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Varicella-zoster virus infection in pregnancy

INTRODUCTION

Varicella-zoster virus (VZV) is the causative agent of varicella (chickenpox) and herpes zoster (shingles). VZV is a member of the herpesvirus family along with herpes simplex types 1 and 2, cytomegalovirus, Epstein-Barr virus, and herpes virus types 6, 7, and 8.

Varicella is generally a mild, self-limited illness in healthy children. Ninety percent of cases occur in children between the ages of 1 and 14 years, with only about 2 percent occurring in adults 20 years of age or older [1].

Rarely, varicella causes problems in pregnancy for the mother and her unborn child. The incidence of varicella is estimated to be 1 to 5 cases per 10,000 pregnancies [2]. The low incidence is largely related to immunity due to prior infection. One study, for example, used fluorescent antibody to VZV membrane antigen to measure antibody status in pregnant women who had no history of varicella; only 5 percent of childbearing women were susceptible [3]. A higher rate of susceptibility is present in childbearing women from subtropical and tropical areas (16 percent). Varicella is highly communicable with secondary attack rates in susceptible household contacts approaching 90 percent [4].

MICROBIOLOGY AND PATHOGENESIS

Molecular studies reveal that VZV has a double-stranded linear DNA (approximately 125,000 base pairs). Each isomeric form of DNA is incorporated into individual virions and is infectious. The virus may spread to neighboring cells within 18 hours of infection [5].

Varicella — Varicella is usually transmitted by infected secretions harbored in the nasopharyngeal mucosa by droplets onto the conjunctival or nasal/oral mucosa. Other mechanisms include direct contact with vesicular fluids that contain virus, and airborne spread of the virus. This is followed by viral replication in regional lymph nodes and tonsils or possibly ductal tissue of salivary glands. Viral replication continues for four to six days.
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