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Question 17

A 17 yo female calls the office reporting that 2 days ago, she babysat a 4 year old with a fever. He developed a pruritic rash that progressed to vesicles. The patient has no record of her immunizations. She’s never had a similar rash. She is asymptomatic. What is the best next step?

Answer Choices:

Immune globulin


Expectant management

Oral acyclovir

Correct Answer:



  • Primary infection with varicella zoster virus (VZV) causes chickenpox and reactivation causes shingles

  • Varicella spread by direct contact, air, droplets

  • Incubation period 14-16 days

  • Varicella vaccination is live attenuated

  • Vaccination is recommended in those who are exposed but have no evidence of immunity (lab results, documented history of the disease or documented vaccine)

  • Should be given within 3-5 days of exposure

  • Varicella immune globulin can be given if vaccination is contraindicated (pregnant women, immunocompromised patients, neonates). Should be given asap but no later than 10 days post-exposures.

  • Serious complications of VZV include encephalitis and sepsis