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From chickenpox exposure to post-exposure prophylaxis

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Additional Insight #82

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Management after chickenpox exposure is a sequence rather than an automatic prescription of prophylaxis.

First establish whether the contact was significant and whether the woman can already be considered immune. A definite history of chickenpox or shingles, or two documented varicella vaccine doses, normally allows reassurance in an otherwise immunocompetent woman.

If immunity is uncertain, measure VZV IgG. At least 80% of pregnant women tested after an uncertain history are IgG positive and can be reassured without prophylaxis.

For a susceptible pregnant woman after significant exposure, UKHSA recommends oral aciclovir or valaciclovir as first-choice post-exposure prophylaxis from days 7–14 after exposure. VZIG is an alternative when oral antivirals are contraindicated or not tolerated and can be effective when given within 10 days of contact.

The key clinical logic is therefore: significant exposure → establish immunity → identify susceptibility → provide correctly timed prophylaxis.

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From chickenpox exposure to post-exposure prophylaxis

Additional Insight #82

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