Intravenous immunoglobulin prophylaxis in children with acute leukemia following exposure to varicella

The high risk of varicella in immunocompromised children has been well documented. With the aim of diminishing this risk, attempts have been made to modify or prevent varicella by passive immunization. From September 1985 to March 1991, five children with leukemia, having a total of seven episodes of intimate exposure to varicella, received a single dose (200 mg/kg) of intravenous immunoglobulin (IVIG) within 3 days of exposure. The patients included four children with acute lymphoblastic leukemia and one child with myelodysplastic syndrome in acute myeloblastic leukemic transformation. None of the five children developed varicella following IVIG infusion. No side effects were observed. IVIG appears to be an effective and safe alternative for preventing varicella in immunocompromised patients upon intimate exposure, when zoster immunoglobulin or varicella-zoster immunoglobulin is unavailable, as in Taiwan.