Exxcellence pearls: varicella infection at term

Question 1

What type of virus is the varicella virus?

Answer 1

Herpesvirus

Question 2

How do women with maternal varicella infection present?

Answer 2

A prodrome of fever, headache, malaise followed by pruritus and a maculopapular rash which becomes vesicular prior to crusting over

Question 3

How should a pregnant woman who is exposed to varicella be managed?

Answer 3

First determine prior history of chickenpox or vaccination. If she cannot recall then serologies should be performed. If negative she should receive VZIG within 10 days of exposure.
Oral antiviral agents within 72 hours of symptoms will reduce the severity and risk of complications.

Question 4

What are the maternal complications of varicella infection?

Answer 4

Respiratory distress and pneumonia

Question 4

How can the risk of neonatal varicella infection be reduced?

Answer 4

Delay delivery by 5–7 days to allow more passive immunity to develop.

Question 6

What is the neonatal concern for maternal varicella infection?

Answer 6

High risk of neonatal infection if infant was born plus or minus 7 days from onset of maternal rash. Two thirds of infected infants will have characteristic rash and and are at risk for pneumonia, liver failure, encephalopathy and coagulopathy.

Question 7

How should neonates exposed to varicella be managed?

Answer 7

Notify pediatrician.
Ophthalmic exam and serology testing.
Neonates delivered to mothers with a rash from five days before delivery to two days following delivery should receive VZIG. Acyclovir if signs of neonatal infection develop.