Prophylactic Acyclovir for Exposure to Recurrent Shingles
Understanding Transmission Risk and Prevention
- The Centers for Disease Control and Prevention recommends that varicella-zoster virus (VZV) causes both chickenpox (primary infection) and shingles (reactivation of latent infection) 3
- Exposure to someone with shingles poses minimal risk of transmission to immunocompetent individuals who have previously had chickenpox 2, 3
- The virus from shingles can only cause primary chickenpox infection in susceptible individuals (those who have never had chickenpox or received the varicella vaccine), not shingles 1, 3
Guidelines for VZV Exposure Management
- The Centers for Disease Control and Prevention recommends that VZV-susceptible individuals (those with no history of chickenpox/shingles or who are seronegative for VZV) should avoid exposure to persons with chickenpox or shingles 1, 2, 3
- If exposure occurs in a VZV-susceptible person, varicella zoster immune globulin (VZIG) should be administered within 96 hours of exposure 2, 3
- The Centers for Disease Control and Prevention states that data are lacking regarding the effectiveness of acyclovir for preventing chickenpox among susceptible HIV-infected children or adults 2, 4
Special Considerations
- For immunocompromised patients who are VZV-susceptible, VZIG is recommended within 96 hours of exposure 3, 5
- If oral acyclovir is used in these cases, VZV serology should be performed to determine if the patient is already seropositive 3, 5
- VZIG is recommended for VZV-susceptible pregnant women within 96 hours after exposure to VZV 6, 7
Treatment vs. Prophylaxis
- There is no evidence supporting the use of acyclovir as prophylaxis after exposure to someone with shingles 1, 2, 3