Pediatr Infect Vaccine.  2015 Aug;22(2):55-62. 10.14776/piv.2015.22.2.55.

Effectiveness of Varicella Zoster Immune Globulin Administration within 96 Hours versus more than 96 Hours after Exposure to the Varicella-Zoster Virus

Affiliations
  • 1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. yaejeankim@skku.edu
  • 2Department of Pediatrics, Good Gangan Hospital, Busan, Korea.
  • 3Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

PURPOSE
Varicella Zoster Immune Globulin (VZIG) is available in Korea for post-exposure prophylaxis of the Varicella-zoster virus (VZV) in high-risk patients. In July 2013, the United States Centers for Disease Control and Prevention (US CDC) recommended extending the time for administration of VariZIG(R) from within 96 hours up to 10 days after VZV exposure. This study was performed to analyze the effectiveness of VZIG prophylaxis between the two groups of patients who received VZIG within 96 hours and more than 96 hours of exposure to varicella.
METHODS
A retrospective chart review was performed in pediatric patients who received VZIG at Samsung Medical Center, Seoul, Korea from January 2001 to December 2012.
RESULTS
A total of 91 patients were identified. Fifty-seven patients were male (62.6%) and the median age was 5.91 years. Thirty-nine patients (42.9%) were exposed to VZV in the hospital. Underlying diseases were solid tumors (41.8%), hematologic malignancies (40.7%), and others (17.5%). Forty-five patients (49.5%) were hematopoietic cell transplant recipients. Seventy-four patients (81.3%) received VZIG within 96 hours after VZV exposure. There was no significant difference in the development of chickenpox between the two groups (2.7% vs. 5.9%, P=0.4664). In 22 seronegative patients, we also observed no significant difference between the groups in terms of the development of chickenpox (6.6% vs. 0%, P=0.667).
CONCLUSIONS
This study showed that the effectiveness of VZIG for the prevention of chickenpox was comparable between patients who received VZIG within 96 hours and those who received VZIG more than 96 hours after exposure to VZV.

Keyword

Varicella-zoster virus; VZIG; VariZIG; Prophylaxis

MeSH Terms

Centers for Disease Control and Prevention (U.S.)
Chickenpox*
Hematologic Neoplasms
Herpes Zoster*
Herpesvirus 3, Human*
Humans
Korea
Male
Post-Exposure Prophylaxis
Retrospective Studies
Seoul
Transplants

Reference

1. Prevention of varicella. Update recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1999; 48:1–5.
2. Feldman S, Hughes WT, Daniel CB. Varicella in children with cancer: Seventy-seven cases. Pediatrics. 1975; 56:388–397.
3. Levin MJ. Varicella vaccination of immunocompromised children. J Infect Dis. 2008; 197:Suppl 2. S200–S206.
Article
4. Marin M, Guris D, Chaves SS, Schmid S, Seward JF. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007; 56:1–40.
5. Orenstein WA, Heymann DL, Ellis RJ, Rosenberg RL, Nakano J, Halsey NA, et al. Prophylaxis of varicella in high-risk children: dose-response effect of zoster immune globulin. J Pediatr. 1981; 98:368–373.
Article
6. Updated recommendations for use of VariZIG--United States, 2013. MMWR Morb Mortal Wkly Rep. 2013; 62:574–576.
7. Winsnes R. Efficacy of zoster immunoglobulin in prophylaxis of varicella in high-risk patients. Acta Paediatr Scand. 1978; 67:77–82.
Article
8. Evans EB, Pollock TM, Cradock-Watson JE, Ridehalgh MK. Human anti-chickenpox immunoglobulin in the prevention of chickenpox. Lancet. 1980; 1:354–356.
Article
9. Enders G, Miller E. Varicella-zoster virus: virology and clinical management. Varicella and herpes zoster in pregnancy and the newborn. Cambridge, UK: Cambridge University Press;2000.
10. Koren G, Money D, Boucher M, Aoki F, Petric M, Innocencion G, et al. Serum concentrations, efficacy, and safety of a new, intravenously administered varicella zoster immune globulin in pregnant women. J Clin Pharmacol. 2002; 42:267–274.
Article
11. Pickering LK, Baker CJ, Kimberlin DW, Long SS. Red book. 2012. p. 92p. 774–781.
12. Cameron JC, Allan G, Johnston F, Finn A, Heath PT, Booy R. Severe complications of chickenpox in hospitalised children in the UK and Ireland. Arch Dis Child. 2007; 92:1062–1066.
Article
13. Balfour HH Jr. Varicella zoster virus infections in immunocompromised hosts. A review of the natural history and management. Am J Med. 1988; 85:68–73.
14. Swingler G. Chickenpox. Clin Evid. 2003. p. 755–762.
15. Prevention of varicella. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention. MMWR Recomm Rep. 1996; 45:1–36.
16. Arvin AM. Varicella-zoster virus. Clin Microbiol Rev. 1996; 9:361–381.
Article
17. Roderick M, Finn A, Ramanan AV. Chickenpox in the immunocompromised child. Arch Dis Child. 2012; 97:587–589.
Article
18. Feldman S, Lott L. Varicella in children with cancer: impact of antiviral therapy and prophylaxis. Pediatrics. 1987; 80:465–472.
Article
19. Brandt L, Broadbent V. A survey of recommendations given to patients going home after bone marrow transplant. Arch Dis Child. 1994; 71:529–531.
Article
20. Weinstock DM, Boeckh M, Sepkowitz KA. Postexposure prophylaxis against varicella zoster virus infection among hematopoietic stem cell transplant recipients. Biol Blood Marrow Transplant. 2006; 12:1096–1097.
Article
21. Bate J, Chisholm J, Heath PT, Breuer J, Skinner R, Manley S, et al. PEPtalk: postexposure prophylaxis against varicella in children with cancer. Arch Dis Child. 2011; 96:841–845.
Article
22. Weinstock DM, Boeckh M, Boulad F, Eagan JA, Fraser VJ, Henderson DK, et al. Postexposure prophylaxis against varicella-zoster virus infection among recipients of hematopoietic stem cell transplant: unresolved issues. Infect Control Hosp Epidemiol. 2004; 25:603–608.
Article
23. Salzman MB, Garcia C. Postexposure varicella vaccination in siblings of children with active varicella. Pediatr Infect Dis J. 1998; 17:256–257.
Article
24. Brunell PA, Ross A, Miller LH, Kuo B. Prevention of varicella by zoster immune globulin. N Engl J Med. 1969; 280:1191–1194.
Article
25. Brunell PA, Gershon AA, Hughes WT, Riley HD, Jr . , Smith J. Prevention of varicella in high risk children: a collaborative study. Pediatrics. 1972; 50:718–722.
26. Zaia JA, Levin MJ, Preblud SR, Leszczynski J, Wright GG, Ellis RJ, et al. Evaluation of varicella-zoster immune globulin: protection of immunosuppressed children after household exposure to varicella. J Infect Dis. 1983; 147:737–743.
Article
27. A new product (VariZIG) for postexposure prophylaxis of varicella available under an investigational new drug application expanded access protocol. MMWR Morb Mortal Wkly Rep. 2006; 55:209–210.
28. FDA approval of an extended period for administering VariZIG for postexposure prophylaxis of varicella. MMWR Morb Mortal Wkly Rep. 2012; 61:212.
29. Enders G, Bolley I, Miller E, Cradock-Watson J, Ridehalgh M. Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases. The Lancet. 1994; 343:1548–1551.
Article
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