Treatment

Varicella Zoster Virus infection can be treated supportively. Manage

pruritus in patients with varicella with cool compresses and regular bathing.
Discourage scratching to avoid scarring. Trimming the childs fingernails and
having the child wear mittens while sleeping may reduce scratching.
Warm soaks and baths may reduce itching and provide comfort. Topical
calamine lotion may produce caking of lesions and excessive drying of the
skin, causing the child to scratch. Oral antihistamines, such as
diphenhydramine and hydroxyzine, are used for severe pruritus. Caution
must be used with topical diphenhydramine; toxicity may occur from
systemic absorption if it is applied to the entire body.
Because of the association of varicella and aspirin therapy leading to
Reye syndrome, acetaminophen is recommended for use for the reduction of
fever.
Pharmacologic treatment may be appropriate for adults and
immunocompromised patients with VZV infections and for people with
shingles, but no treatment is usually necessary for children with varicella.
Acyclovir, famciclovir, and valacyclovir have been approved for the treatment
of VZV infections. Routine use of acyclovir or valacyclovir in healthy children
is recommended if it can be given within 24 hours after the rash first appears
in children older than 12 years, those with chronic cutaneous or pulmonary
disorders, those on long-tern salicylate therapy, and children receiving
corticosteroids. Intravenous acyclovir is recommended only for the treatment
of varicella in immunocompromised children or in healthy children with
varicella pneumonia or encephalitis. In some instances, acyclovir may be
considered for teenagers and adults with otherwise uncomplicated varicella.
Additionally, antiviral therapy should be considered for patients with recent
steroid use or those with extensive eczema.
Prevention
As with other respiratory viruses, it is difficult to limit the transmission
of VZV. Because VZV infection in children is generally mild and induces
lifelong immunity, exposure of children to VZV early in life is often
encouraged. However, high-risk people (immunosuppressed children) should
be protected from exposure to VZV.
Immunosuppressed patients susceptible to severe disease may be
protected from serious disease through the administration of varicella-zoster
immunoglobulin (VZIG). VZIG is prepared through the pooling of plasma from
seropositive people. VZIG prophylaxis can prevent viremic spread leading to
disease but is ineffective as a therapy for patients already suffering from
active varicella or herpes zoster disease.
A live attenuated vaccine for VZV (Oka strain) and is administered after
2 years of age on the same schedule as the measles, mumps, and rubella
vaccine. The vaccine induces the production of protective antibody and cell-

mediated immunity. A stronger version of this vaccine is available for adults

older than 60 years; it boosts antiviral responses to limit the onset of zoster.

Varicella Vaccine Recommendations Children

Routine vaccination at 12-15 months of age
Routine second dose at 4-6 years of age
Minimum interval between doses of varicella vaccine for children younger
than 13 years age
is 3 months
Varicella Vaccine Recommendations Adolescents and Adults
All persons 13 years of age and older without evidence of varicella immunity
Two doses separated by at least 4 weeks
Do not repeat first dose because of extended interval between doses
Varicella Vaccine Postexposure Prophylaxis
Varicella vaccine is recommended for use in persons without evidence of
varicella immunity
after exposure to varicella
70%-100% effective if given within 72 hours of exposure
Not effective if administered more than 5 days after exposure but will
produce immunity if
not infected
*CDC Recommendations
6. What is the treatment of choice?
Management for VSV is supportive such acetaminophen for fever and
calamine lotion and antihistamine for pruritus. Pharmacologic therapy
consists of anti-viral drugs such as acyclovir, famciclovir, and valacyclovir.
7. How can this be prevented?
VZV infection in children is generally mild and induces lifelong
immunity, exposure of children to VZV early in life is often encouraged. For
control and prevention, a routine vaccination of live attenuated vaccine for
children 12-15 months of age and 13 years of age and older without evidence
of varicella immunity. High-risk people (immunosuppressed children and
elderly) should be protected from exposure to VZV by administration of
varicella zoster immunoglobulin.