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VZIG in Pregnancy — SCE Infectious Diseases MCQ

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ModerateTravel Medicine & VaccinationVZIG in PregnancySCE Infectious Diseases

A 35-year-old pregnant woman (26 weeks) is exposed to chickenpox at work (her colleague's child has active varicella). She has no history of prior chickenpox and her VZV IgG is negative. She presents within 24 hours of exposure. What is the recommended post-exposure prophylaxis?

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Correct answer: A — Oral Aciclovir prophylaxis for 14 days

This woman is pregnant, has had a significant varicella exposure, has no reliable past history of chickenpox, and is confirmed VZV IgG negative, so she is susceptible and needs post-exposure prophylaxis. In current UK practice, oral antiviral prophylaxis is first-line for susceptible pregnant contacts at any gestation: aciclovir 800 mg four times daily, started on day 7 after exposure and continued until day 14 after exposure. Although she presents within 24 hours, aciclovir is not started immediately; the correct management is to arrange oral aciclovir PEP timed for days 7–14. VZIG is no longer first-line for pregnant contacts and is reserved for situations where oral antivirals cannot be used, such as malabsorption or renal toxicity. Live varicella vaccine is contraindicated during pregnancy, and chickenpox in pregnancy is not harmless because it can cause serious maternal disease and fetal/neonatal complications.

Reference: UK Health Security Agency. Guidelines on post-exposure prophylaxis (PEP) for varicella or shingles. Updated 19 March 2026. https://www.gov.uk/government/publications/post-exposure-prophylaxis-for-chickenpox-and-shingles/guidelines-on-post-exposure-prophylaxis-pep-for-varicella-or-shingles-january-2023