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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.