What is the post-exposure prophylaxis (PEP) for a school-age child exposed to shingles?

Post-Exposure Prophylaxis for School-Age Children Exposed to Shingles

Varicella vaccine should be administered to susceptible school-age children within 3-5 days of exposure to shingles to prevent illness or modify disease severity. 1

Assessment of Susceptibility

Before administering PEP, determine the child's susceptibility status:

• Susceptible children include those who:

  • Have no history of chickenpox
  • Have no documented varicella vaccination
  • Have no serologic evidence of immunity
  • Are not age-appropriately vaccinated

• Immune children (no PEP needed) include those with:

  • Documented history of chickenpox
  • Completed age-appropriate varicella vaccination
  • Serologic evidence of immunity

Post-Exposure Prophylaxis Options

1. Varicella Vaccine (First Choice)

• Timing: Administer within 3 days of exposure, effective up to 5 days 1
• Efficacy: Prevents illness or modifies disease severity
• Advantage: If exposure doesn't cause infection, vaccination provides long-term protection

2. Varicella Zoster Immune Globulin (VariZIG)

• Reserved for high-risk children who cannot receive the vaccine:
  • Immunocompromised children
  • Pregnant adolescents
  • Newborns whose mothers had varicella shortly before delivery
  • Premature infants
• Timing: Must be administered within 96 hours (4 days) of exposure 1
• Dosing: 125 IU per 10 kg body weight (maximum 625 IU) intramuscularly 1

3. Acyclovir (Alternative)

• Consider only when VariZIG is unavailable or >96 hours have passed since exposure
• Some experts recommend prophylaxis with acyclovir 20 mg/kg body weight (maximum 800 mg) per dose orally 4 times daily for 5-7 days 1

Special Considerations

Immunocompromised Children

• First choice: VariZIG within 96 hours of exposure 1
• For HIV-infected children:
  • Asymptomatic and not immunosuppressed children may receive live varicella vaccine 1
  • Children with severe immunosuppression should receive VariZIG 1

School Setting Considerations

• Exposure in school settings carries lower risk compared to household exposure 2
• School outbreaks can last 3-6 months; vaccination is recommended for outbreak control 1
• State and local health departments may offer vaccination through the health department during outbreaks 1

Follow-Up Management

• Monitor for development of varicella for 21 days after exposure
• If varicella develops despite prophylaxis:
  • Disease is typically milder with fewer lesions
  • Isolate the child until all lesions have crusted over
  • Consider antiviral treatment with acyclovir if indicated

Important Caveats

• Varicella vaccine is not recommended for pregnant adolescents or severely immunocompromised children
• If unsure about immune status and rapid testing is unavailable, proceed with appropriate PEP based on risk assessment
• PEP does not provide 100% protection; monitor for breakthrough infection
• Shingles lesions contain live virus that can cause primary varicella in susceptible contacts, though the risk is lower than from varicella cases

By following these guidelines, healthcare providers can effectively prevent or modify varicella disease in school-age children exposed to shingles, reducing morbidity and potential complications.