Prophylaxis and therapy for varicella zoster virus infections in immunosuppressed children

In order to point out optimal strategies for treatment and prevention of varicella-zoster-infections in immunocompromised children the current proceeding as well as possible alternatives are reviewed. intravenous aciclovir is still considered a first-line agent in the treatment of active varicella and shingles with clear efficacy and a good safety profile. The nucleoside analogue brivudine (bromovinyldeoxyuridine, BVDU) emerges as a promising alternative providing good oral bioavailability. As atypical clinical courses of varicella in immunocompromised children may lead to a significant delay of diagnosis as the main reason for aciclovir treatment failures, prophylactic measures remain essential. Children with a positive history of varicella or after contact with shingles should not be excluded. Passive immunization with varicella tester immune globulin shortly after exposure,which has proved to be effective in preventing or modifying the disease in most cases, is currently considered the method of choice. However, a safe oral and more comfortable alternative is desirable. There is also lack of effective measures for the interruption of the viral replication in cases with delayed recognition of varicella exposition. Oral administration of acyclovir during late incubation period appears to be beneficial in preventing varicella in otherwise healthy children, but studies in immunocompromised patients have not yet been undertaken. Active immunization does not play a major role as it can only be taken into consideration in individual cases, e.g., children before the start of immunosuppressive treatment, or for siblings as the main source of infection.