What is the recommended management for a 13-year-old (thirteen-year-old) patient who has not been immunized against varicella (chickenpox) and has been exposed to varicella?

From the Guidelines

For a 13-year-old patient without varicella immunity who has been exposed to chickenpox, the recommended management is post-exposure prophylaxis with two 0.5-mL doses of single-antigen varicella vaccine administered subcutaneously, 4-8 weeks apart, with the first dose ideally administered within 3-5 days of exposure. This approach is based on the recommendations of the Advisory Committee on Immunization Practices (ACIP) 1. The vaccine should be given as a full dose, with a second dose recommended 4-8 weeks later to complete the series.

Key Considerations

• The varicella vaccine is the preferred method of post-exposure prophylaxis for individuals without contraindications 1.
• If more than 5 days have passed since exposure but less than 10 days, vaccination may still be beneficial.
• For patients where vaccination is contraindicated (such as those who are immunocompromised), alternative prophylaxis methods may be considered.

Additional Recommendations

• Close monitoring for breakthrough infection is important even after prophylaxis.
• The vaccine works by stimulating the immune system to develop antibodies against the virus more quickly than the natural infection can take hold, potentially preventing disease or reducing its severity, as the incubation period for varicella is typically 10-21 days, allowing time for the vaccine to induce protective immunity before the disease manifests 1.

From the FDA Drug Label

VARIZIG ® [Varicella Zoster Immune Globulin (Human)] is indicated for post-exposure prophylaxis of varicella in high risk individuals. High risk groups include: immunocompromised children and adults, newborns of mothers with varicella shortly before or after delivery, premature infants, neonates and infants less than one year of age, adults without evidence of immunity, pregnant women Administer VARIZIG as soon as possible following varicella zoster virus (VZV) exposure, ideally within 96 hours for greatest effectiveness.

The patient is a 13-year-old who has not been immunized against varicella and has been exposed to varicella. Since the patient is not explicitly listed as a high-risk individual in the provided text, no conclusion can be drawn regarding the use of VARIZIG for this patient. 2

From the Research

Management of Varicella Exposure in a 13-year-old Unimmunized Patient

• The patient's lack of immunization against varicella puts them at risk of developing the disease after exposure 3.
• According to the CDC, varicella zoster immune globulin (VARIZIG) is recommended for postexposure prophylaxis in high-risk individuals, such as immunocompromised people, pregnant women, and infants 3.
• However, the provided studies do not specifically address the management of varicella exposure in a 13-year-old unimmunized patient.
• Study 4 discusses the differences in short- and long-term varicella-zoster virus immunoglobulin G levels following varicella vaccination of healthcare workers, but does not provide relevant information for this scenario.
• Study 5 focuses on varicella zoster in pregnancy and emphasizes the importance of vaccination and postexposure prophylaxis in preventing complications, but does not address the management of varicella exposure in a 13-year-old patient.
• Study 6 is unrelated to varicella management and discusses the predictive value of mixed leukocyte culture testing on allograft survival in unrelated dogs.

Postexposure Prophylaxis

• VARIZIG administration up to 10 days after varicella exposure has been shown to be effective in preventing or attenuating varicella-zoster virus infection in high-risk individuals 3.
• The incidence of varicella was similar when comparing VARIZIG administration ≤ 96 hours vs > 96 hours (up to 10 days) postexposure in the entire population and in each subgroup 3.