Chickenpox - Any danger to pregnant women?

BY: Enoch Darfah Frimpong

Dear Mirror Doctor, My four-year-old son came home from school with chicken pox. I am pregnant currently. Is there any danger to the baby? I have had chicken pox already. How do I help my son as he is itching badly? When can he go back to school? Ida, Adenta, Accra.

Chickenpox, also known as varicella, is a self-limiting infection that commonly affects children between five and 10 years of age. It is caused by a virus called the varicella-zoster virus (VZV).

The disease is highly contagious — over 90 per cent of non-immune individuals will develop chickenpox following exposure. VZV is communicable by both direct skin-to-skin contact and via respiratory droplets (for example, coughing, sneezing) from the infected individual.

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While the average incubation period from viral exposure to onset of symptoms is 12 to 14 days, symptoms may appear as early as 10 days or as late as 21 days after exposure to the virus.

Healthy children generally experience one to two days of fever, sore throat, and malaise approximately two weeks following exposure to VZV.

Within 24 hours of these symptoms, a characteristic rash develops initially on the torso and then spreads over the next seven to 10 days outward to the head, arms, and legs.

The rash progresses through a predictable evolution from a red papule to blister (vesicle) to pustule and then scabs over. The vesicle and pustular fluids are highly concentrated with infectious virus particles.

New lesions characteristically come in "waves" over the skin surface. The patient may thus have newly formed papules, middle-aged vesicles and pustules, and crusted lesions all at the same time.

At the peak of the disease, a patient may have over 300 skin lesions at one time. Once all lesions are scabbed over and no new lesions are developing, the person is no longer contagious.

The lesions rarely cause permanent scarring, unless secondary infection develops. Lesions may commonly be found in the mouth and may also involve the genitalia.

In healthy children, chickenpox is a mild disease. Adults are 25 per cent more likely to have significant complications from the diseases.

Common complications affecting both children and adults include the following:

Skin infections: Secondary bacterial infections, caused by either Staphylococcus or Streptococcus bacteria can occur. Rarely, an invasive form of Streptococcus can quickly spread throughout the body and may be life-threatening.

 Lifelong immunity for chickenpox generally follows the disease. If the patient's immune system does not totally clear the body of the virus, it may retreat to skin sensory nerve cell bodies where it is protected from the patient's immune system.

The disease shingles (also known as "zoster") represents release of these viruses down the length of the skin nerve fibre and produces a characteristic painful rash. Shingles is most commonly a disease of adults.

Pneumonia: This is a relatively rare complication in healthy children but is the primary cause of hospitalisation for adults and has a mortality (death) rate of between 10 and 30 per cent.

Neurologic complications: Children most commonly develop an inflammation of the balance centre of the brain called acute cerebellar ataxia.

Symptoms of abnormal eye movements and poor balance develop in about one in 4,000 children approximately one week into the skin manifestations of chickenpox. Symptoms generally last for a few days, and a complete recovery is common.

 Adults more commonly develop a more generalised brain inflammation (“encephalitis") whose symptoms may include delirium and seizures.

Hepatitis, kidney disease, ulcers of the intestinal tract, and inflammation of the testes (orchitis) have all been described as very rare complications of the disease.

Chicken pox can be acquired from mother during pregnancy. This type—called congenital infection—occurs only in infants born to mothers who experience chickenpox for the first time during pregnancy.

Women who are immune to VZV and are exposed to chickenpox during pregnancy do not carry the same risk profile for their infant.

The good news is that the risk of fetal anomalies as a result of congenital VZV infection is very small.

Complications that have been documented from congenital infections include skin pigment abnormalities and scarring (presumably due to intrauterine skin infections), eye abnormalities, brain structural abnormalities resulting in mental retardation, and structural abnormalities of the arms and legs.

Maternal VZV infection during the final two weeks of a pregnancy carries an ominous risk for the infant. Infected infants have up to a 25 per cent mortality rate, and the worse prognosis exists for those infants whose mothers develop chickenpox during the last five days of confinement.

Most cases of chickenpox can be managed at home. Chickenpox rash tends to be extremely itchy. Several treatments can be used at home to help a child feel better such as cold compresses and calamine lotion which when applied to blisters may give relief.

Cool-water baths every three to four hours, adding baking soda to the water calms the itching.

Trimming fingernails can help prevent infection from scratching the blisters. A small infant with chickenpox may benefit from covering the child's hands with mittens to minimise scratching. Antihistamines such as zaditen and cetirizine can relieve the itching. Fever is treated with paracetamol and brufen.

Using antiseptic soap or antiseptic lotion in bathing water used can prevent the bacteria secondarily infecting the blisters. Antibiotics creams may also prevent bacteria superinfection.

Keep children at home from school and day care until all blisters have crusted. A child with chickenpox is extremely contagious until the last crop of blisters has crusted. For people who have severe infections, an antiviral agent called acyclovir (Zovirax) has been shown to shorten the duration and severity of symptoms if given soon after the onset of the rash. Acyclovir may be given by mouth. Neonatal VZV infection may be treated with VZIG (varicella zoster immune globulin) -- a form of highly concentrated anti-VZV gamma globulin.

To prevent chicken pox, a two-dose vaccine is highly recommended for healthy children, adolescents and adults.

It is recommended that all healthy children 12 months through 12 years of age receive two doses of the chickenpox vaccine, administered at least three months apart.

Children who have contracted chicken pox do not need the vaccine. Those aged 13 and over who do not have evidence of immunity should get two doses of the vaccine four to eight weeks apart.

When fully immunised, the vaccine has been shown to be 95 per cent effective in preventing childhood cases of chickenpox. A small percentage of newly immunised or those who do not receive both doses will develop a mild rash. Rarely, people who have been immunised fully also develop very mild form of the disease. Pregnant women and infants younger than one year of age should not be vaccinated.

Please be reminded to contribute your widow’s mite to the Korle Bu Children’s block fund. If everybody contributed two cedis, the estimated 23 million dollars to build and improve the Child Health emergency room and the paediatric intensive care unit could easily be mobilised to cater for our children.

You can call our hotline (0302) 665405 to contribute to this worthy cause or you can come to the second floor of the Children’s block of the Korle Bu Teaching Hospital. Corporate bodies are particularly encouraged to donate. You can also contribute through Child Health Foundation account numbered 1131130007184, Ghana Commercial Bank, Korle Bu Branch. Our children need us.

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