Chickenpox in pregnant women and congenital varicella syndrome

Chickenpox, which mainly occurs in children, is usually mild and easy to treat. However, if adults are infected, the symptoms of the disease are often more severe, prone to some dangerous complications. Chickenpox in pregnant women can cause pneumonia for the mother or congenital chickenpox syndrome for the baby.

1. Chickenpox Outline

Chickenpox (also known as varicella) is a viral infection caused by the Varicella Zoster Virus (VZV). The chickenpox virus is spread through respiratory droplets or direct contact with contaminated objects. The disease is common in children, but can also appear in adults, with an incubation period of about 2 weeks. Clinical symptoms of the disease are easy to recognize, including fever, fatigue, loss of appetite, headache, muscle pain, vomiting, blisters all over the body with vesicles 1-3mm in diameter. In severe cases, the blisters may be larger, or may be cloudy due to pus (if infected with more bacteria).
Chickenpox will last 7-10 days if there are no complications. The blisters will then dry out, scab over and may leave a dark, irreversible scar (if infected with more bacteria, the blister can leave a scar).
However, chickenpox can also leave serious complications for the patient. Specifically, skin infections from blisters can cause bacteria to enter the bloodstream causing bacteremia. More serious complications include pneumonia, cerebellitis, encephalitis, ... which can be life-threatening or leave sequelae later. Especially, after the patient recovers from the disease, the chickenpox virus still exists in the nerve ganglia in an inactivated form. Many years later, when there are favorable conditions such as weakening of the body's resistance, this virus can reactivate, causing shingles (shingles).
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2. Overview of chickenpox in pregnant women

2.1 The danger of getting chickenpox during pregnancy

Chickenpox complications in pregnant women
Compared to children, adults are more likely to experience complications related to chickenpox. Complications include meningitis, encephalitis, pneumonia, cerebellar ataxia, glomerulonephritis, myocarditis, eye diseases, adrenal insufficiency, even death,... Hydropneumonia Smallpox is the most common complication in pregnant women with symptoms including cough, shortness of breath, fever, and rapid breathing. Pneumonia usually develops within 1 week of blistering and can rapidly progress to hypoxia and respiratory failure, and even death.
Complications in the fetus and newborn
Chickenpox in pregnant women can cause some complications in the newborn baby such as:
Congenital chickenpox syndrome: The mother got chickenpox during early pregnancy 8-20 weeks pregnant, the fetus is at risk of congenital chickenpox syndrome. Characteristic of this syndrome is scarring on the skin, neurological abnormalities (microcephaly, hydrocephalus, mental retardation,...), limb abnormalities (weakness, short limb atrophy), eye abnormalities (cataract, optic nerve atrophy, nystagmus, uveitis,...), gastrointestinal abnormalities (gastroesophageal reflux, intestinal obstruction) or weight low birth. Children with congenital varicella syndrome have a mortality rate of up to 30% within the first few months of life and a 15% risk of developing shingles within the first 4 years of life; Preterm birth, spontaneous abortion: When infected with chickenpox in the first 3 months of pregnancy, the virus can cause miscarriage; Neonatal varicella infection: The result of the chickenpox virus being passed from mother to fetus when the mother has chickenpox 5 days before birth or 2 days after birth. Neonatal mortality is up to 25 - 30% of total infections.

2.2 Diagnosis of chickenpox in pregnant women

Diagnosis of pregnant varicella
Based on clinical symptoms of the disease; When clinical diagnosis is in doubt, additional vesicular PCR testing or immunofluorescence testing can be performed; Diagnosis of pneumonia caused by Varicella Zoster Virus may be indicated when the pregnant woman has skin lesions typical of chickenpox, is exposed to an infectious source, and has respiratory symptoms. Diagnosis of congenital varicella syndrome
Using fetal blood or amniotic fluid PCR test for VZV DNA. PCR test is highly sensitive, performed during the 17th - 21st week of pregnancy; Ultrasound detects fetal abnormalities. Fetal morphology ultrasound was performed 5 weeks after maternal varicella infection to evaluate fetal abnormalities. Indication for repeat ultrasound at 22-24 weeks. If a repeat ultrasound is normal, the risk of congenital chickenpox syndrome is very low. If ultrasound shows evidence of pathology, the mother should be counseled about the possibility of fetal disease; After birth, congenital varicella syndrome can be diagnosed based on the mother's history of chickenpox infection (during the first or second trimester), the abnormality of the baby consistent with chickenpox syndrome. congenital, PCR testing for chickenpox virus DNA in newborns, presence of VZV-specific IgM antibodies in umbilical cord blood, children with shingles in early stages,...
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2.3 Treatment of chickenpox in pregnant women

