Three methods are used for the prevention of VZV infections.
- Active immunization: For all children and seronegative adults, two doses of a live attenuated varicella vaccine are recommended. Irrespective of serologic status, pts >50 years old should receive a vaccine with 18 times the viral content of varicella vaccine; zoster vaccine reduces the incidence of zoster and postherpetic neuralgia.
- Passive immunization:Varicella-zoster immune globulin (VZIg) can be given to VZV-susceptible hosts within 10 days (ideally within 96 h) of a significant exposure if the risk of complications from varicella is high (e.g., immunocompromised pts, susceptible pregnant women, premature infants, neonates whose mothers had chickenpox onset within 5 days before or 2 days after delivery).
- Antiviral treatment: Seven days after intense exposure, antiviral prophylaxis can be given to high-risk pts who are ineligible for vaccine or for whom the 96-h window after direct contact has passed. This intervention may lessen illness severity.