Chickenpox in immunocompromised adults

Immune suppression can result from cancer treatment, an organ transplant, immune-modifying medicines or certain medical conditions. In this setting, chickenpox may progress quickly, involve the lungs or nervous system, and produce a rash that is extensive, bleeding or slow to crust. Fever, cough, breathlessness, severe headache or confusion deserve particular attention. A clinician will need to know the immune condition, current medicines, recent exposure and whether the person has had chickenpox or vaccination before.

Call the treating team, GP or urgent care service as soon as chickenpox is suspected, even if symptoms seem mild. Call before attending so the service can limit exposure to other patients. Avoid close contact with pregnant people, newborns and other immunocompromised people. Do not stop prescribed immune medicines or start an antiviral from a previous illness without medical direction. An antiviral may be recommended, with the route and monitoring chosen around the person’s immune status and other medicines.

Get emergency help for breathing difficulty, chest pain, blue lips, confusion, severe drowsiness, fainting, seizures, severe headache or neck stiffness. Urgent review is also needed for persistent fever, a rapidly spreading or bleeding rash, severe abdominal pain, repeated vomiting or signs of dehydration. Report any new cough or breathing change promptly because lung involvement may not be obvious from the skin alone.

Ask which service should assess you, whether antiviral treatment should start now, whether any regular medicine needs review, and what monitoring is needed. Ask how to protect household members, when you are no longer contagious, and whether vaccination is appropriate later or for close contacts.