Antibody to Varicella-Zoster Virus in Parturient Women and Their Offspring During the First Year of Life

Gershon, Anne A.; Raker, Richard K.; Steinberg, Sharon; Topf-Olstein, Barbara; Drusin, Lewis M.

doi:10.1542/peds.58.5.692

Cited by 151 publications

(2 citation statements)

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“…These children were postulated to have acquired antibodies to varicella as a result of retained maternal antibodies and episodes of subclinical varicella. Neither explanation is likely because maternal antibodies are lost before 9 months of age and subclinical varicella is rare [33,41]. It is more plausible that the end point used to indicate immunity was too low, causing false-positive results to occur in gpELISAs.…”

Section: Discussionmentioning

confidence: 99%

Primary Vaccine Failure after 1 Dose of Varicella Vaccine in Healthy Children

et al. 2008

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Universal immunization of young children with 1 dose of varicella vaccine was recommended in the United States in 1995, and it has significantly decreased the incidence of chickenpox. Outbreaks of varicella, however, are reported among vaccinated children. Although vaccine effectiveness has usually been 85%, rates as low as 44% have been observed. Whether this is from primary or secondary vaccine failure-or both-is unclear. We tested serum samples from 148 healthy children immunized against varicella in New York, Tennessee, and California to determine their seroconversion rates, before and after 1 dose of Merck/Oka varicella vaccine. The median age at vaccination was 12.5 months; postvaccination serum samples were obtained on average 4 months later. Serum was tested for antibodies against varicella-zoster virus (VZV) by use of the previously validated sensitive and specific fluorescent antibody to membrane antigen (FAMA) assay. Of 148 healthy child vaccinees, 113 (76%) seroconverted, and 24% had no detectable VZV FAMA antibodies. Our data contrast with reported seroconversion rates of 86%-96% by other VZV antibody tests and suggest that many cases of varicella in immunized children are due to primary vaccine failure. A second dose of varicella vaccine is expected to increase seroconversion rates and vaccine effectiveness.

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Section: Discussionmentioning

confidence: 99%

Primary Vaccine Failure after 1 Dose of Varicella Vaccine in Healthy Children

et al. 2008

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“…If the mother develops herpes zoster peripartum, the neonate is usually protected by the passive transfer of No later than 10 days Treatment Aciclovir Oral: 800 mg 5 times a day for 7 days Intravenous: 10-15 mg/kg of BW or 500 mg/m 2 IV every 8 h for 5-10 days for varicella pneumonitis, and it should be started within 24-72 h of the onset of rash [9] On appearance of rashes immunoglobulins. However, this does not hold true for neonates with a birth weight \ 1000 g or less than 28 weeks gestation [44,45].…”

Section: Management Of Perinatal Infectionsmentioning

confidence: 99%

Chickenpox in Pregnancy

Krishnan

Sharma

2020

Journal of Fetal Medicine

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Pregnant women in the tropics like India are more susceptible to varicella zoster infection due to the lower seroprevalence of varicella as compared to temperate regions. Seronegative pregnant women are highly susceptible following a significant exposure owing to the high secondary attack rate of the virus. Fetal transmission could happen transplacentally while neonatal transmission occurs through close contact post partum. Maternal VZV infection could be severe (particularly varicella pneumonia) with high mortality if untreated. Congenital varicella syndrome has an incidence of about 1-2% and is more likely if maternal symptoms occur between 5th and 24th week of pregnancy. Susceptible pregnant women with a significant contact should be administered VZIG not later than 10 days of exposure. Women presenting with the typical rash of VZV infection should be prescribed oral aciclovir. The mainstay of diagnosis of fetal varicella syndrome is detailed ultrasound scanning starting 4 weeks after the onset of maternal rash. Prenatal diagnosis of varicella can be achieved by varicella PCR of the amniotic fluid at least 6 weeks after maternal infection. However, presence of the virus in the amniotic fluid does not necessarily imply progression to fetal varicella syndrome. If the mother contracts primary infection at term, her delivery should be delayed by at least 5-7 days after the onset of the rash if possible. Neonatal varicella zoster immunoglobulin should be administered to prevent neonatal infection if delivery cannot be postponed. Obstetrician should be aware of the prophylactic and treatment strategies in the event of exposure/infection.

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