Varicella Antibodies

Synonym/acronym: Varicella-zoster antibodies, chickenpox, VZ.

Common use

To assist in diagnosing chickenpox or shingles related to a varicella-zoster infection and to assess for immunity.

Specimen

Serum (1 mL) collected in a gold-, red-, or red/gray-top tube. Place separated serum into a standard transport tube within 2 hr of collection.

Normal findings

(Method: Enzyme immunoassay)

	IgM	Interpretation	IgG	Interpretation
Negative	0.89 index or less	No significant level of detectable antibody	0.89 index or less	No significant level of detectable antibody; indicative of nonimmunity
Indeterminate	0.9–1.0 index	Equivocal results; retest in 10–14 d	0.9–1.0 index	Equivocal results; retest in 10–14 d
Positive	1.1 index or greater	Antibody detected; indicative of recent immunization, current or recent infection	1.1 index or greater	Antibody detected; indicative of immunization, current or past infection

Description

Varicella-zoster is a double-stranded DNA herpes virus that is responsible for two clinical syndromes: chickenpox and shingles. The incubation period for varicella infection is 2 to 3 wk, and it is highly contagious for about 2 wk beginning 2 days before a rash develops. It is transmitted in respiratory secretions and by direct contact with the secretions inside. Painful eruptions appear on the skin and mucus membranes. The primary exposure to the highly contagious virus usually occurs in susceptible school-age children. Adults without prior exposure and who become infected may have severe complications, including pneumonia. Neonatal infection from the mother is possible if exposure occurs during the last 3 wk of gestation. The second syndrome, shingles, results when the presumably latent virus is reactivated and produces painful skin eruptions along nerve tracks. In both syndromes, the presence of immunoglobulin (Ig) M antibodies indicates acute infection and the presence of IgG antibodies indicates current or past infection. A reactive varicella antibody result indicates immunity but does not protect an individual from shingles. There are also polymerase chain reaction methods that can detect varicella-zoster DNA in various specimen types.

This procedure is contraindicated for

N/A

Indications

Determine susceptibility or immunity to chickenpox

Potential diagnosis

Positive findings in:

Varicella infection

N/A

Critical findings

N/A

Interfering factors

N/A

Nursing Implications and Procedure

Potential nursing problems

Problem	Signs & Symptoms	Interventions
Pain (Related to altered nerve root function secondary to viral infection)	Pain that is burning, stabbing, tearing	Keep clothing or bedding from touching the effected area; use a foot cradle as appropriate; assess and monitor the location, duration, and characteristics of pain; explain the importance of pain medication and administer as prescribed; teach how to apply antipruritic lotion (e.g., calamine); discuss the application of wet compresses to decrease itching; consider the use of distraction and relaxation techniques as a pain management modality
Infection (Related to exposure to Varicella zoster)	Headache; fever; malaise; blister rash; chills; nausea; pain and tingling at area of rash before appearance; itching; open sores; loss of appetite	Encourage vaccination of all at-risk family members or friends; administer prescribed antiviral medication; monitor and trend white blood cell count; monitor and trend temperature; decrease exposure to noninfected individuals by limiting visitors; prevent exposure to others from cough or touching infected fluids; practice vigilant hand washing; keep infected individuals home
Skin (Related to itching secondary to varicella infection)	Scratching with open sores; drainage from open sores	Teach how to decrease the itch-scratch cycle (use warm water and pat dry rather than rub); administer prescribed antipruritic creams or lotion
Fluid volume (Related to inadequate fluid intake secondary to nausea and altered appetite associated with varicella infection)	Hypotension; decreased cardiac output; decreased urinary output; dry skin/mucous membranes; poor skin turgor; sunken eyeballs; increased urine specific gravity; hemoconcentration	Monitor intake and output; assess for symptoms of dehydration (dry skin, dry mucous membranes, poor skin turgor, sunken eyeballs); monitor and trend vital signs; monitor for symptoms of poor cardiac output (rapid, weak, thready pulse); record daily weight with monitoring of trends; collaborate with physician with administration of IV fluids to support hydration; monitor laboratory values that reflect alterations in fluid status (potassium, blood urea nitrogen, creatinine, calcium, hemoglobin, hematocrit, sodium); manage underlying cause of fluid alteration; monitor urine characteristics and respiratory status; establish baseline assessment data; collaborate with physician to adjust oral and IV fluids to provide optimal hydration status; administer replacement electrolytes as ordered

Pretest

Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
Patient Teaching: Inform the patient this test can assist in assessing for a viral infection or immunity.
Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
Obtain a history of exposure to varicella.
Obtain a history of the patient’s immune and reproductive systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
Review the procedure with the patient. Inform the patient that several tests may be necessary to confirm diagnosis. Any individual positive result should be repeated in 7 to 14 days to monitor a change in detectable level of antibody. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

Potential complications: N/A
Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
Vaccination Considerations: Record the date of last menstrual period and determine the possibility of pregnancy prior to administration of varicella vaccine to female varicella-nonimmune patients. Instruct patient not to become pregnant for 1 mo after being vaccinated with the varicella vaccine to protect any fetus from contracting the disease and having serious birth defects. Instruct on birth control methods to prevent pregnancy, if appropriate.
Recognize anxiety related to test results, and provide emotional support if results are positive and the patient is pregnant. Inform the patient with shingles about access to pain management. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services.
Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
Patient Education
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
- Instruct the patient in isolation precautions during the time of communicability or contagion.
- Emphasize the need to return to have a convalescent blood sample taken in 7 to 14 days. Provide information regarding vaccine-preventable diseases where indicated (e.g., varicella).
- Provide contact information, if desired, for the Centers for Disease Control and Prevention (www.cdc.gov/vaccines/vpd-vac).
Answer any questions or address any concerns voiced by the patient or family.
Expected Patient Outcomes
- Knowledge
- States importance of taking prescribed antiviral in its entirety to treat infection
- States the importance of good hand washing to prevent disease transmission to others
- Skills
- Demonstrates proficiency in the application of antipruritic lotion
- Demonstrates proficiency in taking and recording temperature
- Attitude
- Complies with the request to remain home to prevent spread of the varicella virus until no longer contagious
- Complies with the request to increase oral fluid intake to decrease dehydration risk

Related Monographs

Refer to the Immune and Reproductive systems tables at the end of the book for related tests by body system.

Varicella Antibodies