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PEPtalk: postexposure prophylaxis against varicella in children with cancer
  1. Jessica Bate1,2,
  2. Julia Chisholm2,
  3. Paul T Heath1,
  4. Judith Breuer3,
  5. Rod Skinner4,
  6. Sue Manley5,
  7. Soonie Patel6,
  8. Keith Wheatley7,
  9. Mary Ramsay8,
  10. Pamela R Kearns7,
  11. Sophie Hambleton9
  1. 1Division of Clinical Sciences, St George's, University of London, London, UK
  2. 2Department of Paediatric Oncology, Royal Marsden NHS Foundation Trust, Sutton, UK
  3. 3Department of Virology, University College London, London, UK
  4. 4Department of Paediatric and Adolescent Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  5. 5Department of Paediatric Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  6. 6Paediatric Department, Mayday University Hospital, Surrey, UK
  7. 7Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, UK
  8. 8Centre for Infections, Health Protection Agency, London, UK
  9. 9Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr Sophie Hambleton, Institute of Cellular Medicine, 4th Floor, Catherine Cookson Building, M4.030, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK; sophie.hambleton{at}


Objectives To describe postexposure prophylaxis (PEP) against varicella zoster virus (VZV) in children being treated for malignancy in the UK and Ireland: the population at risk, frequency of exposure, clinical practice and attitudes among healthcare providers.

Design An observational study in three parts: (1) a retrospective survey of serostatus at diagnosis of malignancy, (2) collation of varicella zoster immune globulin (VZIG) dispensing data over a 3-year period and (3) an online survey of paediatric oncologists' clinical practice and beliefs in relation to VZV disease and its prevention.

Setting UK and Ireland.

Participants Children diagnosed with malignancy in 2009 (serostatus survey) or receiving VZIG between April 2006 and March 2009 (VZIG dispensing study). Paediatric oncologists and haematologists working in tertiary paediatric oncology centres and related shared care units in the UK and Ireland (physician survey).

Results Of 1500 children diagnosed with malignancy each year, at least 24% are VZV seronegative. Few centres make efforts to prevent household exposure by vaccinating VZV-susceptible family members. Exposures to VZV result in the administration of PEP to approximately 250 children with cancer annually: half receive an intramuscular injection of VZIG while the remainder receive a course of oral aciclovir. The choice of PEP is made by doctors. There is no consensus among paediatric oncologists as to which is the better option, reflecting the lack of a secure evidence base.

Conclusions A randomised controlled trial to compare the effectiveness and acceptability of VZIG and aciclovir as PEP against varicella is both desirable and feasible.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.