Abstract
Varicella during pregnancy can be associated with severe illnesses for both the mother and her neonate. Varicella pneumonia must be regarded as a medical emergency, since pregnant women are at risk of life-threatening ventilatory compromise and death. After maternal chickenpox in the first and second trimesters, congenital varicella syndrome may occur in nearly 2% of the cases. The characteristic symptoms consist of skin lesions in dermatomal distribution, neurological defects, eye diseases and skeletal anomalies. If the mother develops varicella rashes between day 4 (5) antepartum and day 2 postpartum, generalized neonatal varicella leading to death in about 20% of the cases has to be expected. Normal zoster has not been shown to be associated with maternal pneumonia, birth defects or problems in the perinatal period. On the basis of the clinical consequences of varicella-zoster virus infections during pregnancy, the present paper summarizes the currently available concepts of prevention, diagnosis and therapy.
Similar content being viewed by others
References
Advisory committee on immunization practices (ACIP) (1996) Prevention of varicella. MMWR Recomm Rep 45:1–36
Akisu M, Yalaz M, Aksu G, Arslanoglu S, Genel F, Kutukculer N, Kultursay N (2003) Maternally acquired varicella-zoster virus antibodies disappear at 6 months of age in prematurely born children. Panminerva Med 45:155–156
Al-Katawee YA, Al-Hassoun YA, Taha MN, Al-Moslem K (2005) Congenital varicella-zoster virus infection. A rare case of severe brain and ocular malformations without limb or cutaneous involvement in a newborn after maternal subclinical infection. Saudi Med J 26:869–871
Baba K, Yabuuchi H, Takahashi M, Ogra PL (1982) Immunologic and epidemiologic aspects of varicella infection acquired during infancy and early childhood. J Pediatr 100:881–885
Carter PE, Duffty P, Lloyd DJ (1986) Neonatal varicella infection. Lancet 2:1459–1460
Chandra PC, Patel H, Schiavello HJ, Briggs SL (1998) Successful pregnancy outcome after complicated varicella pneumonia. Obstet Gynecol 92:680–682
Deutsche Gesellschaft für Pädiatrische Infektiologie (2003) Handbuch 2003: Infektionen im Kindesalter. Futuramed, München, pp 732–739
Enders G, Miller E (2000) Varicella and herpes zoster in pregnancy and the newborn. In: Arvin AM, Gershon AA (eds) Varicella-zoster virus. Virology and clinical management. University Press, Cambridge, pp. 317–347
Enders G, Miller E, Cradock-Watson J, Bolley I, Ridehalgh M (1994) Consequences of varicella and herpes zoster in pregnancy: prospective study of 1,739 cases. Lancet 343:1548–1551
Gershon AA (1998) Varicella-zoster virus. In: Feigin RD, Cherry JD (eds) Textbook of pediatric infectious diseases, 4th edn. W. B. Saunders Company, Philadelphia, pp 1769–1777
Gershon AA, Raker R, Steinberg S, Topf-Olstein B, Drusin LM (1976) Antibody to varicella-zoster virus in parturient women and their offspring during the first year of life. Pediatrics 58:692–696
Grose C (1989) Congenital varicella-zoster virus infection and the failure to establish virus-specific cell-mediated immunity. Mol Biol Med 6:453–462
Gross G, Schofer H, Wassilev S, Friese K, Timm A, Guthoff R, Pau HW, Malin JP, Wutzler P, Doerr HW (2003) Herpes zoster guideline of the German Dermatology Society (DDG). J Clin Virol 26:277–289
Heidl M (1985) Varicella-Zoster-Virus-Infektion in der Schwangerschaft, beim Neugeborenen und jungen Säugling. Z Klin Med 40:245–250
Higa K, Dan K, Manabe H (1987) Varicella-zoster virus infections during pregnancy: hypothesis concerning the mechanisms of congenital malformation. Obstet Gynecol 69:214–221
Holland P, Isaacs D, Moxon ER (1986) Fatal neonatal varicella infection. Lancet 2:1156
Hubbard TW (1878) Varicella occurring in an infant 24 h after birth. Br Med J 1:822
Johansson AB, Rassart A, Blum D, Van Beers D, Liesnard C (2004) Lower-limb hypoplasia due to intrauterine infection with herpes simplex virus type 2: possible confusion with intrauterine varicella-zoster syndrome. Clin Infect Dis 38:e57–e62
King SM, Gorensek M, Ford-Jones EL, Read SE (1986) Fatal varicella-zoster infection in a newborn treated with varicella-zoster immunoglobulin. Pediatr Infect Dis 5:588–589
Koskimies O, Lapinleimu K, Saxén L (1978) Infections and other maternal factors as risk indicators for congenital malformations: a case-control study with paired serum samples. Pediatrics 61:832–837
Kuter BJ, Ngai A, Patterson CM, Staehle BO, Cho I, Matthews H, Provost PJ, White CJ (1995) Safety, tolerability, and immunogenicity of two regimens of Oka/Merck varicella vaccine (Varivax®) in healthy adolescents and adults. Vaccine 13:967–972
