A 4-year-old child with ALL in remission (on maintenance therapy with methotrexate and 6-mercaptopurine) is exposed to varicella (chickenpox) at school. She is susceptible (no previous varicella infection, unvaccinated). What is the MOST appropriate post-exposure prophylaxis?
- A Oral acyclovir prophylaxis for 7 days starting immediately
- B Varicella vaccine immediately (live, but safe in remission)
- C Varicella-zoster immunoglobulin (VZIG) as soon as possible (within 96 hours of exposure) ✓
- D No intervention; observe for 10–21 days and treat if varicella develops
Explanation
Immunocompromised children (including those on chemotherapy for ALL) are at risk of severe, disseminated varicella with visceral involvement and high mortality. Varicella-zoster immune globulin (VZIG / VariZIG) should be administered within 96 hours of exposure to provide passive immunization. Live varicella vaccine is CONTRAINDICATED in immunocompromised patients on chemotherapy. If VZIG is not available, oral acyclovir prophylaxis starting 7 days after exposure (just before the expected onset of rash) is an alternative. Chemotherapy may need to be temporarily suspended if active varicella develops.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.