Healthcare-associated Exposure to the Varicella-Zoster Virus (VZV)

The VZV is transmitted from person-to-person primarily by direct contact with vesicular fluid; inhalation of droplet nuclei from infected respiratory secretions; and less frequently, by contact with freshly contaminated articles and environmental surfaces. If VZV exposure occurs in a healthcare setting, all case-patient contacts should be evaluated immediately for presumptive evidence of immunity.¹³ Persons are considered immune only if they have documentation of:

1. physician-diagnosed varicella (chickenpox)

   or

2. physician-diagnosed herpes zoster

   or

3. laboratory evidence of VZV immunity

   or

4. age-appropriate vaccination against the VZV.

All susceptible HCP exposed to the VZV should receive PEP with two subcutaneous doses (4-8 weeks apart) of the varicella-zoster vaccine (Varivax) as soon as possible, but ideally no later than 120 hours of an exposure.¹² HCP who have received the vaccine more than 5 days after the exposure should be excluded from duty for 8-21 days after exposure.¹²

Susceptible HCP exposed to the VZV for whom the vaccine is contraindicated should be administered varicella-zoster immunoglobulin (VZIG) no later than 96 hours of an exposure.¹² This recommendation also applies to women exposed to the VZV at any stage of pregnancy. The VZIG product currently used in the United States is VariZIG™.