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varicella in pregnancy

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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


  • the introduction of routine childhood varicella zoster vaccination in Australia in 2005 has seen dramatic reductions in neonatal varicella and almost eiminated congenital varicella due to herd effect resulting in pregnant women no longer become infected from children.2)
varicella_preg.txt · Last modified: 2014/10/22 06:38 by

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