Schweizer Empfehlungen für das Management der  Varicella-Zoster-Virus-Infektion

Kempf, W.; Meylan, Pra; Gerber, Susan I.; Aebi, C; Agosti, R.; Büchner, S; Coradi, B; Garweg, Justus G.; Hirsch, HH; Kind, Christian; Lauper, Ursula; Lautenschläger, S; Reusser, P; Ruef, C.; Wunderli, Werner; Nadal, David

doi:10.4414/smf.2007.06325

Cited by 2 publications

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“…We were surprised that none of the 22 patients had been treated with anti-VZV immunoglobulins. Two possible explanations may contribute to this finding: First, awareness of this therapeutic approach was potentially not yet sufficiently established in the early study period [ 18 , 19 ]. Second, the time window for a post-exposure treatment (usually within 96 h) might have been missed in some of these patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical course and therapeutic approach to varicella zoster virus infection in children with rheumatic autoimmune diseases under immunosuppression

Leuvenink

Aeschlimann

Baer³

et al. 2016

Pediatr Rheumatol

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BackgroundTo analyze the clinical presentation and complications of varicella zoster virus (VZV) infection in children with rheumatic diseases treated with immunosuppressive medication such as biological disease-modifying antirheumatic drugs (bDMARDs) and/or conventional disease-modifying antirheumatic drugs (cDMARDs), and to analyze the therapeutic approach to VZV infections with respect to the concomitant immunosuppressive treatment.MethodsRetrospective multicenter study using the Swiss Pediatric Rheumatology registry. Children with rheumatic diseases followed in a Swiss center for pediatric rheumatology and treated with cDMARD and/or bDMARD with a clinical diagnosis of varicella or herpes zoster between January 2004 and December 2013 were included.ResultsTwenty-two patients were identified, of whom 20 were treated for juvenile idiopathic arthritis, 1 for a polyglandular autoimmune syndrome type III, and 1 for uveitis. Of these 22 patients, 16 had varicella and 6 had herpes zoster. Median age at VZV disease was 7.6 years (range 2 to 17 years), with 6.3 years (range 2 to 17 years) for those with varicella and 11.6 years (range 5 to 16 years) for those with herpes zoster. The median interval between start of immunosuppression and VZV disease was 14.1 months (range 1 to 63 months). Two patients had received varicella vaccine (1 dose each) prior to start of immunosuppression. Concomitant immunosuppressive therapy was methotrexate (MTX) monotherapy (n = 9) or bDMARD monotherapy (n = 2), or a combination of bDMARD with prednisone, MTX or Leflunomide (n = 11). Four patients experienced VZV related complications: cellulitis in 1 patient treated with MTX, and cellulitis, sepsis and cerebellitis in 3 patients treated with biological agents and MTX combination therapy. Six children were admitted to hospital (range of duration: 4 to 9 days) and 12 were treated with valaciclovir or aciclovir.ConclusionThe clinical course of varicella and herpes zoster in children under immunosuppression is variable, with 4 (18 %) of 22 children showing a complicated course. Thorough assessment of VZV disease and vaccination history and correct VZV vaccination according to national guidelines at diagnosis of a rheumatic autoimmune disease is essential to minimize VZV complications during a later immunosuppressive treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical course and therapeutic approach to varicella zoster virus infection in children with rheumatic autoimmune diseases under immunosuppression

Leuvenink

Aeschlimann

Baer³

et al. 2016

Pediatr Rheumatol

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“…44 While some multidisciplinary publications [45][46][47] recommend the use of antiviral agents in all pregnant women with chickenpox, the Swiss and Canadian national guidelines dissent. 48,49 The UK Advisory Group on Chickenpox recommends oral aciclovir for pregnant women with chickenpox if they present within 24 hours of the onset of the rash and if they are more than 20 weeks of gestation. 50 Use of aciclovir before 20 weeks should also be considered.…”

Section: Symptomatic Treatment and Hygiene Is Advised To Prevent Seco...mentioning

confidence: 99%

“…51 Guidelines are unanimous, however, in recommending that intravenous aciclovir be administered in cases of severe maternal infection. [45][46][47][48][49][50] VZIG is recommended for post-exposure prophylaxis and is not appropriate treatment for patients with clinical chickenpox. 1 This recommendation is based on the opinion of experts and reflects the accepted understanding of how VZIG works.…”

Section: Symptomatic Treatment and Hygiene Is Advised To Prevent Seco...mentioning

confidence: 99%

Chickenpox: symptoms, treatment and potential complications

2023

Pharmaceutical Journal

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Can the non-immune woman be immunised prior to pregnancy or postnatally?Varicella vaccination prepregnancy or postpartum is an option that should be considered for women who are found to be seronegative for varicella-zoster virus immunoglobulin G (VZV IgG).While universal serological antenatal testing is not recommended in the UK (see below), seronegative women identified in pregnancy could be offered postpartum immunisation.Women who are vaccinated postpartum can be reassured that it is safe to breastfeed.Can varicella be prevented in the pregnant woman at her initial antenatal visit?Women booking for antenatal care should be asked about previous chickenpox/shingles infection.Women who have not had chickenpox, or are known to be seronegative for chickenpox, should be advised to avoid contact with chickenpox and shingles during pregnancy and to inform healthcare workers of a potential exposure without delay.Can varicella infection be prevented in the pregnant woman who gives a history of contact with chickenpox or shingles?When contact occurs with chickenpox or shingles, a careful history must be taken to confirm the significance of the contact and the susceptibility of the patient.Pregnant women with an uncertain or no previous history of chickenpox, or who come from tropical or subtropical countries, who have been exposed to infection should have a blood test to determine VZV immunity or non-immunity.

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Schweizer Empfehlungen für das Management der Varicella-Zoster-Virus-Infektion

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Clinical course and therapeutic approach to varicella zoster virus infection in children with rheumatic autoimmune diseases under immunosuppression

Clinical course and therapeutic approach to varicella zoster virus infection in children with rheumatic autoimmune diseases under immunosuppression

Chickenpox: symptoms, treatment and potential complications

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