[CG] Chickenpox in pregnancy

Warning

exp date isn't null, but text field is

Objectives

Advice and reassurance and action points for the care of Pregnant Women who come into contact with Chickenpox or Shingles.

Please report any inaccuracies or issues with this guideline using our online form

Key points to communicate

  • Once you have had Chickenpox you cannot catch it a second time. You are immune.

  • Most UK adults are immune to Chickenpox

  • Chickenpox is very rare in pregnant women in the UK

  • Although it affects very few babies in the womb, it can be very serious for them and/or their mother.

  • If you are not immune to Chickenpox, or you are not sure whether you are immune, while you are pregnant do all you can to avoid coming into contact with people who may have it.

  • If you have Chickenpox, avoid contact with other pregnant women and new babies until at least 5 days after the rash appears, or until all the blisters have crusted over.

  • Pregnant women with shingles can infect others. The baby will be safe during pregnancy.

Flowchart - telephone contact from pregnant patient with suspected chickenpox/shingles

Appendix 1: Algorithm for the management of varicella-zoster contact in pregnancy

Appendix 2: Human Varicella-Zoster Immunoglobulin

Human Varicella-Zoster Immunoglobulin

Medicines name

Human Varicella-Zoster Immunoglobin

Presentation

250mg solution for injection in glass vials.

The correct volume of solution to give a dose of 250mg is overprinted on the label.

Dose

For women 1,000mg (4vials)

Give as soon as possible after exposure, ideally within 3 days, maximum 10 days post exposure. Women may still develop clinical varicella after administration of VZIG (up to 28 days post exposure) however the infection can be attenuated but may be severe. If the pregnant woman is >20 weeks and develops varicella infection treat with acyclovir (800mg 5x per day for seven days). Aciclovir can be used before 20 weeks but this should be discussed with the woman’s obstetrician. Please contact the clinical team at the West of Scotland Specialist Virology Centre to arrange vesicle swab testing of the rash.

If a second exposure to chickenpox occurs following VZIG administration:

  • Within 3 weeks a further does of VZIG is NOT required
  • Between 3 weeks and 6 weeks, do not test for varicella antibodies and administer another dose of VZIG
  • More than 6 weeks, re-test a new sample for varicella antibody, if negative administer VZIG.

 

Method of administration

Bring product to room temperature before intramuscular injection into the buttock, thigh or deltoid muscle. If the volume to be administered exceeds 5ml, it should be split into two or three doses at different sites. Ensure administration is not into a blood vessel, because of the risk of shock.

 

Storage

Store in a refrigerator. Do not freeze. (If the product is inadvertently stored at room temperature, the expiry date is shortened to a maximum of one week.)

 

Supply – local arrangements

All immunoglobulin preparations are now supplied by pharmacy. Local arrangements for availability of varicella zoster immunoglobulin (VZIG) out-of-hours are detailed below:

  • PRM- available via A&E (2x4 vials) or from the emergency cupboard in the GRI (2x4 vials). The latter may be obtained by paging the hospital co-ordinator via switchboard.

  • QEUH- available via A&E.

  • RAH- available via the EDC Pharmacist.
References

 RCOG Green-top Guideline 13 Chickenpox in Pregnancy January 2015 accessed 1.4.15
https://www.rcog.org.uk/globalassets/documents/guidelines/gtg13.pdf

 

Acknowledgement APPENDIX 1 algorithm for management of varicella zoster contact in pregnancy reproduced from above guideline on following page.


RCOG Chickenpox in Pregnancy patient information leaflet November 2008 accessed  1.4.15
https://www.rcog.org.uk/globalassets/documents/patients/patient-information- leaflets/pregnancy/chickenpox-in-pregnancy.pdf

  

Appendix 2 Human Varicella-Zoster Immunoglobulin pharmacy information
Public Health England. Guidance for issuing varicella-zoster immunoglobulin (VZIG). August 2017

Last reviewed: 18 July 2018

Next review: 01 July 2022

Author(s): Author - Dr Judith Roberts Update – Dr Dawn Kernaghan

Version: V3

Approved By: Approval Obstetric Guideline Group: June 2018 Approval Obstetric Governance Group: June 2018