How can I obtain varicella zoster immune globulin (VZIG)?
In 2004, the Advisory Committee on
Immunization Practices (ACIP) was informed by Massachusetts Public Health Biologic Laboratories that the company had discontinued production of varicella zoster
immune globulin (VZIG).
An investigational VZIG product, VariZIG™ (Cangene Corporation, Winnipeg,
Canada) is now recommended by the ACIP for patients who have been exposed to
varicella and who are at increased risk for severe disease and complications .
As with any product used as an
investigational new drug patients must be informed of potential risks and
benefits and must give informed consent before receiving the product.
VariZIG™ can be obtained from the sole authorized US distributor, FFF Enterprise (Temecula, CA). FFF Enterprises, at 1-800-843-7477 or via the Internet at
www.fffenterprises.com. FFF Enterprises delivers VZIG on an as needed basis
(e.g., when there is an identified exposed person for whom VZIG is indicated).
Under normal circumstances, the distributor delivers the vaccine within 24 hours
The recommended dose is 125 U/10kg (22 lbs) of body weight, up to a maximum of 625 U. VariZIG™ should be
administered intramuscularly as directed by the manufacturer. Currently, VZIG is available only in 625-U vials.
VariZIG™ treatment is expected
to be most effective when it is initiated within 96 hours after exposure.
Treatment after 96 hours is of uncertain value. "In situations in which
administration of VariZIG does not
appear possible within 96 hours of exposure, administration of immune globulin
intravenous (IGIV) should be considered as an alternative. IGIV should also be
administered within 96 hours of exposure. Although licensed IGIV preparations
are known to contain anti-varicella antibody titers, the titer of any specific
lot of IGIV that might be available is uncertain because IGIV is not routinely
tested for anti-varicella antibodies. The recommended IGIV dose for postexposure
prophylaxis of varicella is 400 mg/kg, administered once. For pregnant women who
cannot receive VariZIG within 96 hours of exposure, clinicians may choose either
to administer IGIV or closely monitor the women for signs and symptoms of
varicella and institute treatment with acyclovir if illness occurs. " 
When acyclovir therapy is indicated, the manufacturer recommends it should be
initiated at the earliest sign or symptom of chickenpox. Acyclovir is given 800
mg intravenously 4 times daily for 5 days. There is no information
about the efficacy of therapy initiated more than 24 hours after onset of signs and symptoms.
The dosage is adjusted for patients with renal impairment 
Acyclovir also been shown to be effective in preventing varicella
in some susceptible persons when given prophylactically 800 mg PO five times daily for 5 to 7 days [3,4].
However, the CDC has advised "before such a strategy could be
considered, additional data are needed concerning the prophylactic use of
acyclovir in healthy and immunocompromised persons in all age groups." 
1. A New Product (VariZIG™) for Postexposure Prophylaxis of
Varicella Available Under an Investigational New Drug Application Expanded Access Protocol February 24, 2006 / 55(Early Release);1-
2. Zovirax package insert 2005.
3.Asano Y, Yoshikawa T, Suga S, et al: Postexposure prophylaxis of
varicella in family contact by oral acyclovir. Pediatrics 1993;92:219.PMID 8393173
4. Suga S, Yoshikawa T, Ozaki T, Asano Y. Effect of oral acyclovir against primary and secondary viraemia in incubation period of varicella. Arch Dis Child 1993;69:639-42.PMID
5. CDC. Prevention of varicella: recommendations of the Advisory Committee on
Immunization Practices (ACIP). MMWR 1996;45 (No. RR-11):21.