIG (zoster immune globulin): derived from patients with herpes zoster infections; must be administered within 96 hours of exposure to ensure efficacy

(2) VZIG (varicella-zoster immune globulin): must be administered within 96 hours of exposure to ensure efficacy

(3) ZIP (zoster immune plasma)


Exposure criteria:

(1) Exposure to a person with chickenpox or zoster and

(1a) continuous household contact

(1b) playmate for more than 1 hour indoors

(1c) hospital contact, such as sharing the same room or prolonged face-to-face contact

(1d) mother

(2) Time elapsed since exposure <= 96 hours (4 days), preferably <= 72 hours (3 days)


Candidates for passive immunization, provided a significant exposure has occurred

(1) immunocompromised, susceptible children

(2) immunocompetent, susceptible adolescents (>= 15 years of age) and adults, especially pregnant women

(3) newborn infants of mothers with onset of chickenpox < 5 days before or < 2 days after delivery

(4) hospitalized premature infant >= 28 weeks of gestation when mother has no history of chickenpox

(5) hospitalized premature infant < 28 weeks gestation and/or birthweight <= 1000 grams, regardless of maternal history


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