Varicella Disease (Chickenpox)
varicella-zoster virus (VZV), human herpes virus 3, HHV-3,
Intrauterine infections with varicella-zoster virus following maternal varicella in early pregnancy and resulting in congenital malformations are rare.
Incidence of gestational chickenpox is between 1 and 7 per 10,000.
Neonatal varicella is mostly caused by maternal chickenpox acquired during the last 3 weeks of pregnancy.
Varicella Virus, transmission electron micrograph (Image: CDC USA)
Page Links: Introduction | Some Recent Findings | | Genome | Recommendations (Australia) | ACIP Recommendations (USA) | References | WWW Links | Glossary
Tan MP, Koren G. Chickenpox in pregnancy: revisited. Reprod Toxicol. 2006 May;21(4):410-20. "Varicella infection during the first and second trimester of pregnancy may increase the risk for congenital varicella syndrome 0.5-1.5% above the baseline risk for major malformation. Third trimester infection may lead to maternal pneumonia which can be life threatening if not treated appropriately."
The complete genomic sequence of Human Varicella virus is now known and is 124,884 nucleotides in length (Genes: 71). Davison AJ, Scott JE. The complete DNA sequence of varicella-zoster virus. J Gen Virol. 1986 Sep;67 ( Pt 9):1759-816.
Lineage: Viruses ; dsDNA viruses, no RNA stage ; Herpesviridae ; Alphaherpesvirinae ; Varicellovirus ; Human herpesvirus 3 ; Human herpesvirus 3
Links:
Position statement The management of varicella-zoster virus exposure and infection in pregnancy and the newborn period Australasian Subgroup in Paediatric Infectious Diseases of the Australasian Society for Infectious Diseases (MJA 2001; 174: 288-292)
Heuchan AM, Isaacs D. The management of varicella-zoster virus exposure and infection in pregnancy and the newborn period. Australasian Subgroup in Paediatric Infectious Diseases of the Australasian Society for Infectious Diseases. Med J Aust. 2001 Mar 19;174(6):288-92.
"In February 1999, the Advisory Committee on Immunization Practices (ACIP) expanded recommendations for varicella (chickenpox) vaccine to promote wider use of the vaccine for susceptible children and adults. The updated recommendations include establishing child care and school entry requirements, use of the vaccine following exposure and for outbreak control, use of the vaccine for some children infected with the human immunodeficiency virus (HIV), and vaccination of adults and adolescents at high risk for exposure. These recommendations also provide new information on varicella vaccine postlicensure safety data." Prevention of Varicella Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP) (1999)
Royal College of Obstetricians and Gynaecologists CHICKENPOX IN PREGNANCY Guideline No. 13 (2001) (PDF Document)
See also: "In September 2005, we published an article on Chickenpox, pregnancy and the newborn. One of the issues it considered was fetal varicella syndrome, an uncommon but potentially fatal consequence of in-utero chickenpox infection. We reported evidence suggesting that contracting maternal chickenpox within the first 28 weeks of pregnancy can lead to fetal varicella syndrome. This suggestion was questioned after publication since it was at odds with national guidance in the U.K. and elsewhere, which has indicated that fetal varicella syndrome occurs only where maternal chickenpox develops before 20 weeks of pregnancy. Here we discuss in more detail the basis for our conclusion and its implications."
[No authors listed] Chickenpox, pregnancy and the newborn: a follow-up. Drug Ther Bull. 2005 Dec;43(12):94-5. Review.
Reviews | Articles | Search NCBI Bookshelf | Search PubMed
Reviews
Sauerbrei A, Wutzler P. Neonatal varicella. J Perinatol. 2001 Dec;21(8):545-9.
Chapman SJ. Varicella in pregnancy. Semin Perinatol. 1998 Aug;22(4):339-46.
Freij BJ, Sever JL. Herpesvirus infections in pregnancy: risks to embryo, fetus, and neonate. Clin Perinatol. 1988 Jun;15(2):203-31.
Articles
Tan MP, Koren G. Chickenpox in pregnancy: revisited. Reprod Toxicol. 2006 May;21(4):410-20.
Seward JF, Watson BM, Peterson CL, Mascola L, Pelosi JW, Zhang JX, Maupin TJ, Goldman GS, Tabony LJ, Brodovicz KG, Jumaan AO, Wharton M. Varicella disease after introduction of varicella vaccine in the United States, 1995-2000. JAMA. 2002 Feb 6;287(5):606-11.
Davison AJ, Scott JE. The complete DNA sequence of varicella-zoster virus. J Gen Virol. 1986 Sep;67 ( Pt 9):1759-816.
