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ACOG指南概览:四种围产期感染的关键点(四)水痘-带状疱疹病毒

作者:陈敏
陈敏母胎医学 2019-5-13 阅读 字号:T|T

Varicella Zoster 带状-带状疱疹病毒


Diagnostic points

诊断要点


Varicella is diagnosed based on typical symptoms. Serology is not generally used for diagnosis. Risk of fetal congenital infection is low (0.4%–2.0%) but neonatal infection when maternal disease occurs between 5 days before delivery until 2 days after delivery is associated with a high rate of neonatal death.

水痘是可以基于典型症状进行诊断的,血清学检查一般不用于诊断。胎儿先天性感染水痘的风险很低(0.4%~2.0%),但如果母亲在分娩前5天到分娩后2天内感染,与新生儿的高死亡率相关联。


New points

新的要点


1. From 10% to 20% of pregnant women who contract a primary varicella infection will develop pneumonia and maternal risk of death from varicella is as high as 40%. Thus, these patients should be treated with oral acyclovir and varicella-zoster immune globulin (VZIG).

10%~20%的孕妇初次感染水痘会发展成为肺炎,其死亡风险高达40%。因此,这些患者应口服阿昔洛韦和接受水痘-带状疱疹免疫球蛋白(VZIG)治疗。


2. Varicella immunity status should be documented in early pregnancy by history of disease or history of vaccination. If a woman’s history is negative for either disease or vaccination, she can be tested for varicella IgG.

早孕建册时,需要记录孕妇的水痘免疫状态、疫苗接种史和既往相关病史。如果孕妇从未接触过水痘病毒或从未接受相关免疫,则需要做水痘抗体测试。


3. Congenitally infected fetuses with no varicella-associated anatomic abnormalities have normal neurodevelopment.

先天性感染的胎儿,如果没有水痘相关的解剖学异常,神经发育一般也会正常。


4. Correction: Conception need be delayed by only 1 month after the varicella vaccine is received. The current practice bulletin says 3 months, but this will be corrected by ACOG in early 2016.


Level A recommendations

A级建议


1. Oral acyclovir appears safe and should be considered in pregnant women with varicella lesions. The efficacy of intravenous (IV) acyclovir has not been established but it may reduce maternal morbidity and mortality associated with varicella pneumonia.

口服阿昔洛韦是安全的,有水痘病变的孕妇可以考虑使用。静脉注射(IV)阿昔洛韦的疗效尚未确定,但它可以降低产妇水痘相关性肺炎的发病率和死亡率。


2. Pregnant women who are not immune to varicella and exposed to active varicella should receive VZIG within 96 hours of exposure to prevent or attenuate disease manifestations. (However, please note that it is very difficult to obtain VZIG and it must be gotten directly from the manufacturer [CDC 2013].5)

孕妇如果未曾接种水痘疫苗,应在接触感染性水痘病毒的96小时内接受水痘-带状疱疹免疫球蛋白(VZIG)治疗,以预防或减轻疾病症状。(然而,VZIG的获取非常困难,往往需要直接从制造商得到。)

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