Control of Varicella/ Herpes Zoster Infection - NHS Lanarkshire

Control of Chickenpox (Varicella) & Shingles (Herpes Zoster) Policy 

Policy for the management & control of Chickenpox (Varicella) 

and Shingles (Herpes Zoster) 

Author: 

Responsible Lead Executive 

Director: 

Endorsing Body: 

Governance or Assurance 

Committee 

Implementation Date: June 2014 

Version Number: V1.8 

Review Date: June 2016 

Responsible Persons 

INFECTION CONTROL TEAM 

HAI EXECUTIVE LEAD 

HEALTH PROTECTION COMMITTEE 

LANARKSHIRE INFECTION CONTROL 

COMMITTEE 

Infection Control Team 

Version No.1.8 December 2014 Page 1 of 19


CONTENTS 

i) Consultation and Distribution Record 

ii) Change Record 

1. INTRODUCTION 

2. AIM, PURPOSE AND OUTCOMES 

3. SCOPE, ROLES AND RESPONSIBILITIES 

4. CHICKENPOX 

5. SHINGLES 

6. STANDARD INFECTION CONTROL PRECAUTIONS (SICPs) AND 

TRANSMISSION BASED PRECAUTIONS. 

7. POST EXPOSURE MANAGEMENT: 

7.1 Pregnancy, neonates and infants 

7.2 Immunocompromised patients 

8. PRACTICALITIES OF ISSUING VARICELLA ZOSTER IMMUNOGLOBULIN 

9. MANAGEMENT OF HEALTHCARE WORKERS EXPOSED TO CHICKENPOX OR 

SHINGLES INFECTION 

10. RESOURCE IMPLICATIONS 

11. COMMUNICATION PLAN 

12. QUALITY IMPROVEMENT – MONITORING AND REVIEW 

13. EQUALITY AND DIVERSITY IMPACT ASSESSMENT 

14. SUMMARY OF FREQUENTLY ASKED QUESTIONS 



15. APPENDIX 1: Appendix 1 – Decision making aid for prescribing VZIG 

16. APPENDIX 2: IMMUNOGLOBULIN REQUEST FORM 

17. REFERENCES & BIBLIOGRAPHY 

Contributing Author / 

Authors 

CONSULTATION AND DISTRIBUTION RECORD 

 

 

Jacqueline Shookhye-Dickson, Infection Control Nurse 

Dr Christopher Mackintosh, Associate Medical Director 

Primary Care 

Dr Donald Inverarity, Lead Infection Control Doctor / 

Consultant Microbiologist 

 

 

 

 

 

 

Lindsay Guthrie, Senior Health Protection Nurse 

Dr Thomas Gillespie, Consultant Microbiologist 

Gail Richardson, Head of Pharmacy, Wishaw General 

Hospital 

Steve McCormick, Lead Antimicrobial Pharmacist 

Karen Patterson, Head of Pharmacy, Hairmyres Hospital 

Alexa Wall, Head of Pharmacy, Monklands Hospital 

Consultation Process / 

Stakeholders: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Microbiologists 

Associate Medical Director Primary Care 

General Practitioners 

Health Protection Nurses 

Consultants in Public Health Medicine 

Infection Control Nurses 

Occupational Health Nurses 

Pharmacists 

Antimicrobial Pharmacists 

Consultant Haematologist 

Consultant in Infectious Diseases 

Consultant Paediatrician 

Senior Nurses / Midwives 

Senior Charge Nurses 

Distribution: NHS Lanarkshire intranet – Firstport 

 

NHS Lanarkshire internet 



CHANGE RECORD 

Date Author Change Version No. 

20/02/14 J. Shookhye- Content reviewed & updated. New policy V1.0 

Dickson template applied 

04/04/14 J. Shookhye- Content revised to reflect comments V1.1 

Dickson received from stakeholders 

15/04/14 J. Shookhye- Final draft for approval V1.2 

Dickson 

06/05/14 L. Guthrie Changes to VZIG ordering process & form V1.3 

included in policy section 

21/05/14 L. Guthrie Content revised to reflect comments from V1.4 

stakeholders 

11/06/14 J. Shookhye- Content revised to reflect final comments V1.5 

Dickson and add in contributing authors 

12/06/14 L. Guthrie Clarify indications for use of VZIG as V1.6 

prophylaxis, and not treatment 

23/06/14 L. Guthrie Final approved draft V1.7 

10/12/2014 L. Guthrie Review date revised in line with Vale of 

Leven Report recommendation 

V1.8 



1. INTRODUCTION 

This policy has been developed for use in NHS Lanarkshire as part of the Control of 

Infection policy manual and should be read in conjunction with: 

Chapter 1 - Standard Infection Control Precautions (SICPs) and Chapter 2 Transmission 

Based Precautions (TBPs). 

