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Congenital & Neonatal Varicella Infections

VZV Background

Varicella-Zoster Virus

  • 1 of 8 herpesviruses -> human infection
  • 2 distinct forms of disease:
  • 1) VARICELLA
  • 2) Herpes Zoster

Varicella Infection

  • Primary infection = chickenpox
  • Vesicular rash in various stages of healing
  • <20 weeks = congenital varicella syndrome
  • Immediately before or after delivery = neonatal varicella

Varicella Vaccine

  • Developed 1995 = 1-dose schedule
  • 2006 = 2-dose schedule (ages?)
  • Primary infection -> lifelong immunity

Transmission

  • 90% attack rate
  • Infectious secretions
  • Direct contact with vesicles
  • Airborne spread
  • Incubation:
  • 10-21 days post-exposure
  • Replicates in LN, tonsils, & salivary glands -> viremia

Management of Exposure

Postexposure Prophylaxis

  • VariZIG (ASAP up until 10 days!)
  • Mom with S/S around time of delivery
  • Hospitalized premature >/= 28 weeks gestation & mom does not have documented immunity
  • Hospitalized premature <28 weeks or <1000 grams regardless of maternal immunity

Isolation

  • Disease
  • Mom + active lesion = COMPLETE ISOLATION
  • > 21 days before delivery = no isolation, but baby stays with mom
  • Exposure
  • 6-21 days before hospital = isolated from other moms
  • </= 6 days: no isolation

Treatment

  • Acyclovir
  • Fever reduction?

Varicella & Babies

Diagnosis

  • Clinical (most common)
  • PCR
  • DFA

Neonatal Varicella

  • Chickenpox to disseminated disease
  • Fever -> rash with cephalocaudal progression

Congenital Varicella Syndrome

  • IUGR
  • CNS abnormalities
  • Ocular defects
  • Limb abnormalities
  • GI disorders
  • Scarring skin lesions
  • 5 days before, 2 days after
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