A 5-year-old girl with acute lymphoblastic leukemia on maintenance chemotherapy was exposed to a classmate with active chickenpox yesterday. She has no history of varicella and no antibodies on testing. What is the most appropriate intervention now?
- A Passive immunization with varicella-zoster immune globulin as soon as possible ✓
- B Live attenuated varicella vaccine immediately
- C Oral acyclovir started at the first sign of rash
- D Intravenous valganciclovir for 10 days
Correct answer: A. Passive immunization with varicella-zoster immune globulin as soon as possible
Explanation
Varicella can be fulminant and fatal in immunocompromised seronegative children. Post-exposure passive immunization with varicella-zoster immune globulin, given ideally within 96 hours, prevents or significantly modifies disease. The live vaccine is contraindicated during intensive chemotherapy because of uncontrolled viral replication. Antiviral drugs are therapeutic agents used once disease develops and do not substitute for passive antibody after exposure.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.