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You are seeing a 10 month old with symptoms consistent with varicella. The infant is well-appearing, has no complications, and is 3 days into her illness. Her mother is pregnant.
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June 12, 2019 at 1:54 pm
E) Neither the child nor the mother should receive the varicella vaccine at this time
Up to 95% of women will be immune due to prior infection or vaccination, and if a woman has had well-documented prior varicella, no further testing or treatment is needed. If she is unsure, her titers should be checked, and prophylaxis given only if she has no immunity. Prophylaxis can be with VZIG or acyclovir. The highest risk of congenital infection is in weeks 13-20 of pregnancy. Also, infants of mothers who developed chickenpox within 5 days before to 2 days after delivery are at risk for neonatal varicella. Healthy children outside the neonatal period do not need to be treated with antiviral therapy. Also, viral replication slows considerably after 72 hours, so antiviral therapy is unlikely to offer benefit to the child at this time. Varicella vaccine is a live virus vaccine indicated at age 12-15 months routinely, and contraindicated in the immunosuppressed and pregnant women. Post-exposure immunization can be effective when given within 3 days and possibly up to 5 days, but is only indicated for > 12 months old and no contraindications.