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Chickenpox in neonates

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Chickenpox exposure

An individual with chickenpox (varicella) is infectious from 2 days prior to the appearance of lesions to 5 days after or until the lesions are dry and crusted (whichever is longer).

  • Determine true diagnosis in index case / call infection control
  • Susceptible contacts will require VZIG. VZIG needs to be given within 72 hours of exposure and no later than 96 hours. See VZIG information.
  • Note that VZIG costs $360 per vial and must be approved by the Medical Officer or the "on call" transfusion specialist.
  • Exposed individuals that are non-immune become potentially infectious from 8 days following initial contact until 21 days following the last contact with the index case. 

Chickenpox (Varicella Zoster) information

Chickenpox infectious period

Two days prior to appearance of lesions and 5 days after or until all lesions have crusted over - whichever is longest.

Clinical Charge Nurse responsibility

Obtain a list of all contacts (staff, visitors, siblings etc) who have had significant contact (same room for more than 5 minutes- 1 hour) or prolonged direct fact-to-face contact (see Red Book).

Staff who are contacts of the Chickenpox

  • If known past history of chickenpox - no further action.
  • If unknown past history - refer to Occupational Health for an urgent VZV serology to establish immunity.
  • Contacts do not become potentially infectious until 8 days following initial exposure to the index case.
  • If VZV IgG serology is positive then they are immune and can safely come to work.
  • If VZV IgG serology is negative then they are non-immune and must stay away from work from 8 days following initial exposure until 21 days following last exposure.
  • Since August 1999 all new staff are required to be tested for Varicella serology. Records of results are kept at Occupational Health.

Exposed parents

  1. Parents who have an unknown past history require an urgent VZV serology.
  2. If non-immune, they become potentially infectious from 8 days following initial exposure until 21 days following last exposure.
  3. If VZV IgG serology is positive then they are immune and can attend normally.

Exposed visitors

Visitors with no known history of chickenpox should be asked to stay away for the isolation period (8 days following initial exposure until 21 days following last exposure)

Vaccine

A vaccine for chickenpox is now available from Occupational Health and is recommended for any non-immune newborn services staff. The cost for the VZV vaccine is met by Newborn Services (RC Manager needs to approve and sign off).

VZ Immunoglobulin (VZIG) Information

VZIG is given to all the babies who have been contacts who fit the following criteria:

  • All babies born at <28 weeks gestation or who weighed <1000g at birth irrespective of maternal history of chickenpox.
  • All babies born at ≥28 weeks gestation whose mothers have not had chickenpox or whose status is unknown.
    Do an urgent maternal VZV serology and only VZIG to the baby if the result is IgG negative.
  • Any baby whose mother has had chickenpox within 7 days before delivery or within 7 days after delivery.

Note: If a baby is born after 28 weeks gestation and the mother has had chickenpox then the baby is protected by the mother's antibodies and does not require VZIG.

VZIG must be given within 72 hours of exposure (maximum 96 hours).

Prescribing of VZIG

  • Varicella-Zoster Immune Globulin (VZIG) comes in 200 iu in 1ml vials.
  • All babies to have 125iu = 0.62mls IM in one leg.
  1. Doctor/NS-ANP contacts Medical Officer, New Zealand Blood Service (or "on call" transfusion specialist) to obtain approval to administer VZIG. The Medical Officer will then notify Blood Bank regarding issuing the VZIG.
  2. Doctor/NS-ANP to chart on stat page of medication chart. Parent to consent by countersigning prescription following discussion with Doctor/NS-ANP.
  3. VZIG is a blood product, therefore also need a consent form for Blood and Blood Products signed by parent.
  4. Requisition form sent to Blood Bank for VZIG.

Infectious precautions

  1. Notify Infection Control.
  2. Exposed room closed to admissions.
  3. Contact baby must be isolated from 8 days following initial exposure until 21 days from last exposure. The incubation of chickenpox may be prolonged in babies that have had VZIG from 21 days up to 28 days as an attenuated chickenpox can develop in this period. Therefore single room isolation is necessary for up to 28 days from exposure.
  4. If baby's mother has chicken pox:
    1. she must not come into the unit until all the lesions have crusted.
    2. if baby well enough to go to the postnatal ward isolate in room with mother.
    3. breastfeeding may occur. However if mother has lesions on her breasts they need to be covered with gauze then op-site. The mother should avoid coughing or sneezing on baby.
      If baby in NICU expressed breast milk can be used provided mother has covered the lesions before expressing.
    4. Staff and visitors that are immune to chickenpox should use contact precautions, gown and gloves when handling baby. Staff and visitors who are non immune should not enter the room. If they have to enter room they must wear mask, gown and gloves (airborne and contact precautions).
    5. Linen to go in white linen bag.
    6. Rubbish to be disposed of in white bags unless heavily soiled which then goes in yellow bag.

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Document Control

  • Date last published: 01 October 2009
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years