Talk:Abnormal Development - Varicella Zoster Virus
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Cite this page: Hill, M.A. (2019, May 27) Embryology Abnormal Development - Varicella Zoster Virus. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Talk:Abnormal_Development_-_Varicella_Zoster_Virus
Fetal varicella - diagnosis, management, and outcome
Prenat Diagn. 2012 Apr 18. doi: 10.1002/pd.3843. [Epub ahead of print]
Mandelbrot L. Source Hopital Louis Mourier, Service de Gynécologie-Obstétrique, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, 178 rue des Renouillers, 92701, Colombes cedex, France. firstname.lastname@example.org.
Fetal varicella syndrome (FVS) is due to transplacental infection by the Varicella zoster virus following maternal infection. The risks for the fetus and neonate depend on the timing. When varicella occurs around delivery, it often leads to disseminated neonatal varicella. When varicella occurs during pregnancy, transmission can occur, but is usually asymptomatic; some infants develop zoster postnatally and a few have FVS. Before 20 weeks' gestation, FVS can occur, with an incidence of about 1%. The lesions can affect the skin, limbs, central and autonomous nervous systems, eyes, cause calcifications, and growth retardation; mortality is high. Lesions typically follow one or several nerve territories, suggesting that damage results from in utero zoster following primary fetal infection. There has been little study of prenatal diagnosis of FVS. Serial ultrasound examination can detect various anomalies, magnetic resonance imaging can be of use to investigate for microphthamia and cerebral lesions, and amniocentesis can diagnose viral transmission. Prevention strategies include vaccination and post-exposure prophylaxis with immune globulin and/or antivirals. Perspectives for treating infected fetuses in utero require further research. © 2012 John Wiley & Sons, Ltd. © 2012 John Wiley & Sons, Ltd.
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.
Heuchan AM, Isaacs D. Source King George V Hospital, Sydney, NSW.
Zoster immunoglobulin (ZIG) should be offered to pregnant, varicella-seronegative women with significant exposure to varicella-zoster virus (VZV) (chickenpox) infection. Oral aciclovir prophylaxis should be considered for susceptible pregnant women exposed to VZV who did not receive ZIG or have risk factors for severe disease. Intravenous aciclovir should be given to pregnant women who develop complicated varicella at any stage of pregnancy. Counselling on the risk of congenital varicella syndrome is recommended for pregnant women who develop chickenpox. ZIG should be given to a baby whose mother develops chickenpox up to 7 days before delivery or up to 28 days after delivery. Intravenous aciclovir should be given to babies presenting unwell with chickenpox, whether or not they received ZIG. Breastfeeding of babies infected with or exposed to VZV is encouraged. A mother with chickenpox or zoster does not need to be isolated from her own baby. If siblings at home have chickenpox, a newborn baby should be given ZIG if its mother is seronegative. The newborn baby does not need to be isolated from its siblings with chickenpox, whether or not the baby was given ZIG. After significant nursery exposure to VZV, ZIG should be given to seronegative babies and to all babies born before 28 weeks' gestation.
Policy statement—Prevention of varicella: update of recommendations for use of quadrivalent and monovalent varicella vaccines in children
Pediatrics. 2011 Sep;128(3):630-2. Epub 2011 Aug 28.
Committee on Infectious Diseases. Collaborators (30)
Abstract Two varicella-containing vaccines are licensed for use in the United States: monovalent varicella vaccine (Varivax [Merck & Co, Inc, West Point, PA]) and quadrivalent measles-mumps-rubella-varicella vaccine (MMRV) (ProQuad [Merck & Co, Inc]). It is estimated from postlicensure data that after vaccination at 12 through 23 months of age, 7 to 9 febrile seizures occur per 10,000 children who receive the MMRV, and 3 to 4 febrile seizures occur per 10,000 children who receive the measles-mumps-rubella (MMR) and varicella vaccines administered concurrently but at separate sites. Thus, 1 additional febrile seizure is expected to occur per approximately 2300 to 2600 children 12 to 23 months old vaccinated with the MMRV, when compared with separate MMR and varicella vaccine administration. The period of risk for febrile seizures is from 5 through 12 days after receipt of the vaccine(s). No increased risk of febrile seizures is seen among patients 4 to 6 years of age receiving MMRV. Febrile seizures do not predispose to epilepsy or neurodevelopmental delays later in life and are not associated with long-term health impairment. The American Academy of Pediatrics recommends that either MMR and varicella vaccines separately or the MMRV be used for the first dose of measles, mumps, rubella, and varicella vaccines administered at 12 through 47 months of age. For the first dose of measles, mumps, rubella, and varicella vaccines administered at ages 48 months and older, and for dose 2 at any age (15 months to 12 years), use of MMRV generally is preferred over separate injections of MMR and varicella vaccines.
Update on childhood and adolescent immunizations: selected review of US recommendations and literature: part 2
Curr Opin Pediatr. 2011 Aug;23(4):470-81.
Lai J, Fay KE, Bocchini JA. Source Division of General Pediatrics, Cohen Children's Medical Center, North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA. Abstract PURPOSE OF REVIEW: To provide a clinically relevant synopsis of research findings regarding childhood and adolescent vaccines. RECENT FINDINGS: Vaccine coverage is relatively static or improving for the vaccines included in the 2010 annual harmonized immunization schedules. Providers should be reviewing patients' immunization records at each visit to take advantage of any opportunity to administer indicated, age-appropriate vaccines. There have been infectious disease outbreaks among highly immunized populations, although unvaccinated or undervaccinated individuals continue to play large roles in the spread of disease. Infants, many of whom are too young to be vaccinated, continue to bear a large disease burden, which underscores the importance of cocooning and, in some cases, vaccination of pregnant women. Influenza, measles, mumps, and rubella, varicella, hepatitis A, meningococcal conjugate, human papillomavirus, diphtheria and tetanus toxoids and acellular pertussis, and tetanus and diphtheria toxoids and acellular pertussis vaccines are reviewed in this second of two articles. SUMMARY: New research on childhood and adolescent vaccines is anticipated to shape the practice of pediatric providers. Research will continue to provide the science to optimize protection and to promote the health and well being of all children and adolescents.
