Varicelle, zona et grossesse

[Varicella vaccination, pregnancy and breastfeeding: The current situation]

The varicella vaccine is recommended for women with no history of varicella who are planning to become pregnant, as well as for post-pregnancy women, to prevent the occurrence of this illness and its severe complications, especially an embryopathy, when it occurs in a pregnant woman (congenital varicella syndrome). This live attenuated vaccine should not be administered during pregnancy, nor in the month preceding it. However, when this occurs inadvertently, the data collected on the outcomes of exposed pregnancies, although few in women seronegative at the time of vaccination, allow to reassure the patients to date, as no congenital varicella syndrome has been reported to date following accidental vaccination in early pregnancy. On the other hand, during breastfeeding, a woman may be vaccinated if there is an expected short- or medium-term benefit (varicella exposure, planned pregnancy…).

Rapid detection of varicella-zoster virus based on an immunochromatographic strip

Varicella-zoster virus (VZV) is a highly infectious DNA virus that can cause varicella (chickenpox) and herpes zoster (HZ). A simple, sensitive and specific detection method is desirable for the VZV infection. In this study, VZV gE protein, expressed in CHO cells, was used to immunize BALB/c mice for the generation of monoclonal antibodies (mAbs). For the first time, we developed a colloidal gold-based immunochromatographic strip for rapid detection of VZV using a pair of mAbs against gE protein. The limit of detection (LOD) of the strip was 30 ng mL-1 of purified VZV gE antigen, and it could specifically test VZV without cross-reactivity with Enterovirus 71 (EV-71), Herpes simplex virus 1 (HSV-1) and Herpes simplex virus 2 (HSV-2). The coincidence rate between the strip and commercial real-time PCR diagnostic kit was 100% using vesicle as the clinical sample. Our strip provided a technical support for rapid and specific detection of VZV.

Development of an Indirect ELISA Kit for Rapid Detection of Varicella-Zoster Virus Antibody by Glycoprotein E

Varicella-zoster virus (VZV), a highly infectious agent that causes varicella (chickenpox), can also cause zoster (shingles), a disorder that is frequently associated with severe neuralgia. A reliable serological VZV diagnostic assay would be useful for identifying unprotected individuals and for surveilling post-vaccination immunoprotection status. Toward this goal, VZV membrane glycoprotein E (gE), the immunodominant VZV protein, served as target antigen in an indirect ELISA kit developed here to detect anti-VZV antibodies in clinical samples. For target antigen preparation, Chinese hamster ovary (CHO) cells were modified to express and secrete the VZV gE ectodomain, which was subsequently purified and used as coating antigen in an indirect ELISA. Ultimately, the optimal purified gE coating antigen concentration was determined to be 2 μg.ml⁻¹ and the OD_450nm detection cutoff value was 0.286. The coefficient of variation (CV) of intra-assay and inter-assay were <10 and 15%, respectively. A comparative test of 66 clinical samples showed that the coincidence rate was 93.9% between the indirect ELISA and a commercial varicella-zoster virus IgG ELISA kit. Thus, the indirect ELISA kit developed here may be useful for achieving rapid, sensitive, and specific detection of anti-VZV antibodies.

Genital zoster in near term pregnancy: Case report and need of management guidelines

Genital herpes simplex infection close to delivery may be transmitted to the newborn. Guidelines for genital herpes during pregnancy have been elaborated to reduce the risks of neonatal herpes. Genital herpes zoster due to reactivation of varicella zoster virus (VZV) from sacral ganglia is an under recognized cause of genital lesions. The risks of genital zoster near delivery for the newborn have not been evaluated. No guidelines have taken into account this rare viral infection during pregnancy. A pregnant woman at 38 weeks gestation presented herpes-like genital vesicular lesions in absence of herpes simplex virus (HSV) past history. Rapid HSV molecular testing was negative despite clinically suggestive lesions. A control multiplex PCR was performed, which evidenced VZV. The woman was treated with acyclovir until delivery. The newborn was healthy. VZV should be investigated in HSV- negative herpes-like genital lesions during pregnancy. Diagnosis of genital lesions requires virological confirmation to adapt obstetrical and neonatal management.

