Varicella-Zoster Virus (VZV) is a member of the herpesvirus family. It causes chickenpox (varicella) as a primary infection in immunocompetent individuals, and shingles when dormant infections recur in later life.


Primary infections with VZV can be very serious in immunosuppressed patients. Reactivations of dormant VZV (shingles) are more common and may also be more severe, and may become generalised in highly immunosuppressed patients.

Prevention and management have been transformed by immunisation and the availability of effective antiviral agents. VZV immunoglobulin (VZIG, prepared from hyper-immune recovered patients) is no longer first line, except in the first half of pregnancy. Please follow links below to detailed guidance, but general principles are now that:

  • Transplant candidates who are seronegative for VZV should be immunised before transplant, as long as live vaccines are safe for them (ie not on immunosuppressive therapy). See Immunisations in transplantation.
  • Seronegative transplant patients who come into close contact with someone with active VZV infection should receive prophylaxis with antivirals (aciclovir/valaciclovir).
  • Prophylactic use of VZIG is now reserved for susceptible women in the first 20 weeks of pregnancy, and for those unable to take aciclovir/valaciclovir.

Recurrences (shingles)

Antivirals are usually indicated early in the course of shingles in immunosuppressed patients.

Further info

This page created 8 April 2020 by Neil Turner. The date it was last updated is shown in the footer.