Varicella

Question 1

How is maternal infection with varicella diagnosed?

Answer 1

polymerase chain reaction (PCR) to detect VZV in skin lesions (vesicles, scabs, maculopapular lesions)

Question 2

How is varicella infection transmitted?

Answer 2

by directly touching the blisters, saliva or mucus of an infected person. The virus can also be transmitted through the air by coughing and sneezing.

Question 3

Do you recommend screening for varicella immunity routinely in pregnancy?

Answer 3

Yes

Question 4

Can pregnant women receive varicella vaccination?

Answer 4

No. Conception needs to be delayed by 1 month after vaccination

Question 5

How do you counsel a patient with a positive varicella IgM and positive IgG results?

Answer 5

Recent infection

Question 6

When are patients with varicella infectious?

Answer 6

contagious beginning 1 to 2 days before rash onset until all the chickenpox lesions have crusted

Question 7

If a patient is exposed to varicella, not immune and able to receive the vaccine, when do you administer?

Answer 7

Vaccination within 3–5 days post-exposure

Question 8

If a patient is exposed to varicella, not immune and able to receive the vaccine, and at high risk for severe varicella, what and when do you administer?

Answer 8

Varicella zoster immune globulin (VARIZIG) within 6-10 days.

Can be given for exposure in pregnancy.

Question 9

How is acute varicella in pregnancy managed?

Answer 9

If VZIG is not immediately available, clinicians should provide prophylaxis with acyclovir (800 mg orally 5 times daily for 7 days) or valacyclovir (1000 mg orally 3 times daily for seven days)

Question 10

Does treatment with acyclovir for acute varicella in pregnancy reduce fetal risks?

Answer 10

Yes

Question 11

What are maternal risks of varicella infection?

Answer 11

bacterial superinfection of skin lesions
varicella pneumonia (increases risk of maternal mortality)
post-infectious acute cerebellar ataxia
encephalitis
thrombocytopenia 
Reye Syndrome.

Question 12

What are maternal symptoms of varicella infection?

Answer 12

itchy rash, blisters and fever

Question 13

What ultrasound findings are consistent with in utero varicella infection?

Answer 13

hydrops
hyperechogenic foci in the liver/bowel
cardiac malformations
limb deformities (due to scarring of extremities)
microcephaly
fetal growth restriction

Question 14

How is in utero varicella infection confirmed?

Answer 14

PCR of amniotic fluid

Question 15

If performing an amniocentesis for suspected varicella infection, what tests will you order on the amniotic fluid?

Answer 15

Varicella PCR

Question 16

What is the risk of fetal transmission of varicella in the first trimester?

Answer 16

vertical transmission to the fetus has been detected clinically/serologically and by PCR in approximately 24% and 8% of cases of virologically confirmed maternal chickenpox

Question 17

In which trimester(s) of pregnancy is the greatest risk of fetal infection with varicella?

Answer 17

First and second trimester but the risk is very low

Question 18

What are fetal risks of in utero varicella infection?

Answer 18

usually benign and self-limiting, but may cause congenital varicella syndrome

Question 19

If a pregnant patient is diagnosed with acute varicella and delivers, when is the greatest risk period for neonatal transmission?

Answer 19

Birth through first month of life. Give VZIVG to baby at birth also