Varicella-zoster virus - Revision history

Aidan: /* Immunocompromised Host */

2026-04-09T16:48:18Z

Immunocompromised Host

← Older revision		Revision as of 16:48, 9 April 2026
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	*'''Ramsay Hunt syndrome''': PO [[Is treated by::acyclovir]] or [[Is treated by::valacyclovir]], with prednisone		*'''Ramsay Hunt syndrome''': PO [[Is treated by::acyclovir]] or [[Is treated by::valacyclovir]], with prednisone
	*'''CNS disease''': IV [[Is treated by::acyclovir]] for 10 to 14 days		*'''CNS disease''': IV [[Is treated by::acyclovir]] for 10 to 14 days
			**Consider oral [[valacyclovir]] up to 2 g p.o. q6h[[CiteRef::cunha2016th]]

	==Prevention==		==Prevention==

Aidan at 15:18, 27 January 2026

2026-01-27T15:18:32Z

← Older revision		Revision as of 15:18, 27 January 2026
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	===Immunocompromised Host===		===Immunocompromised Host===

	*'''Primary varicella''': start with IV [[Is treated by::acyclovir]], then step down to oral [[Is ~~treaed~~ by::valacyclovir]]		*'''Primary varicella''': start with IV [[Is treated by::acyclovir]], then step down to oral [[Is treated by::valacyclovir]]
	*'''Herpes zoster''': start with IV [[Is treated by::acyclovir]], then PO with close followup, until no new lesions for 2 days (minimum 7 days)		*'''Herpes zoster''': start with IV [[Is treated by::acyclovir]], then PO with close followup, until no new lesions for 2 days (minimum 7 days)
	*'''Pregnancy''': treat zoster if more than 50 lesions		*'''Pregnancy''': treat zoster if more than 50 lesions

Aidan: /* Management */

2025-05-07T14:00:23Z

Management

← Older revision		Revision as of 14:00, 7 May 2025
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	*'''Primary varicella'''		*'''Primary varicella'''
			**For chickenpox treatment is not necessary but can be considered
⚫	**~~Simple~~ ~~VZV~~ ~~infection~~, start ASAP (<72 hours) after onset of rash ~~if going to treat; or, don't treat~~
	**If higher risk or severe sequelae, more likely to treat		**If higher risk or severe sequelae, more likely to treat
		⚫	**If going to treat, start ASAP (<72 hours) after onset of rash
	**5 days in normal host
			**[[Valacyclovir]] 1 g p.o. three times daily for 5 to 7 days in normal host
	*'''Zoster'''		*'''Zoster'''
	**Start treatment within 72 hours to reduce new lesions (doesn't affect ~~PHN~~)		**Start treatment within 72 hours to reduce new lesions (doesn't affect postherpetic neuralgia)
			**Mild to moderate disease: [[valacyclovir]] 1 g p.o. three times daily for 7 days
			**Severe disease including neurologic, ocular, or disseminated infections: [[acyclovir]] 10 mg/kg IV every 8 hours for 7 to 14 days

	===Immunocompromised Host===		===Immunocompromised Host===

Aidan: /* Management */

2025-03-31T13:28:03Z

Management

← Older revision		Revision as of 13:28, 31 March 2025
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	**Ideally started early, within 72 hours of symptom onset		**Ideally started early, within 72 hours of symptom onset

	===~~Normal~~ ~~host~~===		===Immunocompetent Host===

	*'''Primary varicella'''		*'''Primary varicella'''
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	**Start treatment within 72 hours to reduce new lesions (doesn't affect PHN)		**Start treatment within 72 hours to reduce new lesions (doesn't affect PHN)

	===Immunocompromised ~~host~~===		===Immunocompromised Host===

	*'''Primary varicella''': start with IV [[Is treated by::acyclovir]], then step down to oral [[Is treaed by::valacyclovir]]		*'''Primary varicella''': start with IV [[Is treated by::acyclovir]], then step down to oral [[Is treaed by::valacyclovir]]

Aidan: /* Prevention */

2024-09-16T14:43:04Z

Prevention

← Older revision		Revision as of 14:43, 16 September 2024
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	\|>90% for HZ and PHN, and persists over time		\|>90% for HZ and PHN, and persists over time
	\|50-70% for HZ and 70% for PHL, but decreases significantly by 5 years		\|50-70% for HZ and 70% for PHL, but decreases significantly by 5 years
	\|}~~<br />~~		\|}

			=== Antiviral Prophylaxis ===

			* [[Acyclovir]] 400 mg p.o. twice daily (though range is 200 mg once daily to 300 mg three ties daily)
			* [[Valacyclovir]] 500 mg p.o. daily (or 250 mg daily)
			* [[Famciclovir]] 500 mg p.o. daily

	[[Category:Herpesviridae]]		[[Category:Herpesviridae]]

Aidan: /* Immunocompromised host */

2023-01-07T16:18:39Z

Immunocompromised host

← Older revision		Revision as of 16:18, 7 January 2023
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	*'''Acute retinal necrosis''': IV [[Is treated by::acyclovir]] for 10 to 14 days, with steroids (involve Ophtho)		*'''Acute retinal necrosis''': IV [[Is treated by::acyclovir]] for 10 to 14 days, with steroids (involve Ophtho)
	*'''Ramsay Hunt syndrome''': PO [[Is treated by::acyclovir]] or [[Is treated by::valacyclovir]], with prednisone		*'''Ramsay Hunt syndrome''': PO [[Is treated by::acyclovir]] or [[Is treated by::valacyclovir]], with prednisone
	*'''CNS disease''': IV [[Is treated by::acyclovir]]for 10 to 14 days		*'''CNS disease''': IV [[Is treated by::acyclovir]] for 10 to 14 days