Uncomplicated chickenpox: Use oral acyclovir at a dose of 800mg x 5 times/day x 7 days. Treatment with acyclovir is most effective within the first 24 hours; Chickenpox pneumonia: Use intravenous acyclovir 10mg/kg every 8 hours for pregnant women with chickenpox pneumonia; Rest more, drink plenty of water and eat liquid foods that are easy to digest. If you have a fever, you can use paracetamol to reduce fever, combined with clean body hygiene, pay attention to avoid breaking the blisters to prevent blisters. reduce the risk of superinfection. Pregnant women at high risk of chickenpox should use varicella - zoster immune globulin (VZIG) to prevent serious complications in the mother. To prevent complications for children, it is recommended to use VZIG for newborns.

2.4 Precautionary measures

Women who have had chickenpox before becoming pregnant or who have been vaccinated against chickenpox are immune to the disease. During pregnancy, pregnant women do not need to worry about complications of the disease for the health of both mother and child. Therefore, the best way to prevent the risk of chickenpox complications in pregnant women and congenital varicella syndrome is vaccination.
Chickenpox vaccine is highly effective and long-lasting, helping the body to create antibodies against the chickenpox virus. The dose is as follows:
Children 12 - 18 months old: 1 injection; Children 19 months - 13 years old who have never had chickenpox: 1 injection; Children over 13 years old and adults who have never had chickenpox: 2 injections, booster dose about 4 - 8 weeks after the first dose. 80-90% of people who have been vaccinated against chickenpox have an absolute ability to prevent the disease. The remaining 10% of cases may develop chickenpox after vaccination but usually only mild with few blisters (less than 50 spots) and usually without complications.
Thus, to prevent chickenpox in pregnant women and congenital varicella syndrome, chickenpox vaccine should be fully vaccinated. Pregnant women should avoid contact with people who have chickenpox, and at the same time maintain good environmental and body hygiene. When unfortunately infected, it is necessary to carefully monitor and promptly treat, to avoid the risk of complications.
Vinmec International General Hospital is currently providing a Package Immunization Program with a variety of vaccines for different audiences, from infants, young children, adults, women before and during pregnant. . When you come to get vaccinated at Vinmec Hospital, you will receive the following benefits:
Customers who come to use the vaccination service will be examined and screened by specialist doctors for all physical problems. status and health, advice on preventive vaccines and injection regimens, how to monitor and care for customers after vaccination before ordering vaccination according to the latest recommendations of the Ministry of Health & Organization The World Health Organization aims to ensure the best effectiveness and safety for the people injecting the vaccine. The team of doctors is experienced and professional, applying effective pain relief to customers during the vaccination process. 100% of vaccinated customers are monitored 30 minutes after injection and reassessed before leaving. Underwent general supervision before, during and after vaccination at Vinmec Health System and always have an emergency team ready to coordinate with the vaccination department to handle cases of anaphylaxis, respiratory failure - circulatory arrest, ensuring Ensure timely and correct handling when incidents occur. In particular, the vaccination room is airy and has a play area for children, helping children to feel comfortable and good psychologically before and after vaccination. Vaccines are imported and stored in a modern cold storage system, with a cold chain meeting GSP standards, keeping vaccines in the best conditions to ensure quality. In case parents take their child to get vaccinated, they will receive a reminder message before the vaccination date and the child's vaccination information will be synchronized with the national immunization information system. If you need consultation and examination at Vinmec Hospitals of the national health system, please book an appointment on the website for service.

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