I. BACKGROUND INFORMATION
1. Zoster Immune Globulin
Zoster immune globulin (ZIG) can prevent clinical chickenpox in exposed, susceptible, normal children.1 In a collaborative study2 in which 15 susceptible children at high risk received ZIG within three days following exposure, there were no deaths and only one child developed progressive varicella. At that time, a mortality of 7% and a rate of progressive varicella of 30% were reported in similar children who failed to receive prophylaxis.3 At the present time, varicella may be even more hazardous for children with leukemia, possibly because of the use of more intensive therapy.
2. Varicella-Zoster Immune Globulin
The use of plasma obtained from patients convalescing from zoster to prepare ZIG resulted in a limited supply of this material. The finding that plasma from normal donors with high varicella-zoster (V-Z) antibody could be used to prepare a globulin of similar potency, referred to as varicella-zoster immune globulin (VZIG),4 now assures ample supply. The availability of this material, through the American Red Cross, permits us to recommend it for additional indications. The major deterrent to the use of VZIG is its cost, which in August 1983 was approximately $75 per 125 units (approximately 1.25 mL), the dose for a 10-kg child. The recommended adult dose of 625 units costs about $375.
3. Morbidity from Varicella in Adults
Adults suffer greater morbidity from chickenpox than do children. Although less than 2% of reported cases occur in individuals after the second decade, nearly one quarter of all the reported mortality occurs in this group.5
Of particular concern are pregnant women who develop chickenpox.
- Copyright © 1983 by the American Academy of Pediatrics