Acyclovir for the prevention and treatment of varicella zoster in children, adolescents and pregnancy

Abstract

Varicella causes a mild, self-limiting childhood disease that may reactivate years later as shingles. In immunocompromised patients with altered cell mediated immunity, and rarely in healthy individuals, varicella results in a life-threatening infection. The antiviral drug, acyclovir, substantially reduces the mortality and risk of severe disease in these groups of patients. Early commencement of acyclovir is recommended for children with both varicella and altered cell mediated immunity, newborns during the first 2 weeks of life, preterm infants in the neonatal nursery, and severe varicella or shingles (including ocular zoster) in any patient, as well as during pregnancy. Acyclovir may be considered in children with serious cardiopulmonary disease or chronic skin disorders where varicella may exacerbate the underlying disease or increase the risk of secondary bacterial sepsis. Acyclovir, however, is not recommended for healthy individuals without severe disease, as a prophylactic agent against varicella, for asthmatics receiving aerosolized or low-dose oral steroids and/or as treatment of the post-varicella syndromes. When acyclovir is prescribed it should be given intravenously to those with severe disease, those at risk of dissemination and in children younger than 2 years of age.

Practice Bulletin No. 151

“…Although vertical transmission may occur at any stage of pregnancy, the risk of transmission is greatest in the third trimester (24,25). Approximately 30% of severely infected infants die, and 65-80% of survivors have severe neurologic morbidity (8, 27,28). However, more serious fetal sequelae occur after maternal CMV infection during the first trimester.…”

Opportunistic Infections in Women With HIV AIDS

“…Multiple diagnostic tests are available for confirmation of infection. 33 Disseminated disease is more common in HIV-infected patients, and pregnant women with signs of disseminated disease (eg, pneumonitis) should receive intravenous therapy with acyclovir. Similar to HSV, VZV primary and recurrent infections can be treated with acyclovir, valacyclovir, and famciclovir.…”

Varicella vaccine in non‐immune household contacts of children with cancer or leukaemia

“…Children who are immunocompromised during cancer chemotherapy are more likely to die or to have serious complications from varicella infection than normal children despite the availability of passive immunization and antiviral therapy 1 –4 . In addition, exposure to varicella often results in disruption to the child’s family life, schooling and therapy.…”