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VZV Exposure in Immunosuppressed — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesVZV Exposure in ImmunosuppressedRACP Adult Medicine

A 35-year-old healthcare worker who is a renal transplant recipient on tacrolimus and mycophenolate has a non-immune household contact newly diagnosed with varicella (chickenpox). The transplant recipient has no history of chickenpox and VZV IgG is negative. What is the most appropriate management?

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Correct answer: A — Varicella-zoster immunoglobulin (VZIG) within 96 hours

Varicella-susceptible (VZV IgG negative) immunosuppressed patients exposed to varicella require varicella-zoster immunoglobulin (VZIG) within 96 hours of significant exposure. Live varicella vaccine is contraindicated in immunosuppressed patients. If VZIG is unavailable, post-exposure aciclovir prophylaxis (from day 7 to day 21 post-exposure) is an alternative.

Reference: ATAGI – 2024 – Australian Immunisation Handbook; TSANZ 2024