2. AIM, PURPOSE AND OUTCOMES 

To ensure that patients with chickenpox or shingles receive appropriate care and 

management in line with current national guidelines and best practice. 

To ensure that every effort is made to protect susceptible patients, staff and visitors to 

inpatient areas from the risk of cross infection from known cases of chickenpox or 

shingles. 

3. SCOPE, ROLES & RESPONSIBILITIES 

This policy is designed to safeguard patients / users of NHS Lanarkshire Services and 

visitors to inpatient areas. 

This policy is aimed at all employees of NHS Lanarkshire, in particular: 

 

 

 

 

 

Nurses, midwives and medical staff working in in-patient & community settings 

Domestic staff working in in-patient areas 

Health Protection Team 

Infection Control Team 

Salus Occupational Health & Safety service 

All staff are responsible for implementing and following the information provided in this 

policy. Staff must inform their line manager, SALUS and the Infection Control Team if this 

policy cannot be followed. 

Stakeholders: 

 

 

 

 

 

 

 

 

 

 

 

Microbiologists 

Associate Medical Director Primary Care 

General Practitioners 

Public Health Team 

Infection Control staff 

Occupational Health Nurses 

Antimicrobial Pharmacists 

Consultant in Haematology 

Consultant Paediatrician 

Senior Nurses / Midwives 

SALUS Occupational Health & Safety 



4. CHICKENPOX 

Communicable 

disease/ causative 

organism 

Clinical manifestation 

/ diagnosis 

Incubation period 

Chickenpox / Varicella zoster virus (VZV) 

May initially begin with cold-like symptoms 

Raised temperature 

Intensely itchy vesicular rash. Clusters of vesicular (blisters) spots 

appear over 3-5 days, which start on the face and scalp, spread to 

the trunk, abdomen and limbs. 

It is possible to be infected but show no symptoms. 

Diagnosis can usually be reliably made on physical examination; 

swabs/specimens are not usually required. 

10-21 days. 

Period of infectivity 1-2 days before the onset of the rash until the vesicles (blisters) are 

dry/crusted which is usually 4 - 5 days after the onset of rash. This 

may be prolonged in immunosuppressed patients. 

Mode of transmission Direct contact with an infected person, 

Droplet or aerosol spread from vesicular fluid from skin lesions. 

Secretions from the respiratory tract (the virus enters the individual 

through the upper respiratory tract). 

Indirectly via contaminated articles e.g. clothing / bedding. 

Groups susceptible 

to chickenpox 

 

 

Most commonly seen in children under ten years old. In healthy 

children the illness is usually mild with no complications. 

Non immune adolescents and adults are at increased risk of 

severe disease. 

Definition of a 

significant exposure 

to chickenpox 

Management of 

patients exposed to 

chickenpox 

Groups at increased 

risk of severe disease 

Non immune individuals who have had: 

Contact in the same room as a person with chickenpox (e.g. in a 

house or classroom or a 2-4 bed hospital bay) for a significant 

period of time (15 minutes or more). 

Face to face contact, with a person with chickenpox for example 

while having a conversation (remember that they may be infectious 

up to 48 hours before the rash appears). 

In large open wards, airborne transmission at a distance has 

occasionally been reported. 

Patients who have had significant contact with a person who has 

chickenpox should be assessed by a clinician to determine the risk 

they may have of contracting chickenpox. 

Varicella vaccine may be appropriate. Information on prophylaxis 

can be found in The Green Book: chapter34 

Advice may be sought from a Consultant Microbiologist if required. 

If cross infection occurs, the Infection Control team should be 

informed as soon as possible. 

Adolescents and adults. 

Smokers. 

Non immune pregnant women and their baby. 

Neonates whose mothers develop chickenpox in the period 7 days 



before to 7 days after the birth. 

