- What do you do for a patient on corticosteroids who has not had VZV and is exposed to VZV?
These patients are immunosuppressed (if the dose of steroids is >0.2 mg/kg/d) and require VariZIG or treatment with acyclovir within 72 hours of developing VZV, if VariZIG had not been administered.
- What about asthmatic patients on inhaled steroids? Can they be immunized safely, and are they at risk of more severe varicella if not immunized?
Asthmatics on inhaled steroids can be immunized because the dose of inhaled steroids is not immunosuppressive. Recent data show that asthmatic children who are unimmunized do get more severe varicella.
- Is there any patient who should not receive VZV vaccine?
Yes. Immunosuppressed individuals, pregnant patients, and infants <1 yr old.
- If a child gets zoster, with wild-type or vaccine strain, should she or he be treated with antiviral drugs?
Surveillance studies have demonstrated that adolescents and children who develop herpes zoster have more pain and hospitalizations due to secondary infection than those with vaccine strain. In the future, laboratory testing for VZV strain is likely to be recommended. Also, treatment of herpes zoster in children (just as has been demonstrated in adults) shortens the course of illness and, more importantly, in school-aged children, decreases shedding. Since active surveillance has demonstrated that herpes zoster cases are the index cases in outbreaks, it makes public health sense to apply the lessons learned in adult herpes zoster to herpes zoster of children who are going back to school—i.e., put them on antivirals.
(Modified from 5-Minute Pediatric Consult book)