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Varicella PEP – immunocompromised — RACP Paediatrics MCQ

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ModerateIDVaricella PEP – immunocompromisedRACP Paediatrics

A 10-year-old immunocompromised child (on chemotherapy for ALL) has a significant exposure to varicella (played with a child who developed chickenpox the next day). The patient has never had varicella and has no detectable VZV antibodies. What is the most appropriate post-exposure prophylaxis?

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Correct answer: D — Varicella-zoster immunoglobulin (VZIG)

Immunocompromised children with significant varicella exposure who are seronegative should receive VZIG as soon as possible (ideally within 96 hours). VZIG may not prevent infection but attenuates disease severity. Aciclovir prophylaxis may also be considered. Active varicella vaccination is contraindicated during immunosuppression.

Reference: Australian Immunisation Handbook – 2024; RCH Melbourne – 2023 – Varicella CPG