Congenital varicella syndrome: the evidence for secondary prevention with varicella-zoster immune globulin

Cohen, Arlan; Moschopoulos, Panagis G.; Stiehm, Richard; Koren, Gideon

doi:10.1503/cmaj.100615

Cited by 46 publications

(22 citation statements)

References 18 publications

(24 reference statements)

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“…It has been reported that 50% of the mothers treated with VZIGs present an uncomplicated or mildly evolving form of varicella, and 5%-25% a sub-clinical form [8,54,90,253] . Fetal transmission also seems to be reduced [254] . As the virus crosses the placenta during the two viremic phases of incubation, it has been suggested that passive prophylaxis may be effective if administered before the first [21,22,26] .…”

Section: Prevention and Treatmentmentioning

confidence: 98%

“…As the virus crosses the placenta during the two viremic phases of incubation, it has been suggested that passive prophylaxis may be effective if administered before the first [21,22,26] . It has been reported that ZVIGs can reduce intra-uterine transmission from 12.3% to 1.1%, and reduce or practically eliminate the risk of developing CVS [16,54,90,145,164,254] . There are in fact very few published cases of CVS [166] , but it is unclear whether VZIGs prevent CVS because they prevent fetal viremia or prevent CVS even in the presence of fetal viremia, and so there is still some uncertainty concerning their real effectiveness in this regard [26,159] .…”

Section: Prevention and Treatmentmentioning

confidence: 99%

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Microbiology laboratory and the management of mother-child varicella-zoster virus infection

Paschale

Clerici

2016

WJV

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Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn. Core tip: Although varicella during pregnancy is infrequent and congenital varicella syndrome (CVS) is rare, every available means should be used to prevent and diagnose them. Microbiology laboratories can be crucial in these situations: Evaluating a mother's immune status with sensitive and specific tests for the detection of antibodies; allowing a rapid diagnosis with molecular biology tests when a clinical manifestation may be due to different etiologies; following pregnant women with varicella for the prenatal diagnosis of CVS with close collaboration between molecular biology investigators and specialists in imaging diagnostics.De Paschale M, Clerici P. Microbiology laboratory and the management of mother-child varicella-zoster virus infection. World

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Section: Prevention and Treatmentmentioning

confidence: 98%

Section: Prevention and Treatmentmentioning

confidence: 99%

Microbiology laboratory and the management of mother-child varicella-zoster virus infection

Paschale

Clerici

2016

WJV

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“…Although the varicella vaccine is contraindicated in pregnant women (as are all liveattenuated vaccines), inadvertent vaccination during pregnancy does not appear to result in an increase in incidence of congenital varicella syndrome or other birth defects. 5 In the case of congenital varicella syndrome presented by Cohen and colleagues, 6 the crucial failure was the omission of vaccination for varicella before pregnancy after serologic testing had revealed a lack of immunity in the mother.…”

Section: Varicella Vaccinationmentioning

confidence: 99%

“…This is supported by welldesigned cohort studies, which were analyzed by Cohen and colleagues. 6 However, the administration of varicella-zoster immune globulin has not been found to reliably prevent viremia, which is associated with clinically apparent varicella. In the study by Enders and colleagues, 1 about half of the mothers developed clinical varicella even when varicella-zoster immune globulin was given within one to three days of substantive exposure.…”

Section: Key Pointsmentioning

confidence: 99%

Preventing congenital varicella syndrome with immunization

Sauerbrei

2011

Canadian Medical Association Journal

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“…Pokud se varicella u matky manifestuje v této době, nedojde k významnější tvorbě a transplacentárnímu přenosu mateřských VZV protilátek. Průběh onemocnění u novorozence pak bývá těžký a často dochází k viscerální varicelle, kdy jsou postiženy parenchymatózní orgány (2,3).…”

unclassified

The Evidence of Annual Occurrence of Varicella Zoster Virus (Vzv) in Temper Climate of Czech Republic

Boštíková¹,

Salavec²,

Sleha³

et al. 2018

Mil. Med. Sci. Lett.

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Congenital varicella syndrome: the evidence for secondary prevention with varicella-zoster immune globulin

Cited by 46 publications

References 18 publications

Microbiology laboratory and the management of mother-child varicella-zoster virus infection

Microbiology laboratory and the management of mother-child varicella-zoster virus infection

Preventing congenital varicella syndrome with immunization

The Evidence of Annual Occurrence of Varicella Zoster Virus (Vzv) in Temper Climate of Czech Republic

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