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
- 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
- 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