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Varicella vaccine in pregnancy

BMJ 1996; 313 doi: (Published 21 September 1996) Cite this as: BMJ 1996;313:701
  1. Daniel S Seidman, Research fellow,
  2. David K Stevenson, Professor of neonatology,
  3. Ann M Arvin, Professor of infectious diseases
  1. Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
  2. Department of Pediatrics, Stanford University Medical School, Stanford, CA, 94305-5119, USA

    Routine screening and vaccination should be considered

    A live attenuated varicella vaccine was licensed in the United States by the Food and Drug Administration in March 1995. The manufacturer is currently preparing to license the vaccine in Europe. It is now possible for the first time to prevent varicella infection in pregnancy by vaccination before pregnancy. This raises the question of whether the vaccine should be offered to all women of childbearing age who are not known to be immune to varicella.

    Varicella is a highly contagious infection, caused by a DNA herpes virus. Infection occurs in 0.05-0.07% of all pregnancies.1 Non-immune pregnant women are at risk, as are all susceptible adults, for associated complications and mortality when they contract varicella.2 3 Furthermore, intrauterine infection may result in stillbirth or congenital varicella syndrome, characterised by eye defects, limb hypoplasia, skin lesions, and neurological abnormalities.3 4

    Universal immunisation and serological screening of women intending to become pregnant is already implemented for the rubella virus. The major objective of this programme is to prevent maternal rubella infection and its subsequent teratogenic effects. The overall risk of fetal damage associated with rubella is about 85%,5 while the risk related to varicella is only about …

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