Neonates born to non immune mothers who have been exposed to 

chickenpox or shingles in the first month of the baby’s life. 

Immunocompromised patients (see section 7 for definitions and 

management). 

Complications of May include: 

Chickenpox 

secondary bacterial infections of skin lesions 

pneumonia, 

cerebellar ataxia 

encephalitis 

haemorrhagic conditions. 

Immunity 

The majority of people are infected in childhood and remain immune to 

chickenpox for life. 90% of adults raised in the UK are immune. 

Vaccine preventable Yes, however this is not a routine part of the UK’s childhood 

immunisation programme. 

Treatment Antiviral treatment started within 24 hours of the onset of rash may 

reduce the duration and severity of symptoms in otherwise healthy 

adults and adolescents. 

Immunocompromised individuals will also certainly benefit from 

treatment with IV acyclovir. 

See section 8 for guidance regarding prophylaxis with Varicella 

Zoster immunoglobulin (VZIG) in asymptomatic individuals at 

higher risk of developing severe disease. 

Notifiable disease No. 



5. SHINGLES 

Communicable 

disease/ Causative 

organism 

Clinical manifestation / 

Diagnosis 

Period of infectivity 

Mode of transmission 

Groups susceptible to 

shingles 

Definition of a 

significant exposure to 

shingles 

Management of 

patients exposed to 

shingles 

Groups at increased 

risk of severe disease 

Vaccine preventable 

Shingles / Herpes Zoster (HZ) 

• Previous infection with chickenpox is necessary before a person 

can develop shingles. It appears following reactivation of 

chickenpox virus which lies dormant in dorsal root ganglia (spinal 

nerve tissue) – often for decades. 

• Pain in the area of the affected nerve is often the first symptom 

followed by a dermatomal (one sided) rash of fluid filled vesicles 

(blisters). 

• Diagnosis can usually be reliably made on physical examination; 

swabs/specimens are not usually required. 

Until all the lesions have dried/crusted. 

Direct contact with the fluid from the vesicles which is then 

transferred to the mucous membranes of a non immune individual, 

usually via the hands. 

Individuals who have had chickenpox previously may develop 

shingles at any time in their lives although it does seem to be 

associated with older age and conditions which suppress the immune 

system. 

Direct contact with fluid from the rash blisters is required to infect a 

person who is not immune to chickenpox (see mode of transmission). 

Patients who have had significant contact with a person who has 

shingles should be assessed by a clinician to determine the risk 

they may have of contracting chickenpox. 

Varicella vaccine may be appropriate. Information on prophylaxis 

can be found in The Green Book: chapter28a 

Advice may be sought from a Consultant Microbiologist if 

required. 

If cross infection occurs, the Infection Control team should be 

informed as soon as possible. 

Pregnant women and their baby, when the woman has no 

immunity to chickenpox (a pregnant woman who has shingles 

presents no risk to her unborn baby). 

Neonates born to non immune mothers who come into direct 

contact with a person with shingles may develop chickenpox (see 

section 7). 

Immunocompromised individuals may suffer more severe and 

prolonged symptoms (see section 7 for definitions and 

management). 

Yes. In 2013 a vaccination programme for those of 70 years of age 

began, in conjunction with a catch up programme. 

Treatment Shingles can be effectively treated with oral antiviral drugs; 

systemic antiviral treatment can reduce the severity and duration 

of pain, reduce complications, and reduce viral shedding. 

Treatment should be started within 72 hours of the onset of rash 



Notifiable disease 

and is usually continued for 7–10 days, see The Green Book: 

chapter28a 

Immunocompromised patients at high risk of disseminated or 

severe infection should be treated with a parenteral antiviral drug. 

See sections 7 & 8 for guidance regarding prophylaxis with 

Varicella Zoster immunoglobulin (VZIG) and antivirals in 

asymptomatic individuals at higher risk of developing severe 

disease. 

No. 

6. STANDARD INFECTION CONTROL PRECAUTIONS (SICPs) & TRANSMISSION 

BASED PRECAUTIONS 

Patient placement The patient should be nursed in a single side room (for chickenpox a 

negative pressure room should be used if available) until all the 

vesicles have dried/crusted (and no new crops are appearing if it is 

chickenpox). 

