VZV

Question 1

VZV encephalitis - treatment

Answer 1

15mg/kg aciclovir + steroids (has vasculitis component)

Question 2

Treatment of T10 shingles in immunocompetent person?

Answer 2

Offer oral aciclovir, valaciclovir, or famciclovir within 72 hours of rash onset to:

800mg x5 daily for 5 days

People who are immunocompromised (based on clinical judgement, for example, if the level of immunocompromise is not severe, the rash is localized, there is no eye involvement, the person is not systemically unwell, and they can be closely followed up).
Refer people who are severely immunocompromised for intravenous aciclovir treatment.
People aged 50 years and over.
People with non-truncal involvement (excluding the head and neck, where admission or specialist advice is indicated).
People with moderate or severe pain or moderate or severe rash.
People with predisposing skin conditions.
Consider offering antiviral treatment to other people aged under 50 years with shingles of the extremities or the trunk depending on clinical judgement.
If it is not possible to initiate treatment within 72 hours, consider starting antiviral treatment up to one week after rash onset, especially if the person is at higher risk of severe shingles or complications (for example continued vesicle formation, signs of cutaneous, visceral or neurological dissemination, older age, immunocompromised, or in severe pain).

Question 3

% of susceptible close contacts of chicken pox case who will develop chicken pox?

Answer 3

90%

Question 4

Complications of maternal chicken pox

Answer 4

Foetal varicella syndrome (Highest in first 20 weeks)
Maternal viral pneumonia (highest risk in 2nd/3rd trimester)

Question 5

VZV transmission

Answer 5

Chicken pox - airborne on account of resp droplet production from oral/throat vesicles

Shingles - Direct contact - NB immunosuppressed patients likely to have higher viral loads and resp transmission possible (depending on location).

Question 6

Infectious period
- Chicken pox
- Shingles

Answer 6

Chicken pox - 1 day prior to rash to 5 days after rash (or crusting of rash in immuncomp)

Shingles - rash onset until crusting

Question 7

VZV infections which would constitute a significant exposure

Answer 7

Chicken pox
Disseminated shingles
Immunocompetent patient with exposed shingles
Immunosuppressed patient with shingles

Question 8

What type of VZV expsosure constitutes a significant exposure in a those at risk of severe VZV?

Answer 8

• Continuous exposure (household, carers)
• Those in the same small room for more than 15 mins
• face to face contact
• immunosuppressed contacts in open wards

Question 8

VZV IgG levels which signify immunity
- immuncompetent
- immunosuppressed

Answer 8

• 100
• 150

Question 8

Dose and starting day of aciclovir in a susceptible adult exposed to VZV?

Answer 8

800mg QDS PO for 7 days starting on day 7 after the exposure (can be started up to day 14 if late presentation)

Question 8

VZV strain in vaccine?

Answer 8

Oka

Question 9

Treatment of mother and neonate:

Mum who develops chicken pox day 4 after delivery?

Answer 9

Mum - Oral ACV or IV ACV if severe disease

Neonate - Group 1 exposure
- Neonates whose mum develops chicken pox 7 days before to 7 days after birth
- VZIG/Varitect and IV aciclovir for min 48h before considering PO switch to complete 14 days (prophylaxis)

Question 9

VZV exposure in prem baby who has been in hospital since birth.

What actions would you take, what “group” of exposure and what treatment?

Answer 9

2a exposure

Check neonates VZV IgG (min 150miu/ml) as may not have maternal ab.

Rx - oral Acv from day 7 post exposure

Question 10

What actions would you take, what “group” of exposure and what treatment?

Baby whose gran visits on day 2 of life and develops chicken pox the next day?

Answer 10

Group 2b exposure

Check maternal history of VZV/vaccination

If no hx then check either mum or neonate (aiming level 150)

If negative PO Acv from day 7 to 14 post exposure.