Abnormal Development - Varicella Zoster Virus

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Contents

Introduction

Varicella zoster virus
(CDC electron micrograph)

Varicella Zoster Virus or chickenpox maternal infection can be transmitted to the fetus.

Fetal varicella syndrome (FVS), was first described in 1947[1] and is caused by transplacental infection by the varicella zoster virus following maternal infection.

Commonly called chickenpox or shingles in adults. The chickenpox vaccine is made from a weakened varicella virus producing an immune response that protects you against chickenpox infection. The United States has had a licensed chickenpox vaccine since 1995.


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Fetal and Neonatal Risks

Risks are dependent on the infection timing.

  • before 20 weeks (GA) - 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.
  • during pregnancy - transmission can occur, but is usually asymptomatic; some infants develop zoster postnatally and a few have FVS.
  • around delivery - often leads to disseminated neonatal varicella.
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Some Recent Findings

  • Fetal varicella - diagnosis, management, and outcome[2] "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."

Taxonomy

The International Committee on Taxonomy of Viruses (ICTV) has developed a published code of classification for viruses (currently 2011 Release).

Order: Herpesvirales

Subfamily: Alphaherpesvirinae
Genus: Varicellovirus
Species: Human herpesvirus 3

USA Policy Statement

The 2011 Policy statement by the Committee on Infectious Diseases published in the journal Pediatrics as "Prevention of varicella: update of recommendations for use of quadrivalent and monovalent varicella vaccines in children"[3]

"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."


Links: CDC Factsheet

References

  1. E G LAFORET, C L LYNCH Multiple congenital defects following maternal varicella; report of a case. N. Engl. J. Med.: 1947, 236(15);534-7 PMID:20293114
  2. Laurent Mandelbrot Fetal varicella - diagnosis, management, and outcome. Prenat Diagn: 2012; PMID:22514124
  3. Policy statement—Prevention of varicella: update of recommendations for use of quadrivalent and monovalent varicella vaccines in children. Pediatrics: 2011, 128(3);630-2 PMID:21873692 | Pediatrics

Textbooks

Reviews

Saba Javed, Syed A Javed, Stephen K Tyring Varicella vaccines. Curr. Opin. Infect. Dis.: 2012, 25(2);135-40 PMID:22123665

Graciela Andrei, Robert Snoeck Emerging drugs for varicella-zoster virus infections. Expert Opin Emerg Drugs: 2011, 16(3);507-35 PMID:21699441

Ronald F Lamont, Jack D Sobel, D Carrington, Shali Mazaki-Tovi, Juan Pedro Kusanovic, Edi Vaisbuch, Roberto Romero Varicella-zoster virus (chickenpox) infection in pregnancy. BJOG: 2011, 118(10);1155-62 PMID:21585641

Arlan Cohen, Panagis Moschopoulos, Panagis Maschopoulos, Richard E Stiehm, Gideon Koren Congenital varicella syndrome: the evidence for secondary prevention with varicella-zoster immune globulin. CMAJ: 2011, 183(2);204-8 PMID:21262937


Articles

John W Gnann Varicella-zoster virus: prevention through vaccination. Clin Obstet Gynecol: 2012, 55(2);560-70 PMID:22510639

A M Heuchan, D Isaacs 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, 174(6);288-92 PMID:11297117 | eMJA

| PMC2131083

Search Pubmed

Search Pubmed: Varicella Zoster Virus | Congenital Varicella Syndrome | fetal varicella syndrome



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Cite this page: Hill, M.A. (2014) Embryology Abnormal Development - Varicella Zoster Virus. Retrieved April 21, 2014, from http://embryology.med.unsw.edu.au/embryology/index.php?title=Abnormal_Development_-_Varicella_Zoster_Virus

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Dr Mark Hill 2014, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G
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