Post-exposure prophylaxis for chickenpox and shingles

Post-exposure prophylaxis (PEP) is offered to individuals at high risk of severe chickenpox following an exposure. This includes pregnant women, immunosuppressed individuals, and susceptible neonates.

As varicella zoster immunoglobulin (VZIG) is no longer available in the UK for neonates designated in Group 1 – those exposed to their mother (in utero or post-delivery) within one week of onset of chicken pox in the mother – the antiviral treatment should be supplemented with intravenous (i.v.) varicella immunoglobulin. This can be provided as either:

• a hyperimmune product (Varitect CP), which can be obtained via the duty doctor or the Rabies and Immunoglobulin Service (RIgS) team in the same way that VZIG was (see the guidance on Immunoglubilin: when to use)
• or as normal intravenous immunoglobulin (IVIG) which NHS trusts will have ready access to

A bolus dose of IVIG may also be considered for eligible groups for whom oral antivirals are contraindicated.

The detailed guidance above should be used to assess those at high risk.