Management of Varicella-Zoster Virus (Chickenpox)

When to Administer Varicella-Zoster Immunoglobulin (VZIG):

1) Immunocompromised Patients:
. Administer VZIG if they have been exposed to chickenpox to prevent severe infection.
2) Pregnant Women:
. Administer VZIG if they have been exposed to chickenpox and do not have antibodies against VZV (Varicella-Zoster Virus).
. If exposure was more than 2 days before the appearance of the rash, simply reassure the patient.
3) Newborns:
. Administer VZIG if there is peripartum exposure to chickenpox.

When to Administer Oral Acyclovir:
1) Immunocompromised Patients:
. If they develop chickenpox, initiate oral Acyclovir to reduce the severity and duration of symptoms.
2) Pregnant Women:
. If they develop chickenpox, initiate oral Acyclovir treatment.

Assessing Immunity Status:

Unknown or No History of Chickenpox:
. Check the serum Varicella-Zoster Virus (VZV) antibodies (IgG).
. If the test is positive (indicating immunity), reassure the patient.
. If the test is negative (indicating no immunity), administer VZIG.

Effectiveness of VZIG:
. VZIG is most effective if given within 10 days after exposure to the virus.

Rash Development:
. If a patient develops a chickenpox rash, initiate oral Acyclovir within 24 hours to mitigate the infection’s severity.

Reassurance:
. If the serum VZV IgG test comes back positive, indicating immunity, reassure the patient that they are protected against the virus.

Summary
. VZIG: For immunocompromised, pregnant women with no antibodies, and newborns with peripartum exposure.
. Oral Acyclovir: For immunocompromised and pregnant women who develop chickenpox.
. Immunity Check: Test for VZV IgG; if positive, reassure; if negative, administer VZIG.
. Timing: Administer VZIG within 10 days post-exposure and Acyclovir within 24 hours of rash onset.