Varicella Zoster Virus Infection in Neonates

Abstract

Varicella zoster virus (VZV) can cause a spectrum of clinical manifestations in the fetus and neonate, which range from a self-limited exanthema to congenital malformations and/or death. Once a ubiquitous virus in the community, the epidemiology of VZV has dramatically changed in countries that have introduced the varicella vaccine into their routine immunization schedule. Practitioners must be cautioned against complacency with this virus, however, because unrecognized infection can have far-reaching consequences for the expectant mother, fetus, and neonate. VZV should be included in the differential diagnosis of patients who have a vesicular rash. Multiple factors should be considered before providing prophylaxis or treatment to pregnant women or neonates. Depending on the clinical situation, clinicians may need to know the status of maternal immunity, distinguish primary varicella from secondary zoster infection, determine if the neonate has high-risk characteristics (birth weight, gestational age), and be able to estimate the timing of maternal infection. Nosocomial infection can pose a significant risk to hospitalized neonates. Care provider vigilance coupled with appropriate pharmacologic interventions can help mitigate the consequences of this now uncommon viral infection.