Distribution of varicella-zoster virus DNA and gene products in tissues of a first-trimester varicella-infected fetus
J Infect Dis. 2005 Feb 15;191(4):540-5. Epub 2005 Jan 7.
Nikkels AF, Delbecque K, Pierard GE, Wienkotter B, Schalasta G, Enders M. Source Department of Dermatopathology, University Hospital Sart Tilman, Liege, Belgium. email@example.com
Precise information about varicella-zoster virus (VZV) infection in first-trimester fetuses remains sketchy. After varicella infection was diagnosed in a woman, her 12-week-old fetus was aborted and was investigated, by histological examination, virus culturing, polymerase chain reaction, in situ hybridization (ISH), and immunohistochemistry (IHC), for the presence of VZV infection. Only the results of the histological examination suggested the presence of alpha -herpesvirus infection, in the gastrointestinal tract and liver; results of ISH were positive for VZV, and results of IHC staining were positive for intermediate early protein 63 (IE63) but negative for glycoprotein E (gE), in the dorsal root ganglia (DRG), meninges, gastrointestinal tract, pancreas, smooth muscle, liver, and placental trophoblast, indicating the presence of a nonproductive, latency-like VZV infection. Only the gastrointestinal tract and liver exhibited simultaneous staining for IE63 and gE, a result suggesting that active replication of VZV was present. In conclusion, widespread nonproductive VZV infection in the absence of histological clues is an early event in VZV infection in fetuses. The observed gene-expression pattern in most tissues resembles that of latent VZV infection in DRG. Latency-like infection in nonneural cell types may potentially reactivate, leading to multifocal necrosis, fibrosis, and dystrophic calcifications, as observed in advanced congenital varicella syndrome.
Arch Pathol Lab Med. 1992 Feb;116(2):181-6.
Magliocco AM, Demetrick DJ, Sarnat HB, Hwang WS. Source Department of Pathology, Faculty of Medicine, University of Calgary, Alberta, Canada.
Varicella embryopathy is a rare entity afflicting infants born to mothers who have contracted varicella during the first 20 weeks of pregnancy. The teratogenicity of varicella has not been established from epidemiologic studies, but isolated case reports describe characteristic malformations following early maternal infection. We describe a male neonate delivered at 40 weeks' gestation to a 26-year-old grava 2, para 2 mother who developed varicella during the first trimester. The infant lived 7 days and died of bronchopneumonia. At postmortem examination there was growth retardation, multiple cicatricial skin lesions, flexion contractures of all major joints, hypoplastic right diaphragm, bilateral hydroureters and mucosal fibrosis of the trachea, as well as intestinal fibrosis and colonic stricture. The brain contained areas of cystic necrosis involving the frontal, parietal, temporal, and occipital lobes, with generalized ventriculomegaly. The midbrain, pons, and medulla were hypoplastic. There was denervation atrophy of muscles of the lower limbs and loss of dorsal root ganglia as well as of neurons of the anterior horn of the spinal cord. The cerebral white matter was degenerated, with proliferation of reactive astrocytes. Chorioretinitis was not observed. Immunocytochemical stains using two commercially available antivaricella antibodies were negative in all tissues examined. The sporadic nature and pathogenesis of the varicella embryopathy, which may have been caused by focal defects in the fetal T-cell immune response, are discussed.
Studies on shingles: is the virus ordinary chickenpox virus?
Lancet. 1954 Dec 25;267(6852):1299-302.
SIMPSON RE. PMID 13222825
Excerpts from the full factsheet http://www.cdc.gov/vaccines/vpd-vac/combo-vaccines/mmrv/vacopt-factsheet-hcp.htm
There are two options for protecting children who are 12 months - 12 years old against measles, mumps, rubella, and varicella
- varicella vaccine and the trivalent measles, mumps, and rubella (MMR) vaccine.
- quadrivalent measles, mumps, rubella, and varicella (MMRV) vaccine.
This means that parents and caregivers have a decision to make, and they will rely on you as their child’s healthcare provider for help in making that decision.
MMR and Varicella Vaccines
(Administered at the same doctor visit)
|Protection against measles, mumps, rubella and varicella||Provides the same protection against the four diseases as the MMRV vaccine||Provides the same protection against the four diseases as the MMR and varicella vaccines|
|Number of shots||Two shots needed at the same doctor visit to provide protection against measles, mumps, rubella, and varicella||One shot needed to provide protection against measles, mumps, rubella, and varicella|
|Fever||Fewer children have fevers of 102°F or higher within 42 days of being vaccinated (about 15 out of every 100 children vaccinated; the highest risk for fever occurs during 5-12 days after vaccination)||More children have fevers of 102°F or higher within 42 days of being vaccinated (about 22 out of every 100 children vaccinated; the highest risk for fever occurs during 5-12 days after vaccination)|
|Febrile seizures (Seizures caused by fever)||Fewer children have febrile seizures during the 5-12 days after vaccination (about 4 out of every 10,000 children vaccinated)||More children have febrile seizures during the 5-12 days after vaccination (about 8 out of every 10,000 children vaccinated)|