VZV

Question 1

When is a case of VZV most infectious? When are they infectious until?

Answer 1

• most infectious during prodrome
• Infectious from one to two days before the onset of the rash until the lesions have fully crusted over (i.e. fully dried)

Question 2

What is the natural history of VZV? Progression of rash?

Answer 2

• Prodrome: fever, malaise, anorexia
• Rash day 3-5:
  
  • Pruritic macules - papules - vesicles - umbilication - crusting
  • Central (Scalp, face, trunk)
  • Fully crusted lesions by day 10

Question 3

How is VZV spread

Answer 3

• Spread by direct contact/droplet spread

Question 4

When is vaccination recommended?

Answer 4

• Recommended for >12mo and seronegative adults

Question 5

When are complications more common with VZV, and what are the possible complications?

Answer 5

More common in infants, >15yo and IC pts:
	• bacterial superinfection (particularly group A beta haemolytic streptococcus and Staph aureus)
	• Pneumonia
	• Encephalitis
	• Cerebellitis
	• Hepatitis
	• Arthritis
	• Reye syndrome

Question 6

What can VZV recur as?

Answer 6

• Herpes zoster (shingles) – can occur > 1 dermatome in kids, post-herpetic neuralgia less common.

Question 7

What kind of post-exposure Tx is there fore VZV? When is it given? Who is it recommended for?

Answer 7

• Zoster immunoglobulin 
• Give within 96 hours of exposure 
• For:
	○ Pregnant women 
	○ Neonates whose mother develops varicella from 7 days before to 2 days after delivery. 
	○ Immune deficiency

Question 8

What infection precautions should be taken in VZV?

Answer 8

• Must be notified within 5 days of varicella diagnosis in Victoria
• No school until fully recovered (all lesions crusted over) or at least one week after the eruption first appears
• Any admitted child with active chickenpox or zoster should be isolated
• Cut nails short at first sign of disease - scratching increases risk of 2ndary bacterial infection

Question 9

What is the Mx of VZV in an immunocompetent child?

Answer 9

Symptomatic:

• hydrate
• Calamine lotion, cool compresses
• Possible oral anti-histamines to improve sleep
• Paracetamol for fever, not aspirin

Question 10

When does the Mx of VZV differ, and how does it differ?

Answer 10

• Mx in immunocompromised/certain neonates (i.e. <28d)/severe eczema
• IV aciclovir