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Varicella-Zoster Infection During Pregnancy

Varicella-Zoster Infection During Pregnancy. Reported by 葉長青 醫師 Modulated by 楊明智 主任 March 3, 2007. Chickenpox. Rare disease during pregnancy in most industrial countries （ protected by IgG antibodies ）

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Varicella-Zoster Infection During Pregnancy

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  1. Varicella-Zoster Infection During Pregnancy Reported by 葉長青 醫師 Modulated by 楊明智 主任 March 3, 2007

  2. Chickenpox • Rare disease during pregnancy in most industrial countries（protected by IgG antibodies） • Only 3–4% of women were found to be susceptible to primary varicella-zoster virus (VZV) infection（Germany） • Average incidence of varicella in pregnant women：0.7-3 per 1000 pregnancies • Usually mild clinical course, but may occasionally lead to serious maternal and fetal diseases during pregnancy

  3. Pathogenesis • Highly contagious infectious agent • Easily cultured from skin lesion of patients • Transmitted from person to person by direct contact with the vesicular fluid of the skin lesions and/or by secretions from the respiratory tract

  4. Figure 1

  5. Varicella Pneumonia • Greater morbidity in adults, namely pneumonia, hepatitis, and encephalitis • Varicella pneumonia in pregnancy must be regarded as a medical emergency. • Mortality：10-20% in general population, 45% in pregnancy, both decreased to 10% • Seems to occur more often in 3rd trimester • Considerably more fatal in pregnant than in non-pregnant immunocompetent adults.

  6. Varicella Pneumonia

  7. Intra-Uterine Infection • Any stage of pregnancy • Viremia / transplacental or ascending infection • Primary VZV infection during the first two trimesters of pregnancy may result in intrauterine infection in up to 25% of the cases. However, the reported rate of spontaneous abortion following acute varicella did not exceed the rate of abortion in pregnant women without chickenpox.

  8. Congenital Varicella Syndrome • 12% of infected fetuses • The incidence of congenital anomalies after maternal varicella infection in the first 20 weeks of pregnancy is about 1–2%.

  9. Congenital Varicella Syndrome • Generally after maternal chickenpox between the 5th and 24th gestational weeks • Characteristic clinical symptoms • Skin lesions in dermatomal distribution • Neurological defects • Eye diseases • Limb hypoplasia

  10. Fetal Neonatal Varicella

  11. Congenital Varicella

  12. Table 1

  13. Congenital Varisella Syndrome • Nearly 30% of infants born with signs of CVS died during the first few months of life. • CVS is not the immediate consequence of intrauterine varicella, but caused by intrauterine zoster-like VZV reactivations with accompanying encephalitis. • The fetus is not able to mount a VZV-specific cell-mediated immune response.

  14. Zoster During Pregnancy • Zoster during pregnancy is not associated with birth defects on the basis of current knowledge • Maternal zoster during the perinatal period does not cause problems for newborn infants as the infants possess specific maternal IgG class antibodies and there is usually no longer viremic spread of VZV unless the woman is immunocompromised.

  15. Preventive Methods • Active immunization of seronegative women before pregnancy is recommended for effective prophylaxis of varicella in pregnant women and neonates. • As all live-attenuated vaccines, varicella vaccine is contraindicated in pregnant women and pregnancy has to be avoided for at least 4 weeks following vaccination.

  16. Preventive Methods • Preliminary results show no hints to any birth defects related to vaccine exposure. • The risk for CVS from breakthrough varicella can be regarded as considerably lower than that for CVS in unvaccinated women with varicella. • It is important to advise non-immune pregnant women to avoid exposure to chickenpox and zoster.

  17. Preventive Methods • If pregnant women with a negative or indeterminate history of varicella have been exposed significantly (household contact, face-to-face contact for at least 5 min or indoors contact for more than 15 min) to VZV, virus-specific IgG antibodies should be measured without delay. • Antibodies detected within 7–10 days of contact must have been acquired before exposure.

  18. Preventive Methods • In case of negative, indeterminate or unknown serologic status, the application of VZIG within 72 (to 96) hours has been recommended intramuscularly at a concentration of 125 U/10 kg of body weight, up to a maximum of 625 U or 0.5 ml/kg of body weight. • The primary reason for VZIG is to prevent severe maternal chickenpox and its complications, such as pneumonia.

  19. Figure 2

  20. Diagnostic Procedures • Fetal ultrasound and magnetic resonance imaging (MRI) at 16-22 weeks gestational age or 5 weeks after infection can identify signs of CVS. • If suspicious fetal abnormalities can be detected, laboratory investigations for VZV DNA in placental villi, fetal blood or amniotic fluid and for VZV IgM in fetal blood are indicated.

  21. Therapeutic Measures • An antiviral treatment has immediately to be introduced at first signs of varicella pneumonia or other disseminated infections. • Aciclovir has to be administered orally at a dosage of 5 x 800 mg or intravenously at a concentration of 3 x 10–15 mg/kg for 7–10 days. • Zoster during pregnancy should only be treated with aciclovir in severe courses of the disease.

  22. Thank You

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