Management of chickenpox in pregnant women: an Italian perspective

Chickenpox is a highly contagious disease caused by primary infection of varicella zoster virus (VZV). The disease is spread worldwide and is usually benign but, in some groups of population like pregnant women, can have a severe outcome. Due to a not optimal vaccination coverage, a relatively high number of childbearing-aged women in a European country such as Italy tested seronegative for VZV and so are currently at risk of acquiring chickenpox during pregnancy, especially if they live in contact with children for family or work reasons. Only few data are available about the risk of infection in this setting: the incidence of chickenpox may range from 1.5 to 4.6 cases/1000 childbearing females and from 1.21 to 6 cases/10,000 pregnant women, respectively. This review is aimed to focus on the epidemiology and the clinical management of exposure to chickenpox during pregnancy. Particular emphasis is given to the accurate screening of childbearing women at the time of the first gynecological approach - the females who tested susceptible to infection can be counseled about the risks and instructed on procedure should contact occur - and to the early prophylaxis of the at-risk exposure. Lastly, the achievement of adequate vaccination coverage of the Italian population remains a cornerstone in the prevention of chickenpox in pregnancy.

Chickenpox: An update

Despite its benign characteristics, chickenpox is a childhood disease responsible for complications and deaths, particularly in the high-risk population. VariZIG^®, not commercialized in France, is a good alternative for seronegative individuals exposed to the virus and not eligible for vaccination. The efficacy of routine vaccination has been demonstrated with a decrease in chickenpox incidence and with the development of herd immunity. Over time, the protective antibody titer of vaccinated people decreases and can be maintained by two doses of the vaccine. A tetravalent measles-mumps-rubella-chickenpox vaccine, used in the United States, has a good tolerability in spite of the occurrence of fever and febrile seizures. Routine vaccination would contribute to make savings in France, by reducing direct and indirect costs of chickenpox.

[Perinatal varicella: fetal and neonatal risks and management]

La survenue d'une varicelle clinique en cours de grossesse est rare, pouvant entrainer des risques maternels et fœtaux. La varicelle maternelle périnatale peut entrainer une varicelle néonatale potentiellement grave, notamment en cas d'éruptions maternelles survenant entre 5 jours avant et 2 jours après l'accouchement. Nous rapportons huit observations de nouveau-nés de mères ayant eu une varicelle en péri-partum dans le but de synthétiser, l'état actuel des connaissances sur le risque de ce virus et d'essayer d'élaborer un protocole de prise en charge. Il s'agit d'une étude descriptive menée au centre de maternité et de néonatologie de Sousse, sur une période de 10 ans. Huit nouveau-nés ont été inclus dans l'étude. Le diagnostic était fait avant l'accouchement chez 7 mères. Une seule femme avait développé sa varicelle 3 jours après l'accouchement. Cinq nouveau-nés étaient symptomatiques à l'admission. Ils avaient tous des lésions cutanées typiques de la varicelle, trois parmi eux avaient une atteinte respiratoire associée. La prise en charge était basée sur l'isolement des nouveau-nés, les soins locaux, et le traitement par Acyclovir. L'évolution était favorable dans tous les cas. La survenue d'une varicelle au cours de la grossesse reste possible dans les pays ou la vaccination n'est pas encore accessible à tous. Les risques de complications maternelles et fœtales qu'elle occasionne justifient une prise en charge spécifique et bien codifiée.

[Acute herpesviridae hepatitis during pregnancy: A review]

Viral hepatitis are well defined during pregnancy, including hepatitis A, B, C, D or E. In contrast, viral hepatitis called non-alphabetic, like viruses Herpesviridae family hepatitis [cytomegalovirus (CMV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV) or herpes simplex virus (HSV)] are rarely described. The aim of this article is to make a focus on the care of these viral herpesviridae hepatitis during pregnancy. Herpes hepatitis is more common during pregnancy, with a neonatal risk at peripartum period. VZV infection can cause disease to the fetus, with possible vertical transmission, and induce congenital or neonatal varicella. While EBV infection during pregnancy seems benign, the CMV is a high risk of birth defects. The management of these patients therefore depends on the gestational age, but especially the type of virus involved. The diagnosis is therefore essential to adapt treatment and obstetrical care.