Please see full details at: post-exposure prophylaxis guidance for varicella or shingles.
Chickenpox (varicella) infection in immunosuppressed individuals, susceptible pregnant individuals and neonates can result in severe and even life-threatening varicella disease. Post-exposure prophylaxis (PEP) is recommended to attenuate disease and reduce the risk of complications such as pneumonitis, rather than to prevent infection in these at-risk individuals.
Previously this was achieved through intramuscular varicella zoster immunoglobulin (VZIG), but this is no longer available, and antiviral prophylaxis is now recommended for all at risk groups including susceptible neonates. Exceptions include neonates whose mother develops chickenpox 7 days before to 7 days after delivery, when antivirals should be supplemented with intravenous (i.v.) varicella immunoglobulin. A bolus dose of IVIG may also be considered for eligible groups for whom oral antivirals are contraindicated.
For immunocompetent individuals including pregnant individuals, a history of previous chickenpox, shingles or 2 doses of varicella vaccine is sufficient evidence of immunity.
A pregnant or immunosuppressed patient with a VZV IgG negative result will need antiviral prophylaxis from day 7 after first exposure. Please note that anti-VZV IgG is not assessed at booking, but – where available – the retained booking sample can be used for subsequent testing on request. Clinicians should email the duty virologist (loth.virologyadvice@nhs.scot) with patient details to request this. Where there is no available booking sample, this information helps the laboratory team look out for the new clotted blood sample (brown tube).
If urgent, please call the duty virologist instead (0131-536 3373, option 2 between 9am and 5 pm, Monday – Friday). VZV IgG testing is not performed during weekends, so that needs to be taken into consideration.
For those needing advice out with these hours, please call the RIE switchboard and ask for the Virology consultant on call.
SR & CM 4/12/2025
Please refer to the latest UK Health Security Agency version of the post-exposure prophylaxis guidance for varicella or shingles.
