Fatal Neonatal Varicella Infection

Holland, P.; Isaacs, David; Moxon, E. Richard

doi:10.1016/s0140-6736(86)90556-8

Cited by 42 publications

(23 citation statements)

References 6 publications

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“…When a neonate who has received VZIG is discharged home, it should be made clear to the parents that prompt hospital review should be undertaken if the baby becomes unwell or develops rashes. It has been generally accepted that passive immunization of the newborn can modify the clinical course of neonatal varicella but it does not prevent the disease and, although decreased, the risk of death is not completely eliminated [16,19].…”

Section: Preventive Measuresmentioning

confidence: 99%

Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 2: Varicella-zoster virus infections

Sauerbrei

Wutzler

2006

Med Microbiol Immunol

132

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Varicella during pregnancy can be associated with severe illnesses for both the mother and her neonate. Varicella pneumonia must be regarded as a medical emergency, since pregnant women are at risk of life-threatening ventilatory compromise and death. After maternal chickenpox in the first and second trimesters, congenital varicella syndrome may occur in nearly 2% of the cases. The characteristic symptoms consist of skin lesions in dermatomal distribution, neurological defects, eye diseases and skeletal anomalies. If the mother develops varicella rashes between day 4 (5) antepartum and day 2 postpartum, generalized neonatal varicella leading to death in about 20% of the cases has to be expected. Normal zoster has not been shown to be associated with maternal pneumonia, birth defects or problems in the perinatal period. On the basis of the clinical consequences of varicella-zoster virus infections during pregnancy, the present paper summarizes the currently available concepts of prevention, diagnosis and therapy.

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Section: Preventive Measuresmentioning

confidence: 99%

Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 2: Varicella-zoster virus infections

Sauerbrei

Wutzler

2006

Med Microbiol Immunol

132

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“…No babies died in either studies (Table 3). However, death from varicella following VZIG treatment has been documented [11,13]. A combination of VZIG and ACV (simultaneous administration) was therefore suggested by some investigators [8,9,19] but it still failed to prevent this neonatal infection.…”

Section: Discussionmentioning

confidence: 99%

“…The administration of varicella-zoster immune globulin (VZIG) or zoster immune globulin (ZIG) to these high risk infants is recommended to prevent or reduce the severity of the illness [6,14]. Neonatal infections may still occur in about 50% of the infants receiving ZIG prophylaxis and some of these infections may still be severe or fatal [3,10,11,13,15]. Therefore, some investigators [8,9,19], based on clinical experience, suggest that a combination of VZIG (or ZIG) and acyclovir (ACV) may be helpful for babies at risk of neonatal varicella.…”

Section: Introductionmentioning

confidence: 99%

Prophylaxis of intravenous immunoglobulin and acyclovir in perinatal varicella

Huang¹,

Lin²,

Lin

et al. 2001

Eur J Pediatr

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“…The administration of VZIGs to newborns is indicated if the mother had varicella symptoms between seven days before and seven days after childbirth, and especially between five days before and two days afterwards, but is probably not necessary if maternal varicella appeared before or after this period . In general, the combined neonatal administration of VZIGs (and antiviral agents) alters the clinical course of the disease, but does not completely prevent it, and 50% of the infants may still experience clinical symptoms [87,191] ; however, mortality is reduced (even if not entirely eliminated) [16,153,191,261,262] . VZIGs are also recommended in premature infants (born after 28 wk or later) who have been exposed in the neonatal period and have mothers without any evidence of immunity (i.e., there has been no passive transmission of antibodies from the mother), and in those born before 28 wk (or weighing ≥ 1000 g) who have been exposed neonatally regardless of the immune status of the mother (because the reduced gestational period means that they cannot have acquired maternal antibodies) [5,26,165,199,263,264] .…”

Section: Prevention and Treatmentmentioning

confidence: 99%

“…VZIGs are also recommended in premature infants (born after 28 wk or later) who have been exposed in the neonatal period and have mothers without any evidence of immunity (i.e., there has been no passive transmission of antibodies from the mother), and in those born before 28 wk (or weighing ≥ 1000 g) who have been exposed neonatally regardless of the immune status of the mother (because the reduced gestational period means that they cannot have acquired maternal antibodies) [5,26,165,199,263,264] . However, once again, infant administration is not indicated if varicella has already appeared [261,262] .…”

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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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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Fatal Neonatal Varicella Infection

Cited by 42 publications

References 6 publications

Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 2: Varicella-zoster virus infections

Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 2: Varicella-zoster virus infections

Prophylaxis of intravenous immunoglobulin and acyclovir in perinatal varicella

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

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