Varicella ( Chicken Pox ) Infection in Adults - Guideline for management
|Last review: 06/06/2018|
|Next review: 06/06/2021|
|Approved By: Improving Antimicrobial Prescribing Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2018|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
Varicella (chicken pox) infection in adults - Guideline for management
Varicella ( Chicken Pox ) Infection in Adults
Immunocompetent adults – complicated disease
Duration of treatment
Infection prevention and control
Available antiviral agents
Aciclovir is the principle treatment for VZV. It can be used orally (800mg 5 times daily) or intravenously (10mg/kg every 8 hours). It should be noted that higher doses of Aciclovir are required to treat VZV compared to treating herpes simplex. Aciclovir doses should be calculated according to ideal body weight and adjusted to renal function. Valaciclovir (the pro-drug of Aciclovir ) 1 gram 3 times daily has much greater bioavailability and produces blood levels 3-4 times higher than oral Aciclovir 1.
Uncomplicated Varicella in immunocompetent adults
Complicated Varicella in immunocompetent adults
Varicella in pregnancy
Aciclovir is not known to be harmful in pregnancy10 although manufacturers advise use only when potential benefits outweigh risks11. It is not licensed for use in pregnancy in the UK, so the risks and benefits should be discussed with the patient beforehand12. (Evidence Level C)
If the pregnant woman develops chickenpox or shows serological conversion in the first 28 weeks of pregnancy, she has a small risk of fetal varicella syndrome (FVS) and she should be informed of the implications. Women who develop chickenpox in pregnancy should be referred to a fetal medicine specialist, at 16–20 weeks gestation or 5 weeks after infection, for discussion and detailed ultrasound examination.
Post exposure prophylaxis with Varicella zoster immunoglobulin (VZIG) may be given to attempt to avoid or attenuate severe chickenpox in high risk patients who have been exposed to an index case. VZIG can be considered in patients who fulfil the following criteria:
If a patient is thought to fulfil this criteria, the case should be discussed with the on call consultant virologist. VZIG has no role in the treatment of chickenpox once it has developed.
A live attenuated Varicella vaccine is available. At present, it is chiefly used to vaccinate non-immune individuals who are in regular close contact with patients at high risk of severe chickenpox. This may include non-immune healthcare workers or close family and friends of immunocompromised patients. The Varicella vaccine is contraindicated in immunosuppressed and pregnant patients due to its live attenuated formulation15
|Clinical condition:||Varicella (chickenpox) infection|
|Target patient group:||Adults|
|Target professional group(s):||Secondary Care Doctors
- Tunbridge AJ, Breuer J, Jeffery KJ. Chickenpox in adults - clinical management. 2008, Journal of Infection: 57 (2):95-102.
- UKMi (2016) Do NSAIDs increase the risk of severe skin reactions in children with chickenpox? UK Medicine Information. www.ukmi.nhs.uk
- Gould, D. Varicella zoster virus: chickenpox and shingles. 2014, Nursing Standard. 28 (33), 52-58.
- AL-Nakib W, Al-Kandari S, El-Khalik DM, El-Shirbiny AM. A randomised controlled study of intravenous acyclovir (Zovirax) against placebo in adults with chickenpox. 1983, Journal of Infection; 6:49-56.
- Wallace MR, Bowler WA, Murray NB, Brodine SK, Oldfield EC. Treatment of adult varicella with oral acyclovir: A randomized, placebo-controlled trial. 1992, Annals of Internal Medicine; 117:358-63.
- Andreoni M, Canfarini M, Grint PC, Martorelli M, Di Luzio Paparatti U, Rocchi G. A double blind, placebo controlled trial of efficacy and safety of oral acyclovir (Zovirax) in the treatment of chickenpox in adults. 1992, European review for medical and pharmacological sciences: 14:63-9.
- Klassen TP, Hartling L, Wiebe N, Belseck EM. Acyclovir for treating varicella in otherwise healthy children and adolescents. 2005, Cochrane Database of Systemic Reviews; (4):CD002980.
- Albrecht MA. Treatment of Varicella (chickenpox) infection. March 30 2017, UpToDate Topic 8336 Version 19.0
- Harger JH, Ernest JM, Thurnau GR et al. Risk factors and outcome of varicella-zoster virus pneumonia in pregnant women. 2002, Journal of Infectious Diseases; 185: 422-7.
- Stone KM, Reiff-Eldridge R, White AD, et al. Pregnancy outcomes following systemic prenatal acyclovir exposure: Conclusion from the international acyclovir pregnancy registry, 1984-1999. 2004, Birth defects research. Part A, Clinical & molecular teratology; 70:201-7.
- British National Formulary – 8 February 2018
- Royal College of Obstetricians and Gynaecologists. Green-top Guideline No.13: Chickenpox in pregnancy. January 2015.
- Gnann, J. Current antiviral treatments for Varicella. 2006, Herpes; 13(S1):13A-15A.
- Public Health England: Guidance for issuing Varicella-zoster immunoglobulin (VZIG) – August 2017
- The Green Book: chapter 34 (Varicella) – August 2015
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)
Improving Antimicrobial Prescribing Group
LHP version 1.0
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