Laforet EG, Lynch CJ Jr (1947) Multiple congenital defects following maternal varicella. N Engl J Med 236:534–537
Miller E (1994) Varicella-zoster virus infection in pregnancy. Arch Dis Child 70:F157–F158
Miller E, Cradock-Watson JE, Ridehalgh MK (1989) Outcome in newborn babies given anti-varicella-zoster immunoglobulin after perinatal maternal infection with varicella-zoster virus. Lancet 2:371–373
Mouly F, Mirlesse V, Meritet JF, Rozenberg F, Poissonier MH, Lebon P, Daffos F (1997) Prenatal diagnosis of fetal varicella-zoster virus infection with polymerase chain reaction of amniotic fluid in 107 cases. Am J Obstet Gynecol 177:894–898
Pastuszak AL, Levy M, Schick B, Zuber C, Feldkamp M, Gladstone J, Bar-Levy F, Jackson E, Donnenfeld A, Meschino W, Koren G (1994) Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Engl J Med 330:901–905
Paulman PM, McLellan R (1990) Varicella during pregnancy: the timing of effective treatment. J Am Board Fam Pract 3:121–123
Pretorius DH, Hayward I, Jones KL, Stamm E (1992) Sonographic evaluation of pregnancies with maternal varicella infection. J Ultrasound Med 11:459–463
Prober CG, Gershon AA, Grose C, McCracken GH, Nelson JD (1990) Consensus: varicella-zoster infections in pregnancy and the perinatal period. Pediatr Infect Dis J 9:865–869
Robert Koch-Institut (2004) Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut/Stand: Juli 2004. Epidemiol Bull 30:235–250
Royal College of Obstetricians and Gynecologists (2001) Guideline no. 13, Chickenpox in pregnancy
Sauerbrei A, Wutzler P (2000) The congenital varicella syndrome. J Perinatol 20:548–554
Sauerbrei A, Wutzler P (2001) Neonatal varicella. J Perinatol 21:545–549
Sauerbrei A, Wutzler P (2003) Das fetale Varizellensyndrom. Monatsschr Kinderheilkd 151:209–213
Sauerbrei A, Wutzler P (2004) Labordiagnostik der Varizellen. Kinderärztl Prax Sonderh Impfen 18–21
Sauerbrei A, Wutzler P (2005) Varicella-zoster virus infections during pregnancy: epidemiology, clinical symptoms, diagnosis, prevention and therapy. Curr Pediatr Rev 1:205–216
Sauerbrei A, Müller D, Eichhorn U, Wutzler P (1996) Detection of varicella-zoster virus in congenital varicella syndrome: a case report. Obstet Gynecol 88:687–689
Sauerbrei A, Glück B, Jung K, Bittrich H, Wutzler P (2000) Congenital skin lesions caused by intrauterine coxsackie virus B3 infection: a case report. Infection 28:326–328
Sauerbrei A, Pawlak J, Luger C, Wutzler P (2003) Intracerebral VZV reactivation in congenital varicella syndrome? A case report. Dev Med Child Neurol 45:837–840
Schulze A, Dietzsch HJ (2000) The natural history of varicella embryopathy: a 25-year follow-up. J Pediatr 137:871–874
Schulze-Oechtering F, Roth B, Enders G, Grosser R (2004) Kongenitales Varizellensyndrom—besteht eine Infektionsgefahr für die Umgebung? Dtsch Med Wochenschr 208:25–28
Sever J, White LR (1968) Intrauterine viral infections. Annu Rev Med 19:471–486
Shields KE, Galil K, Seward J, Sharrar RG, Cordero JF, Slater E (2001) Varicella vaccine exposure during pregnancy: data from the first 5 years of the pregnancy registry. Obstet Gynecol 98:14–19
Smego RA Jr, Asperille MO (1991) Use of acyclovir for varicella pneumonia during pregnancy. Obstet Gynecol 78:1112–1116
Spranger S, Stute H, Blankenagel A, Jauch A, Hager D, Tariverdian G (1998) MIDAS-Syndrom—Eine X-chromosomale Erkrankung. Differenzialdiagnose zum kongenitalen Varizellensyndrom. Monatsschr Kinderheilkd 146:761–765
Tan MP, Koren G (2006) Chickenpox in pregnancy: revisited. Reprod Toxicol 21:410–420
Vázquez M, Shapiro ED (2005) Varicella vaccine and infection with varicella-zoster virus. N Engl J Med 352:439–440
Verstraelen H, Vanzieleghem B, Deroort P, Vanhaesebrouck P, Temmerman M (2003) Prenatal ultrasound and magnetic resonance imaging in fetal varicella syndrome: correlation with pathology findings. Prenat Diagn 23:705–709
Watson B (2002) Varicella: a vaccine preventable disease? J Infect 44:220–225
Wutzler P, Sauerbrei A, Scholz H, Müller D, Wiedersberg H (1990–1991) Varicella-Zoster-Virusinfektionen in der Schwangerschaft. Paediatr Prax 41:213–224
Wutzler P, Färber I, Wagenpfeil S, Bisanz H, Tischer A (2001) Seroprevalence of varicella-zoster virus in the German population. Vaccine 20:121–124
Zieger W, Friese K, Weigel M, Becker KP, Melchert F (1994) Varizellen-Infektion am Geburtstermin. Z Geburtshilfe Perinatol 198:134–137
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sauerbrei, A., Wutzler, P. Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 2: Varicella-zoster virus infections. Med Microbiol Immunol 196, 95–102 (2007). https://doi.org/10.1007/s00430-006-0032-z
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00430-006-0032-z