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Chickenpox in Pregnancy (Green-top Guideline No. 13)

Published: 21/01/2015

Update May 2018: New evidence and guidance in this field were reviewed at the February 2018 Guidelines Committee meeting and it was decided that revision of this guideline would be deferred for 1 year (February 2019). The version available on the website and app will remain valid until replaced.

This is the fourth edition of this guideline, originally published in 1997 and reviewed in 2001 and 2007 under the same title.

Varicella, the primary infection with varicella-zoster virus (VZV; human herpesvirus 3), in pregnancy may cause maternal mortality or serious morbidity. It may also cause fetal varicella syndrome (FVS) and varicella infection of the newborn, which includes congenital varicella syndrome (CVS) and neonatal varicella.

This guideline addresses the role of varicella vaccination in susceptible women of reproductive age. The guideline also assesses the evidence regarding the maternal and fetal risks of VZV infection in pregnancy and whether or not these complications can be prevented or modified beneficially by the administration of varicella-zoster immunoglobulin (VZIG) or by treatment of infected individuals with aciclovir.

This information should guide the prudent use of VZIG, which is manufactured from the plasma of human blood donors and hence is a limited and expensive resource.

The management of neonates is outside the scope of this guideline. Guidance on neonatal exposure and disease is available on the website.