Clinical Guidelines for Immunization

Clinical guidelines for immunization against chickenpox have been published by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) Committee on Infectious Diseases.

In 2006, the CDC reported on VariZIG for postexposure prophylaxis of varicella (provided under an investigational new drug application expanded access protocol).^[36]In 2008, the CDC Advisory Committee on Immunization Practices (ACIP) published recommendations for the administration of combination measles, mumps, rubella, and varicella (MMRV) vaccine.^[37]The ACIP updated the MMRV guideline in 2010.^[38]Yearly updates to the ACIP recommended immunization schedule for adults include guidelines for immunization to varicella, as in 2009^[39]and 2011; adults aged 60 years or older are candidates for immunization to herpes zoster.^[40]

The AAP Committee on Infectious Diseases has published recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule, issued in 2007 and reaffirmed in 2010.^[41]Yearly AAP schedules for immunization of children and adolescents provide recommendations for the use of combined MMRV or MMR with varicella given separately.^{[42, 43, 44]}

Clinical Guidelines for Chickenpox in Pregnancy

The Royal College of Obstetricians and Gynaecologists recently released their 2014 guidelines for treating chickenpox in pregnancy, summarized below.^[45]

Clinicians should ask women presenting for antenatal care about previous chickenpox or shingles infection.

Pregnant women who have not had chickenpox, or who are known to be seronegative for chickenpox, should avoid contact with persons who have chickenpox or shingles and should promptly inform their clinician of potential exposure.

Clinicians should confirm potential exposure by careful history to confirm the significance of the contact and the susceptibility of the patient, as well as by blood test to determine varicella-zoster virus (VZV) immunity or nonimmunity.

Pregnant women may need a second dose of varicella-zoster immunoglobulin if there is further exposure and 3 weeks have elapsed since the last dose.

Pregnant women who develop the characteristic rash should immediately inform their clinician, and they should be isolated from other pregnant women and neonates until the lesions have crusted over (usually about 5 days after rash onset).

Symptomatic treatment and hygiene are helpful to prevent secondary bacterial infection.

Clinicians should consider hospital assessment of women at high risk for severe or complicated chickenpox, regardless of clinical status.

Clinicians should refer pregnant women who develop chickenpox to a fetal medicine specialist, virologist, and neonatologist for decision regarding treatment.

Clinicians should individualize the timing and mode of delivery of the pregnant woman with chickenpox.

Women with chickenpox should breast-feed if they so desire and are in sufficiently good health.

Medication

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Media Gallery

Dewdrop on rose petal characteristic vesicle of chickenpox. Reprinted with permission from Cutis 65: 355, 2000.
Vesicular eruption on the trunk demonstrating papules, vesicles, and crusts. Reprinted with permission from Cutis 65: 355, 2000.

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Author

Anthony J Papadopoulos, MD Private Practice

Anthony J Papadopoulos, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, Medical Society of New Jersey, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Camila K Janniger, MD Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, Rutgers New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Susan M Swetter, MD Director, Pigmented Lesion and Melanoma Program, Professor, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Veterans Affairs Palo Alto Health Care System

Susan M Swetter, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, Pacific Dermatologic Association, Society for Investigative Dermatology, Society for Melanoma Research, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.