Abnormal Development - Varicella Zoster Virus
Contents |
Introduction
(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.
- Viral Links: TORCH Infections | Cytomegalovirus | Hepatitis Virus | HIV | Measles Virus | Parvovirus | Polio Virus | Rubella Virus | Chickenpox | Lymphocytic Choriomeningitis Virus | Vaccination | Environmental
Some Recent Findings
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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
- Genus: Varicellovirus
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
- ↑ 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
- ↑ Laurent Mandelbrot Fetal varicella - diagnosis, management, and outcome. Prenat Diagn: 2012; PMID:22514124
- ↑ 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
- Medical Microbiology. 4th edition. Baron S, editor. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Chapter 55 Togaviruses: Rubella Virus | Chapter 54Alphaviruses (Togaviridae) and Flaviviruses (Flaviviridae) | Table 55-1 Abnormalities Associated with Congenital Rubella Syndrome | Figure 55-3 Incidence rates of rubella USA 1966-1993
- Molecular Biology of the Cell. 4th edition. Alberts B, Johnson A, Lewis J, et al. New York: Garland Science; 2002. Viruses Exploit Host Cell Machinery for All Aspects of Their Multiplication
- Disease Control Priorities in Developing Countries. 2nd edition. Jamison DT, Breman JG, Measham AR, et al., editors. Washington (DC): World Bank; 2006. Chapter 20Vaccine-preventable Diseases
- Antenatal Care: Routine care for the healthy pregnant woman. NICE Clinical Guidelines, No. 62. National Collaborating Centre for Women's and Children's Health (UK). London: RCOG Press; 2008 Mar. 10.8. Rubella
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 R E H SIMPSON Studies on shingles: is the virus ordinary chickenpox virus? Lancet: 1954, 267(6852);1299-302 PMID:13222825
R Cole, A G Kuttner THE PROBLEM OF THE ETIOLOGY OF HERPES ZOSTER. J. Exp. Med.: 1925, 42(6);799-820 PMID:19869091 | PMC2131083
Search Pubmed
Search Pubmed: Varicella Zoster Virus | Congenital Varicella Syndrome | fetal varicella syndrome
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External Links
External Links Notice - The dynamic nature of the internet may mean that some of these listed links may no longer function. If the link no longer works search the web with the link text or name.
- Department of Health and Ageing (Australia) Immunise Australia Program Website | The Australian Immunisation Handbook 9th Edition 2008
- World Health Organization (WHO)
- CDC (USA) - Varicella (Chickenpox) Vaccination
- International Committee on Taxonomy of Viruses
