Varicella zoster virus: Occupational aspects of management 2010

Key recommendations

Healthcare settings

• A history of chickenpox has a high positive predictive value (95–98%) in HCWs from temperate climates. In this group, history alone is sufficient to determine immunity to chickenpox. Those with a negative or uncertain history should be serologically tested.
• A history of chickenpox has a lower positive predictive value in HCWs born or raised in tropical or subtropical climates. This group should have serological screening regardless of a history of chickenpox.
• VZV vaccine is effective in providing adults with long-term protection from serious VZV disease, and VZV-susceptible HCWs should be offered vaccination using two doses of vaccine.
• Where an HCW declines vaccination, the occupational health (OH) professional should explore their reasons for declining, explain the benefits of vaccination and the individual’s professional duty to protect their patients from infection, and encourage them to take up vaccination.
• Where HCWs have a contraindication to vaccination, eg they are immunocompromised through illness or treatment, the OH professional should assess the risk of varicella infection to the HCW and the risk of onward transmission of infection to their patients.
• When considering whether restrictions are necessary for HCWs who cannot or will not be vaccinated, the OH professional should take into account the level of infection risk to the HCW and their patients, and the effect of redeployment on staffing levels, skill mix and therefore patient safety.
• Decisions about restrictions will need to be taken in conjunction with the HCW, their manager and infection control, while respecting the HCW’s right to medical confidentiality.
• HCWs diagnosed with chickenpox should be excluded from the workplace until there are no new lesions and all lesions have crusted over.
• HCWs diagnosed with localised herpes zoster on a part of the body that can be covered with a bandage and/or clothing should be allowed to work if they are clinically well. If they work with high-risk patients, an individual risk assessment should be carried out, to determine the appropriate action.
• HCWs with localised herpes zoster lesions that cannot be covered or who are immunocompromised, and HCWs with disseminated herpes zoster, should be excluded from the workplace until there are no new lesions and all lesions have crusted over.
• Susceptible HCWs who have a significant exposure to VZV should either be excluded from contact with high-risk patients or inform their occupational health department if they feel unwell or develop a rash or fever during the incubation period.
• In the majority of situations a high level of vigilance for malaise, rash or fever (including taking temperature daily) throughout the incubation period will be adequate.
• Pregnant HCWs exposed to chickenpox or shingles should be assessed by an OH or other appropriate health professional for varicella zoster immunoglobulin (VZIG).

Prisons and immigration removal centres

• Staff in prisons and immigration removal centres should follow their sector’s guidance.

General workplaces (outside the healthcare and prison sector)

• Chickenpox vaccination and antibody testing is not routinely recommended for workers in employment sectors outside healthcare or the prison service.
• A worker diagnosed with chickenpox should remain away from the workplace until there are no new lesions and all lesions have crusted over.
• A worker with localised herpes zoster on a part of the body that can be covered with a bandage and/or clothing should be allowed to continue working. Workers with disseminated zoster, localised zoster that cannot be covered (eg facial), and those who are immunocompromised, regardless of the site and extent of the lesions, should remain away from the workplace until the lesions have crusted over.
• Employers should ask pregnant or immunosuppressed workers who have been exposed to an infected colleague at work to contact their GP or relevant specialist immediately for advice.