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Investigating the pregnant woman exposed to a child with a rash
Cite this as:
BMJ
2012;344:e1790
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I am writing to alert readers of an important policy change announcement in the USA1 that coincided with publication of “Investigating the pregnant woman exposed to a child with a rash”. In that article I stated that “The recommended time frame for VZIG varies. US guidance advises VZIG within 96 hours of exposure, but in the UK, VZIG can be given to a household contact within 10 days of onset of the rash in the index case.” As published recently in the Morbidity and Mortality Weekly Report however, this discrepancy no longer applies. This follows the US Federal Drug Administration (FDA) approval of a longer period of 10 days during which a patient may receive VZIG following exposure to varicella zoster virus.
1. Centers for Disease Control and Prevention. FDA Approval of an Extended Period for Administering VariZIG for Postexposure Prophylaxis of Varicella. MMWR Morb Mortal Wkly Rep. 2012 Mar 30;61:212.
Competing interests: None declared
Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital
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I partially agree with Dr. Peter J Flegg. Humans are the sole natural host of syphilis. The disease is most common in Sub-Saharan Africa, South and Southeast Asia, and South America though it has declined in developed countries including USA1,2. The diagnosis of syphilis beyond early infancy (among children) raises concerns for possible child sexual abuse, although progression of congenital syphilis may account for some cases2. At this juncture , I shall highlight (as stated in my previous response as well) that the pregnant woman can acquire the infection from other age groups too and not necessarily from a child.
References:
1, Philipot R. Future directions for STIs and sexual health in Asia-Pacific region: 2002-2020. In : Kumar B, Gupta S, editors, Sexually transmitted infections. 1 st ed. Elsevier: New Delhi; 2005. p. 18-26.
2, Woods CR. Syphilis in children: congenital and acquired. Semin Pediatr Infect Dis. 2005 Oct;16(4):245-57.
Competing interests: None declared
Indian Council of Medical Research, Ansari Nagar, New Delhi-110029
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According to author the rash could be due to any one of several infectious or non-infectious causes, but the initial approach needs to focus on those infections that pose risks to the mother and fetus or neonate, and for which intervention can improve the outcome.1 These infections are measles, rubella, parvovirus B19, and varicella zoster virus1. But author has forgotten that secondary syphyllis may also present in this way and can be harmful to the unborn child, however it is treatable and should be kept in mind.
Moreover, due to widespread immunization epidemiological changes have occurred in Measles. These epidemiological changes include a shift in the age distribution of measles towards older children and adults2,3,4.
Thus, we can infer that child with a rash could be a secondary syphillitic case and the pregnant woman should be investigated for this too. And measles may occurr in adults as well and the pregnant woman should be investigated when exposed to any person presenting with rash and just not the child only.
References:
1. Macmahon E.Investigating the pregnant woman exposed to a child with a rash. BMJ. 2012 Mar 26;344:e1790. doi: 10.1136/bmj.e1790.
2. Cutts FT, Steinglass R.Should measles be eradicated? BMJ. 1998 Mar 7;316(7133):765-7.
3. Cutts FT, Henderson RH, Clements CJ, Chen RT, Patriarca PA. Principles of measles control. Bull WHO. 1991;69:1–7.
4. Gay NJ, Hesketh LM, Morgan-Capner P, Miller E. Interpretation of sero-logical surveillance data for measles using mathematical models: implications for vaccine strategy. Epidemiol Infect. 1995;115:139–156.
Competing interests: None declared
Indian Council of Medical Research, Ansari Nagar, New Delhi-110029
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13 April 2012
Am I alone in finding Neeru Gupta's scenario of a pregnant woman catching syphilis from a child rather fanciful and highly improbable?
Competing interests: None declared
Victoria Hospital, Blackpool FY3 8NR
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