PROPHYLAXIS AND THERAPY FOR VARICELLA-ZOS TER VIRUS-INFECTIONS IN IMMUNOSUPPRESSED CHILDREN

In order to point out optimal strategies for treatment and prevention of varicella-zoster-infections in immunocompromised children the curre nt proceeding as well as possible alternatives are reviewed. intraveno us aciclovir is still considered a first-line agent in the treatment o f active varicella and shingles with clear efficacy and a good safety profile. The nucleoside analogue brivudine (bromovinyldeoxyuridine, BV DU) emerges as a promising alternative providing good oral bioavailabi lity. As atypical clinical courses of varicella in immunocompromised c hildren may lead to a significant delay of diagnosis as the main reaso n for aciclovir treatment failures, prophylactic measures remain essen tial. Children with a positive history of varicella or after contact w ith shingles should not be excluded. Passive immunization with varicel la tester immune globulin shortly after exposure,which has proved to b e effective in preventing or modifying the disease in most cases, is c urrently considered the method of choice. However, a safe oral and mor e comfortable alternative is desirable. There is also lack of effectiv e measures for the interruption of the viral replication in cases with delayed recognition of varicella exposition. Oral administration of a cyclovir during late incubation period appears to be beneficial in pre venting varicella in otherwise healthy children, but studies in immuno compromised 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 immunosuppres sive treatment, or for siblings as the main source of infection.