Immunocompromised patients may require a longer period of 

isolation. 

Patients with chickenpox in their own homes should avoid contact 

with non immune people until their lesions are dried and crusted. 

Patients with shingles in their own homes may not necessarily 

require to be off of work e.g. if the rash is not on the extremities, can 

be covered, the patient will comply with hand hygiene advice and is 

not working with people at high risk of contracting chickenpox and 

complications from same. 

A risk assessment can be carried out by the Infection Control team / 

Health Protection team. 

Patient care Patients should only be cared for by staff who are immune to chickenpox. 

Hand hygiene 

Personal Protective 

Equipment 

Healthcare Waste 

Laundry 

Equipment 

Decontamination 

Patient transfers 

between hospitals/ 

With soap and water or alcohol gel as per SICP /TBP Policy on Firstport. 

Patients should also be encouraged to carry out hand hygiene. 

As per SICP /TBP Policy on Firstport: 

Waste should be designated as clinical / healthcare waste and placed in 

an orange bag. Waste Policy is available on Firstport 

Linen should be treated as infected. Laundry Policy is available on 

Firstport. 

The patient should be allocated their own equipment which should not be 

shared with other patients. Where this is not possible, equipment must 

be thoroughly cleaned with a chlorine based detergent before being used 

on another patient. Decontamination Policy Section I is available on 

Firstport. 

The patient’s room and equipment should be cleaned at least once daily 

by Nursing and Domestic staff with a chlorine based detergent. 

Once the patient is no longer infectious / is discharged, a terminal clean 

of the room may be required. Please discuss with the Infection Control 

Team. 

Transfer of infectious patients should be prevented where possible. If it is 

essential then the receiving area must be informed prior to moving the 



wards 

patient in order that the appropriate facilities can be prepared for them. 

Refer to SICP /TBP Policy and consult the Infection Control Team for 

advice if required. 

7. MANAGEMENT OF AT- RISK INDIVIDUALS FOLLOWING SIGNIFICANT 

EXPOSURE 

People at higher risk of developing serious complications from chickenpox or shingles may 

be given antiviral drugs and/or prophylactic immunoglobulin (VZIG), which may prevent 

severe illness developing. 

The aim of post-exposure management is to protect individuals at high risk of suffering 

from severe chickenpox and those who might transmit infection to those at high risk. There 

is no benefit once chickenpox is present. 

See Appendix 1: Decision making aid for prescribing VZIG. 

In these circumstances seek advice from an Infectious Diseases Specialist (Monklands 

Hospital 01236 748 748 or local Microbiologist). 

Further treatment information is available in the Green Book: Chapter 28a and Chapter 34 

and the British National Formulary. 

VZIG is a blood product, therefore the nature of this preventative treatment MUST be 

discussed with the patient by the clinician prior to prescription. The patient may 

then provide verbal consent or refuse the product. This discussion and outcome 

should be recorded in the patient’s care record. 

VZIG can be given within 10 days of exposure. Therefore most prescriptions for 

VZIG can be requested within standard working hours and is not a clinical 

emergency. Patients should be reassured of this, and provided with a prescription 

as soon as is reasonably practical. 

7.1 PREGNANCY, NEONATES & INFANTS 

Management of a pregnant woman exposed to chickenpox or shingles should be 

discussed with an Obstetrician and/ or midwife, who will contact the Microbiologist and, if 

appropriate, arrange for the booking blood to be tested. 

The management of neonates or infants should be decided by a Paediatrician, in 

conjunction with a Consultant in Infectious Diseases and Microbiologist. 

Varicella–zoster immunoglobulin (VZIG) is recommended for individuals who have been 

exposed: 

 

 

 

who are at increased risk of severe chickenpox, and 

who have no antibodies to varicella–zoster virus (VZV), and 

who have had significant exposure to chickenpox or herpes zoster. 

However it should be noted that chickenpox can still develop in infants who have received 

VZIG. 



Those at increased risk during pregnancy, or the neonatal period include: 

Patients at increased risk 

Neonates whose mothers 

develop chickenpox rash in 

the period 7 days before to 7 

days after delivery. 

Susceptible neonates exposed 

in the first 7 days of life. 

Neonates born to non immune 

mothers, exposed within the 

first month of life. 

Neonates / infants exposed 

during intensive/prolonged 

special care. 

