Varicella Zoster 带状-带状疱疹病毒
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.
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).
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.
3. Congenitally infected fetuses with no varicella-associated anatomic abnormalities have normal neurodevelopment.
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
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.
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)