Download IS0600: Chickenpox (Varicella-Zoster) and Herpes Zoster (Shingles)

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Infection Prevention and Control
Section 08S – IS0600 (Chickenpox (Varicella-Zoster) and Herpes Zoster (Shingles)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS0600:
EFFECTIVE DATE: September 2006
Chickenpox (Varicella-Zoster) and
Herpes Zoster (Shingles)
REVISED DATE: November 2010,
December 2012
REVIEWED DATE:
1.0 PURPOSE
To prevent the spread of Varicella-zoster and herpes zoster to patients and staff.
2.0 DEFINITIONS
Varicella-zoster virus (VZV) – is the causative agent of two diseases:
 Varicella (chickenpox), the primary infection.
 Herpes zoster (shingles), a secondary infection due to a reactivation of latent varicella infection
in the dorsal root ganglia.
Chickenpox – typically infects children under the age of 10 years.
 Transmitted from person to person by direct contact, droplet or airborne spread of vesicle fluid or
sections of the respiratory tract and indirectly through articles freshly soiled by discharges from
vesicles or mucous membranes of infected people.
 Incubation period between 10-21 days.
 Is most contagious from 2 days before onset of rash until all lesions have crusted.
 Susceptible persons should be considered potentially infectious 7 to 21 days following exposure.
 Scabs from the lesions are not infective.
Shingles – lifetime risk of reactivation as zoster/shingles is about 15-20%.
 Can occur any time, most often in the elderly population
 Vesicles with an erythematous base appear in crops in irregular fashion along nerve pathways.
 Severe pain and paresthesia are common.
 Transmitted from person to person by direct contact, droplet or airborne spread of vesicle fluid
and indirectly through articles freshly soiled by discharges from vesicles or mucous membranes
of infected people.
 Scabs from the lesions are not infective.
Localized Shingles – localized lesions (< 2 dermatomes).
Disseminated Shingles – must be diagnosed by physician; very rare
Immunocompromised patients – those with cancer, especially leukemia and lymphoma; those with
HIV; those who have undergone bone marrow or solid organ transplantation; those who are taking
immunosuppressive medications, including steroids, chemotherapy, or transplant – related
immunosuppressive medications; patient status determined by the physician.
Healthcare Worker Exposure Contact – non immune staff that have had contact with a patient
with varicella who is not on Airborne/Contact Precautions.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0600 (Chickenpox (Varicella-Zoster) and Herpes Zoster (Shingles)
Page 2

Healthcare provider exposure: Contact WH&S 1-866-922-9464 or email
[email protected]

NOTE: Immune staff does NOT need to wear N95 respirator in patient room.
3.0 PROCEDURE
Precautions
1.
Chickenpox
(Varicella Zoster)
2.
Airborne
Contact

Infective
material
Respiratory

secretions +
drainage from
lesions
Duration of
Precautions
Until all lesions 
are crusted and 
dry
Notify/ Comments
HCWs must be immune
Non-immune HCW that
must enter room must
wear N95 respirator
Shingles
2a.


2b.


2c.
(Herpes Zoster)
Immunocompetent
patient with:
Localized lesions
AND
Lesions can be
covered with clothing
or dressing
Routine Practice
Immunocompetent
patient with:
Localized lesions
AND
Lesions cannot be
covered with a
dressing
Contact
Immunocompromised
patient with localized
Airborne
Contact

Drainage from
lesions
Drainage from 
lesions
Until all lesions

are crusted and

dry

shingles
Precautions

Drainage from 
lesions and
possibly
respiratory
secretions

Until 72 hours of 
effective antiviral 
treatment
OR
If untreated until
all lesions are
crusted & dry
Infective
material
Duration of
Precautions
Note: in this document the term “patient” is inclusive of patient, resident or client.
All HCW must be immune
HCW exposure: If nonimmune individuals are
exposed to vesicular fluid
Roommate should be
immune to Chickenpox
HCWs must be immune
Non-immune HCW that
must enter room must
wear N95 respirator
Notify/ Comments
Infection Prevention and Control
Section 08S – IS0600 (Chickenpox (Varicella-Zoster) and Herpes Zoster (Shingles)
Page 3
2d.
Patient with
disseminated
shingles
Airborne
Contact

Drainage from
lesions and
possibly
respiratory

secretions



Discontinue
precautions:
72 hours after
start of effective
antiviral therapy
AND
No new lesions
appear
AND
Existing lesions
are crusted and
dried
OR
If untreated until
all lesions are
crusted and dry


HCWs must be immune
Non-immune HCW that
must enter room must
wear N95 respirator
4.0 Dermatomes – for a diagram of the levels of principal dermatomes
5.0
REFERENCES
4.1.
B.C. Centre for Disease Control (BCCDC) Communicable Disease Manual – Varicella
Zoster; July 2004.
4.2.
Alberta Health Services Infection Prevention and Control Manual 2012.
4.3.
CDC Center for Disease Control and Prevention – Shingles (Herpes Zoster); 2012.
Note: in this document the term “patient” is inclusive of patient, resident or client.