In response to a significant national shortage of varicella zoster immunoglobulin (VZIG) due to manufacturing issues, from 6th July 2018, the use of VZIG in pregnancy has been limited to susceptible pregnant women who have had a significant exposure to chickenpox or shingles in the first 20 weeks of pregnancy. As the majority of adults in England are immune to chickenpox, this change is likely to affect a very small proportion of the antenatal population.
On 1st August 2018, an urgent review was undertaken by an expert working group convened by Public Health England (PHE). Based on the current supply situation and evidence of efficacy and safety of antivirals for post exposure prophylaxis, these updated guidelines including further restrictions on the use of VZIG have been developed.
This group have advised that the restrictions on the use of VZIG in pregnancy should continue and strengthened the recommendation that susceptible pregnant women who have had a significant exposure after 20 weeks, should be given the oral anti-viral drug, aciclovir (800mg four times a day from day 7 to 14 after exposure). Valaciclovir can be considered as a suitable alternative.
In addition, the restrictions on the use of VZIG are being extended to immunosuppressed individuals. Susceptible individuals should now receive either aciclovir or valaciclovir in the event of a significant exposure, unless there is a specific contraindication to these oral antiviral agents, when VZIG will still be required.
Guidance on the use of VZIG in neonates and susceptible women exposed in the first 20 weeks of pregnancy remain unchanged.
These restrictions will be kept under review in light of the ongoing supply situation.
Please note - requests for varicella immunity checks on individuals exposed to varicella sent into UHNM should include dates, length and type of exposure to help determine what action needs to be taken
For further information please refer to: Varicella zoster immunoglobulin - GOV.UK