Non immune women exposed 

at any stage of pregnancy. 

Babies born to immune 

mothers but who are being 

discharged home where a 

household member has 

chickenpox or shingles. 

Babies born at


2mg/kg/day for at least one week, or 1mg/kg/day for one month. For adults, an 

equivalent dose is harder to define but immunosuppression should be considered in 

those who, in the previous 3 months, have received 40mg of prednisolone per day for 

more than one week. Occasionally, there may be individuals on lower doses of 

steroids who may be immunosuppressed, and are at increased risk from infections. 

Therefore, live vaccines should be considered with caution in discussion with a 

relevant specialist physician. 

 

 

 

 

 

 

All patients currently being treated for malignant disease with immunosuppressive 

chemotherapy or radiotherapy, and for at least six months after terminating such 

treatment. 

All patients who have received a solid organ transplant and are currently on 

immunosuppressive treatment. 

Patients who have had a bone marrow transplant within the previous 6 months, and 

until at least 12 months after finishing all immunosuppressive treatment, or longer 

where the patient has developed graft-versus-host disease. 

Patients receiving other types of immunosuppressive drugs (e.g. azathioprine, 

cyclosporine, methotrexate, cyclophosphamide, leflunomide and the newer cytokine 

inhibitors) alone or in combination with lower doses of steroids. The advice of the 

physician or immunologist in charge should be sought for at least six months after 

treatment. 

Patients with evidence of severe primary immunodeficiency, e.g. severe combined 

immunodeficiency (SCID), Wiskott-Aldrich syndrome and other combined 

immunodeficiency syndromes 

Patients with immunosuppression due to HIV infection. 

VZIG MANAGEMENT IN IMMUNOSUPPRESSED PATIENTS 

Whenever possible, immunosuppressed patients exposed to chickenpox / shingles should 

be tested irrespective of their history of chickenpox. 

However, VZIG administration should not be delayed past seven days after initial contact 

while an antibody test is done. Under these circumstances, VZIG should be given on the 

basis of a negative history of chickenpox. If the patient has a positive history of 

chickenpox, wait for the antibody results. Those with a positive history in whom VZ 

antibody is not detected by a sensitive assay should be given VZIG. 

VZIG is not indicated in immunosuppressed contacts with detectable antibody as the 

amount of antibody provided by VZIG will not significantly increase VZ antibody titres in 

those who are already positive. 



Second attacks of chickenpox can occasionally occur in immunosuppressed VZ antibody 

positive patients, but these are likely to be related to defects in cell-mediated immunity. 

VZ antibody detected in patients who have been transfused or who have received 

intravenous immunoglobulin in the previous three months may have been passively 

acquired. Although VZIG is not indicated if antibody from other blood products is 

detectable, re-testing in the event of a subsequent exposure will be required, as the patient 

may have become antibody negative. 

8. PRACTICALITIES OF ISSUING VZIG 

 

 

 

 

 

 

VZIG is a Prescription only medicine (POM) and needs to be prescribed in the 

casenotes / kardex. 

VZIG stock release from pharmacy requires completion of specific VZIG request 

form (see Appendix 2) by the requesting/prescribing physician. 

Requests for the issue of VZIG within NHS Lanarkshire should be discussed 

with a NHS Lanarkshire Consultant Microbiologist. 

VZIG will be issued when there is laboratory evidence of a lack of immunity to 

chickenpox in an 'at risk' individual who has had significant contact with a patient 

diagnosed as having active varicella infection. Stocks of VZIG are held by 

Pharmacy at Wishaw General Hospital, Hairmyres Hospital and at the Blood 

Transfusion Service (BTS) at Monklands Hospital. 

VZIG will be detectable in the blood for 3 months. But if a second exposure 

occurs after 3 weeks of administration of VZIG, a further dose is indicated but 

does not require additional laboratory testing. 

Patients who receive VZIG are potentially incubating the illness and therefore 

may still develop chickenpox. Administration of VZIG may extend the incubation 

period up to 28 days. Therefore such patients should avoid contact with 

susceptible others from day 10 to day 28 following their own exposure. 

Please note that a separate local arrangement has been approved for the supply of VZIG 

in Haematology at Monklands District General Hospital. 



