varicella in pregnancy

see also:

Summary for ED clinicians:
  • antivirals for clinical varicella:
    • high risk patients (incl. pregnant, immunocompromised, age < 28 days, or very unwell) with clinical chickenpox should be considered for aciclovir, and perhaps consider also for those over the age of 12yrs if within 24hrs of rash
      • admit for iv aciclovir if either:
        • neonatal chickenpox and either:
          • mother developed chickenpox within 7 days prior to delivery or within 28 days after delivery
          • unwell, poor feeding, or tachypnoeic
          • immunocompromised
          • premature (<28wks gestation)
          • on corticosteroids
          • less than 7 days old when exposed
        • non-neonates (including adults) with chickenpox and either:
          • immunocompromised
          • altered mental state (?encephalitis)
          • respiratory symptoms and CXR suggests pneumonia
      • patients with shingles should be considered for aciclovir if within 72hrs of onset.
  • post-exposure prophylaxis for non-immune contacts:
    • non-immune contacts who are immunocompromised, pregnant or neonates should be considered for ZIG within 96hrs post-exposure
      • neonatal indications for post-exposure ZIG (ie. age < 28 days):
        • neonatal age < 96hrs and mother developed chickenpox within 7 days of delivery
        • neonate aged < 7 days and born < 28wks gestation OR mother seronegative or unknown immune status for varicella
        • immunocompromised neonate and no immunoglobulin within last 3 weeks and no PH chickenpox1)
    • non-immune adolescent and adult contacts who are not pregnant nor immunocompromised should be offered post-exposure varicella vaccination if within 5 days of contact

introduction

1)
RCH guideline
2)
Archives Dis Childhood Feb 2011