A 3-year-old child with nephrotic syndrome on high-dose prednisolone develops varicella (chickenpox). The child has never received varicella vaccine. Which statement about post-exposure prophylaxis is correct?
- A No intervention is needed as the disease is established ✓
- B Varicella Zoster Immunoglobulin (VZIG) is indicated
- C Both vaccine and VZIG should be given simultaneously
- D Varicella vaccine should be given within 3-5 days of exposure
Correct answer: A. No intervention is needed as the disease is established
Explanation
Once the child has developed clinical varicella (rash appears), post-exposure prophylaxis is no longer relevant as the disease is already established. VZIG is indicated within 96 hours of exposure for high-risk susceptible individuals to prevent or attenuate disease. Varicella vaccine can be given within 3-5 days of exposure for post-exposure prophylaxis in immunocompetent individuals. However, since this immunocompromised child has already developed the disease, treatment (acyclovir) is indicated, not prophylaxis.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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