Efficacy of Zoster Immunoglobulin in Prophylaxis of Varicella in High‐risk Patients

Abstract

During a period of 2 1/2 years 190 children have been prophylactically treated with zoster immunoglobulin in norway. Information on 130 (68%) of these children was obtained. This group included patients suffering from leukemia, lymphoma, and other malignant disorders, and patients with autoimmune diseases, with impaired immune mechanisms or with for other reasons increased frequency of infections, as well as premature and weak newborns, and infants born to mothers who developed varicella during the last 4 days before delivery. Of the patients who received zoster immunoglobulin within 3 days after exposure, 2.9% developed weak symptoms of varicella. When zoster immunoglobulin was administered 4-5 days after exposure, 37.5% contracted varicella, and when given more than 5 days after exposure, 50% developed the disease. The 9 neonates with possible intrauterine exposure are not included in these figures.

Immunotherapy for infectious diseases in haematological immunocompromise

“…Consistent with this, current British Society of Haematology guidelines do not recommend the use of immunoglobulins for routine prophylaxis for CMV (Emery et al , ). Zoster immune globulin is commonly used as post‐exposure prophylaxis in immunocompromised individuals and non‐immune pregnant women, based on strong early data in immunocompromised children indicating clear benefit if given within 3 days of exposure (Winsnes, ).…”

“…Consistent with this, current British Society of Haematology guidelines do not recommend the use of immunoglobulins for routine prophylaxis for CMV (Emery et al, 2013). Zoster immune globulin is commonly used as post-exposure prophylaxis in immunocompromised individuals and non- Delsing et al (2014); Armstrong-James et al (2010); Dignani et al (2005) immune pregnant women, based on strong early data in immunocompromised children indicating clear benefit if given within 3 days of exposure (Winsnes, 1978). Monoclonal antibodies (mAbs) are currently revolutionizing the management of a wide range of automimmune conditions and cancers, and have enormous potential in infectious diseases.…”

Question 3

“…Medline search using the PubMed interface (1950 to date/no limits set): (1) using the MeSH terms “infant, newborn”, “chickenpox” and “varicella-zoster immune globulin” joined by the Boolean operator AND revealed 27 publications, only one of which was relevant,3 and (2) using (congenital OR neonatal OR perinatal) AND (varicella OR chickenpox) AND zoster immunoglobulin yielded 199 publications, only five of which were relevant 3 – 7. Search of the ISI Web of Science using the second strategy yielded 36 publications, but no further relevant publications were identified.…”

Outbreak of Varicella in a Newborn Intensive Care Nursery

“…15 The ELISA appears to be particularly suited to situations in which rapid and accurate identification of susceptible individuals is imperative. Exposed susceptible personnel should be ap¬ prised of the fact that they may have varicella develop and should be ex¬ cused from patient care duties from the tenth to the 21st days following exposure.…”