Behzad-Behbahani A, Pouransari R, Tabei SZ, Rahiminejad MS, Robati M, Yaghobi R, Nourani H, Ramzi MM, Farhadi-Andarabi A, Mojiri A, Rahsaz M, Banihashemi M, Zare N. Risk of viral transmission via bone marrow progenitor cells versus umbilical cord blood hematopoietic stem cells in bone marrow transplantation. Transplant Proc. 2005 Sep;37(7):3211-2.
McIver CJ, Jacques CF, Chow SS, Munro SC, Scott GM, Roberts JA, Craig ME, Rawlinson WD. Development of multiplex PCRs for detection of common viral pathogens and agents of congenital infections. J Clin Microbiol. 2005 Oct;43(10):5102-10.
Mirlesse V, Sole Y, Jacquemard F, Delhommeau F, Daffos F. Persistent maternal viremia after varicella infection during pregnancy as a possible cause of false positive prenatal diagnosis of fetal infection on amniotic fluid. BJOG. 2004 Aug;111(8):885-7.
Hartung J, Enders G, Chaoui R, Arents A, Tennstedt C, Bollmann R. Prenatal diagnosis of congenital varicella syndrome and detection of varicella-zoster virus in the fetus: a case report. Prenat Diagn. 1999 Feb;19(2):163-6.
Search NCBI Bookshelf: Bookshelf - varicella | Medical Microbiology - varicella
"varicella (chickenpox), the virus establishes latency in multiple ganglia of the human neuraxis. Years later, the virus may reactivate, and the distribution of lesions in the skin corresponds closely to areas of innervation (dermatome) from an individual dorsal root ganglion" Medical Microbiology - Varicella-Zoster Virus
Search PubMed: Search May 2006 "varicella" 10,075 reference articles of which 1,330 were reviews. Search term = varicella
CDC Publications (USA) Varicella Disease (Chickenpox) | Varicella (PDF document)
Australia National Varicella (Chickenpox) Vaccination Program (Commenced 1 November 2005)
World Health Organisation (WHO) Varicella Vaccine
International Committee on Taxonomy of Viruses Parvovirus B19
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Below is a list of some known maternal (then fetal) infections that impact upon neurological development.
Only a very brief overview is given, for more details see Abnormal Development Notes or the listed internal and external links.
Viral infection causes systemic infection and extensive brain damage and cell death by necrosis.
NCBI Bookshelf (external link) Medical Microbiology: Cytomegalovirus | Search Medical Microbiology "Cytomegalovirus"
Viral infection causes systemic infection and extensive brain damage and cell death by necrosis.
NCBI Bookshelf (external link) Search Medical Microbiology "Herpes Simplex Virus"
Bacterial infection by E. coli or streptocci B. can cause vascular thrombosis involving choroid plexus which can effect CSF flow, and can cause hydrocephalus.
NCBI Bookshelf (external link) Search Medical Microbiology "Purulent Meningitus"
Toxoplasma infection causes random necrosis throughout the brain and can cause hydrocephalus.
NCBI Bookshelf (external link) Medical Microbiology: 84. Toxoplasma Gondii | Figure 84-1. Girl with hydrocephalus due to congenital toxoplasmosis. | Search Medical Microbiology "Toxoplasmosis"
The Australian NHMRC (1988) recommends neonates be assessed for follow-up care under the following conditions.
(see the NHMRC WWW Page)
These developmental abnormalities usually involve only small DNA mutations affecting individual or a few genes, two exceptions are the major chromosomal abnormalities usualy trisomy; trisomy 21 (Down syndrome) and trisomy 18 (Edwards syndrome) (also trisomy 9, 13, 15). Note that the occurance of chromosomal abnormalities also increases with increasing maternal age. There are many pamphlets providing information about prenatal diagnosis (see NSW State Health Publication Checking your baby's health before birth).
Each section of the notes covering early development and specific systems contain references to specific abnormalities (on Page 2 of each notes section). The best source for Australian statistical data is the Australian Institute of Health and Welfare National Perinatal Statistics Unit, UNSW which publishes "Congenital Malformations Australia" every 2 years. Be aware that some congenital abnormalities, by their nature, affect multiple systems. In the USA, the Center for Disease Control (CDC) keeps and publishes relevant statistical information. A very difficult issue in abnormal development are the many different Ethical implications.
This current page is a link to Normal and Abnormal Development and Population Data.
You should look at normal development. Development Notes
Alternatively, go on to look at Systematic Development of organs and tissues.
For those wanting to see dynamic processes of development (and have a reasonably quick connection) then the Movies pages are good for watching changes occur.
The study of human development has relied extensively on studying the process in other model animals. For those wanting to see the process of development in other species then the other embryos pages are a good start.
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Abnormalities in human development can be due to many different maternal factors, this page gives introduces Parvovirus infection and links to several external resources for further information.
Please email Dr Mark Hill if you wish to make a comment about this current project.