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PEPtalk 3: oral aciclovir is equivalent to varicella zoster immunoglobulin as postexposure prophylaxis against chickenpox in children with cancer – results of a multicentre UK evaluation
  1. Claire Cuerden1,
  2. Charlotte Gower2,
  3. Kevin Brown3,
  4. Paul T Heath4,
  5. Nick Andrews5,
  6. Gayatri Amirthalingam3,
  7. Jessica Bate1
  1. 1Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
  2. 2Department of Immunisation and Counter Measures, Public Health England Colindale, London, UK
  3. 3Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
  4. 4Vaccine Institute, St George's, University of London, London, UK
  5. 5Statistics, Modelling and Economics Unit, UK Health Security Agency, London, UK
  1. Correspondence to Dr Jessica Bate, Paediatric Oncology, Southampton Children's Hospital, Southampton, UK; jessica.bate1{at}


Objective To compare the occurrence of chickenpox in children with cancer who received varicella immunoglobulin (VZIG) or aciclovir as postexposure prophylaxis (PEP).

Design Prospective multicentre service evaluation of children with cancer who received either VZIG or aciclovir as PEP following significant exposure to varicella zoster virus (VZV) over a 24-month period from May 2018.

Setting Data were collected from 9 UK Paediatric Oncology Primary Treatment Centres.

Patients Children under 16 years old with a diagnosis of cancer and/or previous haematopoietic stem cell transplant who were VZV seronegative at exposure and/or diagnosis and received PEP following significant VZV exposure.

Main outcome measures The primary outcome was the incidence of breakthrough varicella within 6 weeks of VZV exposure and treatment with PEP.

Results A total of 105 eligible patients were registered with a median age of 4.9 years (range 1.1–10.5 years). Underlying diagnoses were acute leukaemia (64), solid tumours (22), Langerhans cell histiocytosis (9), central nervous system (CNS) tumours (8) and other (2). Aciclovir was received by 86 patients (81.9%), 18 received VZIG (17.1%) and 1 valaciclovir (0.9%). There were seven reported break-through VZV infections in 103 patients at follow-up (7/103, 6.8%). Clinical VZV developed in 5/84 of the aciclovir group (6.0%, 95% CI 2.0 to 13.3) and 2/18 of VZIG group (11.1%, 95% CI 1.4 to 34.7). All breakthrough infections were either mild (5/7) or moderate (2/7) in severity.

Conclusion Aciclovir is a safe and effective alternative to VZIG as VZV PEP in children with cancer and should be considered as standard of care.

  • Infectious Disease Medicine
  • Paediatrics
  • Virology

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • CC and CG are joint first authors.

  • Twitter @jessica_bate

  • Contributors JB, PTH, KB and GA contributed to the design and implementation of the research, to the analysis and interpretation of the results and to the writing of the manuscript. NA provided statistical input to the study design and contributed to the analysis of the results. CMG coordinated the study and contributed to the implementation of the research and analysis of the results. CC led on writing of the manuscript with input from the study team. JB is guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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