Chicken Pox Quarantine Period
Individuals with chicken pox (varicella) should be excluded from school, work, or public settings until all lesions have dried and crusted, typically 4-7 days after rash onset. 1
Duration of Quarantine for Active Infection
- Individuals with active varicella should be excluded from duty/school/work until all lesions have dried and crusted 1
- For lesions that do not crust (macules and papules), exclusion should continue until no new lesions appear within a 24-hour period 1
- The period of contagiousness begins 1-2 days before the onset of rash and continues until all lesions have crusted 2
- Typical duration of quarantine is 4-7 days after rash onset, depending on lesion healing 2
Post-Exposure Management
- Unvaccinated individuals without evidence of immunity who are exposed to varicella should be excluded from institutions (schools, workplaces) for 21 days after the onset of rash in the last case of varicella 1
- For healthcare personnel without evidence of immunity who are exposed to varicella, exclusion from duty is recommended from the 8th day after first exposure through the 21st day after the last exposure 1
- If varicella-zoster immune globulin was administered, the exclusion period extends to 28 days after the last exposure 1
Special Considerations
- Vaccination within 3-5 days of exposure may modify the disease if infection occurred and can be used as part of outbreak control 1
- Persons receiving either their first or second dose of varicella vaccine as part of outbreak control may be readmitted to school immediately 1
- Immunocompromised individuals may experience slower healing of lesions (7-14 days or longer) and may require longer periods of isolation due to prolonged viral shedding 2
Common Pitfalls to Avoid
- Assuming that starting antiviral therapy immediately makes the patient non-contagious - viral shedding continues until lesions are fully crusted 2, 3
- Allowing return to school/work too early before all lesions have crusted, which can lead to continued transmission 1
- Failing to recognize that immunocompromised patients may have prolonged periods of viral shedding and contagiousness 2
- Not implementing appropriate quarantine measures for exposed susceptible individuals during outbreaks, which can lead to continued transmission for up to 4-5 months 1
Healthcare Setting Considerations
- Healthcare workers with varicella should be excluded from duty until all lesions dry and crust 1
- Healthcare workers with localized herpes zoster who are immunocompetent should cover all lesions completely and be restricted from caring for high-risk patients until all lesions have dried and crusted 2
- Healthcare workers with disseminated zoster or localized zoster in immunocompromised individuals must be excluded from duty until all lesions have dried and crusted 2