VariZIG for Varicella Postexposure Prophylaxis: Updated CDC Recommendations.


The new recommendations extend the treatment window from 4 to 10 days postexposure.

 

In the 1960s, zoster immune globulin (immune globulin prepared from patients recovering from zoster) was found to reduce severity of primary varicella as well as attack rates. The development of varicella zoster immune globulin (VZIG) followed in the late 1970s for high-risk patients with varicella exposure. In 2006, VZIG was replaced by a similar product — VariZIG. VariZIG was available as an investigational new drug expanded access protocol until late 2012 and administration was recommended up to 4 days after exposure.

In December 2012, the FDA approved VariZIG for postexposure prophylaxis of varicella in high-risk susceptible individuals. Now, the CDC recommendations extend the treatment window to 10 days postexposure. This recommendation concurs with the current American Academy of Pediatrics recommendations for VariZIG use for the following exposed groups:

  • Immunocompromised patients without evidence of immunity
  • Newborn infants whose mothers have signs of varicella 5 days before to 2 days after delivery
  • Hospitalized premature infants ≥28 weeks’ gestation born to susceptible mothers
  • Hospitalized premature infants <28 weeks’ gestation and birth weight ≤1000 g irrespective of maternal immunity
  • Pregnant women without evidence of immunity

COMMENT

These new recommendations outline the use of passive immunoglobulin (VariZIG) for postexposure prophylaxis of susceptible patients with varicella exposure. The patient groups for which prophylaxis is recommended have not changed from the original VZIG recommendations, but the time for administration of postexposure prophylaxis has been extended to 10 days following exposure. Efficacy is increased if prophylaxis is given as soon as possible after exposure. Vaccination against varicella provides the best protection; however, in patients for whom a live viral vaccine is contraindicated, passive immunity with VariZIG provides protection. VariZIG is available in the U.S. through FFF Enterprises.

Source: NEJM

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