9. MANAGEMENT OF HEALTHCARE WORKERS EXPOSED TO CHICKENPOX OR 

SHINGLES INFECTION 

Healthcare workers 

with chickenpox 


with shingles 

Immune Healthcare 

workers exposed 

to Chickenpox or 

shingles 

Non immune 


exposed to 

chickenpox or 

shingles 

Pregnant 


Treatment of non 

immune Healthcare 

workers exposed 

to chickenpox or 

shingles 

Should inform Occupational Health and be excluded from work until no 

new crops are appearing and all lesions have dried and crusted. 

Should inform Occupational Health who will carry out a risk 

assessment. 

May be able to continue to work if the lesions can be covered with a 

dressing, do not impede hand hygiene and do not work with high risk 

patients (patients in oncology/ haematology, transplant and maternity 

units for e.g.) 

Healthcare workers with either a definite history of chickenpox/ 

shingles or who have been vaccinated against varicella, should be 

considered protected and be allowed to continue working. 

If however they develop any symptoms consistent with chickenpox 

they should report to Occupational Health for assessment before 

having further patient contact. 

Healthcare workers without a definite history of chickenpox and who 

have not been vaccinated against it should report to their 

Occupational Health department before having further patient 

contact. 

May require to be excluded from contact with high-risk patients 

(patients in oncology/ haematology, transplant and maternity units for 

e.g.) until their immune status is known. 

Occupational Health can provide advice and take blood for 

serological testing where immunity is uncertain. 

 

 

 

 

 

 

 

 

 

Pregnant staff who have previously had chickenpox / were previously 

vaccinated against it are likely to be immune and at less risk; 

regardless they should discuss this with Occupational Health and 

their own Obstetrician/ Midwife without delay. 

Pregnant staff that have not had chickenpox / were not previously 

vaccinated against it may be at increased risk and should discuss 

this with Occupational Health and their own Obstetrician / Midwife 

without delay. 

• Occupational Health can provide advice and take blood for 

serological testing where immunity is uncertain. 

Should be discussed with the Occupational Health team. 

There is some evidence that varicella vaccine administered within 

three days of exposure may be effective in preventing chickenpox. 

Irrespective of the interval since exposure, vaccine should be offered 

to reduce the risk of the healthcare workers being exposed / 

exposing patients to chickenpox virus in the future. 

Exceptions: Varicella vaccine is not suitable for pregnant or 

immunocompromised people. 

In pregnancy, treatment with immunoglobulin may be indicated; see 

section 7 for information and speak to Occupational Health and own 

Obstetrician/Midwife for guidance without delay. 

• Immunocompromised staff should speak to Occupational Health for 

advice. Sections 7 and 8 contain information regarding definitions 

and treatment with antivirals and / or immunoglobulin. 



10. RESOURCE IMPLICATIONS 

There are no resource implications. 

11. COMMUNICATION PLAN 

This policy will be launched using the weekly staff briefing and will be accessible on 

Firstport. 

This policy will be discussed at the relevant management team meetings and the local 

partnership meetings. 

12. QUALITY IMPROVEMENT 

Compliance with this policy will be monitored by the Infection Control Team. 

13. EQUALITY AND DIVERSITY IMPACT ASSESSMENT 

This policy meets NHS Lanarkshire’s EDIA 

√ 

(tick box) 

14. SUMMARY OF FREQUENTLY ASKED QUESTIONS (FAQS) 

If you have any questions about this policy or how to implement it, please contact the 

Infection Control Team to discuss your query. 



15. Appendix 1 – Decision making aid for prescribing VZIG Prophylaxis 

YES to any 

INITIAL ASSESSEMENT 

Has the patient had a significant exposure to varicella or zoster (as per section 4 or 5 of CIM)? 

House hold contact 

Face to face exposure 

Open ward exposure 

AND was the exposure to a case: 

within 48 of the onset of rash until crusting of lesions (Chickenpox) OR 

between day of onset of rash until crusting (Shingles) 

NO to all 

Is the patient: 

Pregnant? 

Immunocompromised? 

A neonate/infant where: 

Mother has developed 

Chickenpox 7 days before or 

after delivery 

Neonate is antibody negative 

AND exposed to chickenpox 

or zoster in first 7 days of life 

Neonate requires intensive 

care? 

