Review Question - QID 215025

This patient's recent history of close contact with her niece and nephew, who have rashes that are consistent with chickenpox, suggests that she was recently exposed to the varicella-zoster virus. Given her recent exposure, she requires post-exposure prophylaxis with varicella zoster immune globulin (VZIG) to prevent the development of varicella infection in the mother and fetus (as she has never had the vaccine or disease in the past).

VZIG provides passive varicella immunity to the mother in the form of anti-varicella antibodies and is safe to give during pregnancy. It is used in individuals who are exposed to varicella and are ineligible for the varicella vaccine or are at high risk for severe infection or complications. It is administered as a single dose intramuscularly and must be given within 10 days of exposure. Since many individuals will still develop varicella infection after immunoprophylaxis, the patient will require monitoring for 1 month after exposure.

The Centers for Disease Control and Prevention (CDC) discusses recommendations for the use VZIG. The authors find that VZIG administered within 4 days is as effective as administration within 10 days. The authors recommend administering VZIG to eligible patients as soon as possible.

Incorrect Answers:
Answer 1: Administering recombinant zoster vaccine is incorrect because it is a live vaccine which is contraindicated during pregnancy. It is used in older adults to prevent shingles rather than to protect against varicella exposure. This patient was exposed to varicella through her niece and nephew who have chickenpox, and therefore she needs protection specifically against varicella.

Answer 2: Administering the varicella vaccine is contraindicated during pregnancy because it is a live vaccine and can cause congenital varicella syndrome in the fetus.

Answer 4: Conducting serology for VZV IgG would be used to check the patient's immunity status against varicella. Regardless of the patient’s prior vaccination history or immunity status, exposure to varicella during pregnancy needs to be managed with VZIG to prevent infection of the mother and fetus.

Answer 5: Continuing with routine prenatal care would not protect the patient and her fetus from developing varicella infection. Therefore, the most appropriate next step in management is to administer VZIG.

Bullet Summary:
Exposure to varicella during pregnancy should be managed with varicella zoster immune globulin (VZIG) and avoiding live vaccines.