Postexposure Varicella Management of Nonimmune Personnel: An Alternative Approach

Abstract

See also pages 300 and 335.

Management of Varicella-Vaccinated Patients and Employees Exposed to Varicella in the Healthcare Setting

“…Currently in health care, it is important that there be evidence to support practices that are recommended and implemented. Since our last report in 1994, 3 As a result of these investigations, we found 4,170 employees and 2,241 patients who were potentially exposed to varicella. The immune status of the employees was reviewed and the patients were evaluated for exposure, the need for continued stay in the hospital, and, if immunocompromised, the need for varicella-zoster immune globulin.…”

“…At the time of our prior report, 3 1 of the 4 employees who had developed the disease had stopped wearing a mask 2 days before the end of the incubation period and developed varicella the last day that employee was supposed to be wearing a mask. Exposed patients and employees were observed for 21 days after this exposure and there were no further related cases.…”

“…Our policy for the management of non-immune employees exposed to varicella has been previously published. 3 We have expanded our policy to address varicella-vaccinated employees, patients, and visitors since 1996. A subcommittee was constructed, once the varicella vaccine was licensed, to make decisions regarding (1) the administration of vaccine to healthcare workers and other hospital employees, (2) the management of varicella-vaccinated employees and patients exposed to varicella, and (3) provisions for employees who developed a rash during the postvaccination period.…”

“…These employees were required to wear a mask while at work from 10 to 21 days after exposure and to assess themselves daily for symptoms, and were sent home if symptoms of varicella or of the varicella prodrome were detected. 3 Individuals with negative serology who were not vaccinated were offered the vaccine within 72 hours of the exposure, or varicellazoster immune globulin within 96 hours, if indicated and if available. The reason for this is that the vaccine and immune globulin can modify the severity of the disease.…”

“…We previously reported our experience of allowing non-immune employees exposed to varicella to work while wearing masks, checking daily for prodromal symptoms, and excluding these employees from duty only if such symptoms occurred. 3 " 6 Since our original report from 1994, we have continued this practice without adverse consequences.…”