The author of this blog is currently in day 7 of illness, suffering from a moderate form of varicella. In spite of starting acyclovir (thanks to vigilant and quick-acting wife) on the day of eruptions, the disease process was not halted and vesicles are florid. While we are taking precautions against pneumonia, encephalitis, and other adult-onset associated complications, it is my 2yr old that I agonise about.
He is an 'exposed' individual. Varicella infections in children are mild and rarely complicated. Being an otolaryngologist, however, we know that Ramsay-Hunt (herpes zoster oticus; i.e. reactivation of virus in facial nerve) syndrome causes debilitating facial palsy - sometimes irreversible. Shingles is painful, too. My question is, should I bother vaccinating him now? He was planned for his jab next week, but now that he is exposed, shouldn't I just wait and see if he develops the infection which would obviate vaccination altogether?
Well, this is where the evidence is really useful:
According to the Cochrane review of randomized trials evaluating varicella vaccine in children and adults; from 3 trials with 110 healthy siblings of household contacts where they received post-exposure prophylaxis (PEP) within 3 days of exposure or not at all:
- varicella developed in 18% (PEP) vs. 78% (no PEP) (p < 0.05)
- moderate to severe varicella developed in 2% (PEP) vs. 76% (no PEP) (p < 0.05)
- PEP group who developed varicella had mild disease (< 50 skin lesions)
- no trials reported on adverse events following immunization
Also, for all my healthcare worker friends out there, don't be a hero (or a chicken, depending why you're delaying.) Get yourself jabbed now! Varicella vaccine is recommended for those who have never had chickenpox and are seronegative for varicella antibodies. The caveat (or bonus) is 1-5% adult develop varicella-like rashes that shed the virus and should be removed from patient contact (perfect excuse for holiday, no?) [Am Fam Physician 1997 Dec;56(9):2291]
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