We describe the management of an exposure to varicella in a neonatal intensive care unit. Thirty-seven hospital staff members with negative histories of varicella were tested by enzyme-linked immunosorbent assay for antibody to varicella zoster; all were seropositive. None were restricted from clinical duties, were given varicella-zoster immune globulin, or developed disease. Although only 1 of 38 cord serum samples from normal term infants was seronegative, 10 of 22 neonatal intensive care unit infants were seronegative. The high rate of seronegativity among these patients was related to chronological age older than 2 months and to multiple transfusions of packed red blood cells. This probably reflects natural catabolism of maternal antibody and loss of antibody in serum removed from these infants for diagnostic tests. Infants lacking antibody were given varicella-zoster immune globulin. Antibody levels following administration of varicella-zoster immune globulin were directly related to the dose administered.

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A varicella-like illness occurred in five of 52 children with acute lymphocytic leukemia following the administration of live varicella vaccine. Only one of the children required treatment with acyclovir. Virus isolated from two of the children was "vaccine-like" but differed slightly from the original vaccine strain when tested by restriction enzyme analysis. There did not appear to be a reversion to virulence because two of the household contacts who seroconverted had mild or subclinical infections. Vaccinees in whom this reaction developed tended to have a poor cellular immune response to varicellazoster virus.

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Cord serum samples treated with staphylococcus protein A and an immune affinity column to remove immunoglobulin G were used to establish a seronegative range for herpes simplex virus and cytomegalovirus. No seroconversions or increased heterologous antibody levels to herpes simplex virus or cytomegalovirus were found in live varicella vaccine recipients.