CONCEPTS, COMPONENTS & CONFIGURATIONS varicella-zoster virus, management of exposure Management of Varicella-Zoster Virus-Exposed Hospital Employees Emergency physicians frequently manage hospital employee health services. A common hospital infection control problem is varicella-zoster virus infec- tion. We reviewed the literature to determine a rational basis for the man- agement of the varicelIa-zoster virus-exposed hospital employee. Exposed employees include those with direct face-to-face contact with an infected person. The immune status should be determined in those employees with a negative or uncertain history of varicella infection by using a sensitive and specific technique such as the FAMA or ELISA tests. Employees with a positive history or a positive titer are immune and can return to work. Those with a negative titer are susceptible and should avoid patient contact from day eight to 21 following exposure. High-risk, susceptible contacts should be given varicella-zoster immune globulin. Varicella infection will become much less common after the release of varicella vaccine. [Sayre MR, Lucid EJ: Management of varicella-zoster virus-exposed hospital employees. Ann Emerg Med April 1987;16:421-424.] INTRODUCTION Emergency physicians frequently manage the health care needs of hospital employees. Even if not responsible for the entire hospital, an emergency phy- sician usually is responsible for infection control in the emergency depart- ment. There are an estimated 2.8 million cases of varicella (chickenpox) an- nually in the United States. 1 The incidence of herpes zoster is not well documented. One study estimated that 300,000 cases occur annually in the United States. z With so many cases, it is no surprise that many occur in the hospital environment. There are approximately 6,460 hospitalizations each year for varicella. 3 Employees also may be exposed by cases of herpes zoster, new cases of varicella in patients hospitalized for other conditions, and the children and other contacts of the employees outside the hospital environ- ment. Primary varicella is a benign disease in the immunologically normal child. Disease in immunocompromised children and healthy adults can be severe. Seven percent of children with acute lymphocytic leukemia who contract varicella will die. 4 Only 1.5% of varicella cases occur in patients older than 19, but 27% of the deaths occur in this groupJ Varicella is spread by direct contact with fresh vesicles, by airborne nasal droplet nuclei, and by indirect contact such as on the hands of hospital per- sonnel. The virus has a limited ability to survive outside of living human cells. It cannot be recovered from crusts, and room dust is not infectious, s Eighty-seven percent of pediatric household contacts of chickenpox cases with a negative history acquire the disease. 6 Demonstrating the contagious nature of the virus, 13 of 24 susceptible patients on a ward with a defective air conditioner acquired chickenpox. 7 There are numerous reports of the nosocomial transmission of vari- cella.S 12 Others have described an algorithm for the management of the ex- posed patient. 13 No one has provided detailed guidelines for the management of the exposed hospital employee. Our purpose was to determine a rational basis for the effective management of the varicella-zoster vires-exposed hos- pital employee. DETERMINATION OF EXPOSURE The exact mechanisms of person-to-person transmission of varicel.la-zoster Michael R Sayre, MD Emily Jean Lucid, MD, FACEP Pittsburgh, Pennsylvania From the Division of Emergency Medicine, Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania. Received for publication January 20, 1986. Accepted for publication May 7, 1986. Address for reprints: Emily Jean Lucid, MD, Division of Emergency Medicine, Allegheny General Hospital, 320 E North Ave, Pittsburgh, Pennsylvania 15212. 16:4 April 1987 Annals of Emergency Medicine 421/77