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 child’s 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 monthsVaricella 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.