Chickenpox Guidelines

Updated: Jun 03, 2022
  • Author: Anthony J Papadopoulos, MD; Chief Editor: Dirk M Elston, MD  more...
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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.