	==Prevention==		==Prevention==

Aidan: /* Management */

2023-01-07T16:18:32Z

Management

← Older revision		Revision as of 16:18, 7 January 2023
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	===Immunocompromised host===		===Immunocompromised host===

	*'''Primary varicella''': start with IV [[Is ~~treaed~~ by::acyclovir]], then step down to oral [[Is treaed by::valacyclovir]]		*'''Primary varicella''': start with IV [[Is treated by::acyclovir]], then step down to oral [[Is treaed by::valacyclovir]]
	*'''~~Zoster~~''': start with IV [[Is treated by::acyclovir]], then PO with close followup, until no new lesions for 2 days (minimum 7 days)		*'''Herpes zoster''': start with IV [[Is treated by::acyclovir]], then PO with close followup, until no new lesions for 2 days (minimum 7 days)
	*'''Pregnancy''': treat zoster if more than 50 lesions		*'''Pregnancy''': treat zoster if more than 50 lesions
	*'''Ophthalmic zoster''' should be treated (involve Ophtho)		*'''Ophthalmic zoster''' should be treated (involve Ophtho)
	*'''Acute retinal necrosis''': IV [[Is ~~treaed~~ by::acyclovir]] for 10 to 14 days, with steroids (involve Ophtho)		*'''Acute retinal necrosis''': IV [[Is treated by::acyclovir]] for 10 to 14 days, with steroids (involve Ophtho)
	*'''Ramsay Hunt syndrome''': PO ~~antiviral~~ with prednisone		*'''Ramsay Hunt syndrome''': PO [[Is treated by::acyclovir]] or [[Is treated by::valacyclovir]], with prednisone
			*'''CNS disease''': IV [[Is treated by::acyclovir]]for 10 to 14 days

	==Prevention==		==Prevention==

Aidan at 17:36, 18 September 2020

2020-09-18T17:36:43Z

← Older revision		Revision as of 17:36, 18 September 2020
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	===Microbiology===		===Microbiology===

	*dsDNA virus in the ~~Alphaherpesvirus~~ family, related to HSV		*dsDNA virus in the ''Alphaherpesvirinae'' subfamily within the [[Herpesviridae]] family, related to HSV
	*Key glycoproteins		*Key glycoproteins
	**gB II target of neutralizing antibodies like VZIg		**gB II target of neutralizing antibodies like VZIg

Aidan: /* Post-Exposure Management */

2020-09-15T23:18:01Z

Post-Exposure Management

← Older revision		Revision as of 23:18, 15 September 2020
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	**i.e. day 8 to 21 if no VZIg, day 8 to 28 if VZIg		**i.e. day 8 to 21 if no VZIg, day 8 to 28 if VZIg
	*'''Post-exposure vaccination'''		*'''Post-exposure vaccination'''
	**Recommended for ~~everyone~~, assuming that there is no documented immunity and there is no contraindication		**Recommended for '''all susceptible''' exposed individuals, assuming that there is no documented immunity and there is no contraindication
	**Within 3-5 days post-exposure to prevent disease (or any time because they need vaccination anyway)		**Within 3-5 days post-exposure to prevent disease (or any time because they need vaccination anyway)
	*'''VZIg''' (or IVIg, if VZIg not available)		*'''VZIg''' (or IVIg, if VZIg not available)
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	***Immunocompromised individuals, including [[HIV]] with CD4 <200 or <15%		***Immunocompromised individuals, including [[HIV]] with CD4 <200 or <15%
	***[[HSCT]] who have not completed their vaccines post-transplant, regardless of prior immunity		***[[HSCT]] who have not completed their vaccines post-transplant, regardless of prior immunity
			**Significant contact includes:
			***Continuous household contact
			***Indoors for more than 1 hour, including same hospital room
			***15 minutes face-to-face contact
			***Touch lesions, clothes, or bedsheets
	**Start within 4 days of exposure to prevent disease, or within 10 days of exposure to attenuate it		**Start within 4 days of exposure to prevent disease, or within 10 days of exposure to attenuate it

Aidan: /* Post-Exposure Management */

2020-09-15T17:43:24Z

Post-Exposure Management

← Older revision		Revision as of 17:43, 15 September 2020
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	*'''VZIg''' (or IVIg, if VZIg not available)		*'''VZIg''' (or IVIg, if VZIg not available)
	**Indicated ''only'' for '''susceptible''' individuals with significant '''exposure''' who are at '''high risk''' of poor outcome and have a '''contraindication''' to vaccination		**Indicated ''only'' for '''susceptible''' individuals with significant '''exposure''' who are at '''high risk''' of poor outcome and have a '''contraindication''' to vaccination
	**That is, anyone who is already fully vaccinated or is eligible for vaccination is ineligible for VZIg		***That is, anyone who is already fully vaccinated or is eligible for vaccination is ineligible for VZIg
			***If their serostatus is unknown and can be checked within 96 hours, then do that first (except for patients with HSCT, who get immunized regardless)
	**High risk groups include:		**High risk groups include:
	***Neonates exposed to mother who had onset of varicella 5 days before to 2 days after delivery		***Neonates exposed to mother who had onset of varicella 5 days before to 2 days after delivery