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HOW EFFECTIVE IS VARICELLA-ZOSTER IMMUNOGLOBULIN (VZIG) IN PREVENTING CHICKENPOX IN NEONATES FOLLOWING PERINATAL EXPOSURE?
On a routine neonatal check on the postnatal ward you come across a neonate whose mother developed chickenpox 3 days before delivery. You are aware that according to UK guidelines1 a baby should be given prophylactic varicella-zoster immunoglobulin (VZIG) if its mother develops chickenpox during the period that spans 7 days prior to delivery to 7 days after (and that the US Red Book recommends VZIG for neonates born to mothers with onset of chickenpox 5 days prior to delivery to 2 days after2). The mother, who is keen for her baby to have this preventive treatment, asks you how likely it is that this measure will prevent the disease. You are unsure and consult the Department of Health (UK) publication Immunisation against Infectious Diseases (the Green Book),1 which provides limited information on this aspect, citing one reference only. The British National Formulary for Children (2007) offers even fewer details, and refers you to the former publication. Therefore, you wonder what evidence exists for the effectiveness of VZIG in preventing or modifying chickenpox in this setting.
STRUCTURED CLINICAL QUESTION
In a neonate born to a mother with chickenpox around the time of delivery [patient], does varicella-zoster immunoglobulin [intervention] effectively prevent or ameliorate chickenpox [outcome]?
SEARCH STRATEGY AND OUTCOME
Search of the Cochrane Library database using the terms “chickenpox” and “varicella” yielded no relevant reviews. Medline search using the PubMed interface (1950 to date/no limits set): (1) using the MeSH terms “infant, newborn”, “chickenpox” and “varicella-zoster immune globulin” joined by the Boolean operator AND revealed 27 publications, only one of which was relevant,3 and (2) using (congenital OR neonatal OR perinatal) …