Management of Active Varicella in an Adult Mother
Do not give the varicella vaccine to this mother—she already has active chickenpox with a confirmed rash, and vaccination during active infection is contraindicated. 1
Immediate Management
The mother requires supportive care and monitoring for complications, not prophylaxis, since she already has active disease. 2, 3
Treatment Considerations
Oral acyclovir 800 mg five times daily should be initiated within 24 hours of rash onset if the mother is at increased risk for moderate to severe varicella, though routine acyclovir is not recommended for mild, uncomplicated cases. 2
Treatment efficacy decreases significantly after the 24-hour window from rash onset. 2, 3
The mother should be monitored for complications, particularly pneumonia, as pregnant and postpartum women are at higher risk for severe varicella complications. 2
Infection Control
Implement airborne and contact precautions—the mother is infectious from 2 days before rash onset through complete crusting of all lesions. 3
Maintain isolation until all lesions are dry and crusted. 1, 3
Vaccination Timing After Recovery
Defer varicella vaccination for at least 5 months after recovery from active chickenpox. 1
The mother does not need vaccination after recovering from natural varicella infection, as she will have acquired natural immunity. 1, 3
If she had received varicella-zoster immune globulin (VZIG) for any reason, vaccination should be delayed 5 months after VZIG administration. 1
Critical Distinction: This is NOT a Post-Exposure Scenario
VZIG is indicated for susceptible (non-immune) individuals within 96 hours of exposure to prevent disease—not for those who already have active infection. 1, 2, 3
Varicella vaccine is for prevention in susceptible individuals or post-exposure prophylaxis within 3-5 days of exposure—not for treatment of active disease. 1, 3
The question describes a mother with confirmed active varicella rash, making both VZIG and vaccination inappropriate interventions. 1
Household Contact Management
Assess immunity status of all household contacts, including the father and any other children. 1, 3
Susceptible household contacts should receive varicella vaccine within 3-5 days of exposure to modify disease. 3
High-risk susceptible contacts (immunocompromised individuals, pregnant women, premature infants) require VZIG within 96 hours of exposure. 1, 2, 3
Common Pitfall to Avoid
Do not confuse post-exposure prophylaxis (which requires intervention before disease develops) with management of active infection (which requires supportive care and monitoring). The mother's confirmed rash indicates she is beyond the window for any prophylactic intervention. 1, 3