NO to all 

YES to any 

Patient (or mother in case of neonates) has 

a previous history of Chickenpox infection 

OR known antibody positive status? 

NO or UNCERTAIN 

YES 

Reassure patient. No further 

action required. 

Check antibody status (either stored booking blood (obstetrics) or fresh blood sample 

Antibody positive 

Antibody negative 

Reassure patient. No further 

action required. 

DISCUSS TREATMENT OPTIONS WITH PATIENT. IF 

PATIENT CONSENTS: Complete VZIG request form & 

proceed with administration within 10 days of exposure. 

Continue to observe for signs of rash. 



16. Appendix 2 – Varicella-Zoster Immunoglobulin Pharmacy Request Form 

Varicella-Zoster Immunoglobulin (VZIG) Pharmacy Request Form 

VZIG is recommended for individuals who are at increased risk of severe 

chickenpox and who have NO antibodies to varicella–zoster virus (VZV) and who have 

had significant exposure * to chickenpox or shingles (herpes zoster). 

* See Section P of NHSL Control of Infection Manual or ‘The Green Book’ for full guidance 

Location 

Hospital VZIG Stock Process 

Wishaw Pharmacy Complete this form 

Hairmyres Pharmacy Complete this form 

Monklands Blood Bank Lab Contact directly 

Appropriate Use 

N.B. VZIG is rarely required urgently 

The aim of post-exposure VZIG administration is to protect individuals (pregnant, neonate, infant, 

immunocompromised patients) at high risk of suffering from severe chickenpox. The dose should be given 

within 10 days of exposure, preferably within normal working hours 

All requests must be discussed with an NHS Lanarkshire Consultant Microbiologist, 

Microbiology Speciality Doctor or ID Consultant prior to requesting stock release. 

Name of Consultant Microbiologist, Microbiology 

Speciality Doctor or ID Consultant authorising supply: 

Patient Details 

Addressograph 

Consultant/GP: 

Name: 

Speciality: 

CHI Number: 

Ward/Clinic: 

Date of Birth: Inpatient Outpatient * 

Please Circle 

Supply Details [Pharmacy Only] 

Number of VZIG 

250mg Vials Supplied: 

Batch Number: 

Expiry Date: 

Dispensed by: 

Date: 

Checked by: 

0-5 years - 250mg (one vial) 

6-10 years - 500mg (two vials) 

11-14 years - 750mg (three vials) 

15 years and over - 1000mg (four vials) 

Collected by[signature and block capitals]: 

Date: 



17. REFERENCES AND BIBLIOGRAPHY 

British National Formulary (Feb 2014) http://www.bnf.org/bnf/index.htm 

Centers for Disease Control and Prevention: Chickenpox: 

http://www.cdc.gov/chickenpox/ 

Centers for Disease Control and Prevention: Shingles: 

http://www.cdc.gov/shingles/index.html 

Health Protection Agency: Chickenpox 

http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/ChickenpoxVaricellaZoster/ 

GeneralInformation/ 

Health Protection Agency: Shingles 

http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Shingles/GeneralInformatio 

nShingles/ 

Health Protection Scotland (2012) Infection Prevention and Control Manual for Scotland 

http://www.documents.hps.scot.nhs.uk/hai/infection-control/ic-manual/ipcm-p-v2-3.pdf 

NHS GGC (2009) Chickenpox Policy: 

http://library.nhsggc.org.uk/mediaAssets/Infection%20Control/Chickenpox%20Policy%20- 

%2011.01.10.pdf 

NHS GGC (2011) Shingles Policy: 

http://library.nhsggc.org.uk/mediaAssets/Infection%20Control/26.07.11%20- 

%20Shingles%20V3.pdf 

NHS Scotland (2013) Protect yourself against Shingles. 

http://firstport2/staffsupport/immunisation/Documents/Shingles/Protect%20yourself%20against%20shingles_p 

atient%20leaflet.pdf 



Public Health England (2013) The Green Book Chapter 28 Shingles. 

https://www.gov.uk/government/publications/shingles-herpes-zoster-the-green-bookchapter-28a 

Public Health England (2013) The Green Book Chapter 34 Varicella: 

https://www.gov.uk/government/publications/varicella-the-green-book-chapter-34

Control of Varicella/ Herpes Zoster Infection - NHS Lanarkshire

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