Top 5 Takeaways

1. Case Overview: A newborn was delivered at 24 weeks’ gestation with congenital varicella syndrome after the mother contracted varicella at 12 weeks’ gestation.
2. Maternal History: The mother, aged 27, had no documented history of varicella disease or vaccination and was born outside the United States.
3. Impact of Varicella Vaccination: The U.S. varicella vaccination program has significantly reduced the incidence of varicella, but severe cases can still occur.
4. Congenital Varicella Syndrome: This syndrome can lead to severe birth defects and is estimated to occur in 0.4%-2.0% of newborns whose mothers develop varicella during the first or second trimester.
5. Recommendations: Emphasizes the importance of assessing varicella immunity in adults, vaccinating nonimmune persons, and ensuring prenatal assessment and postpartum vaccination for susceptible women.

Original Article Author and Citation

Corresponding Author

Jessica Leung, ctf2@cdc.gov

Suggested Citation

Leung J, Reid HD, Morgan J, Kadyk H, Havener G, Marin M. Notes from the Field: Congenital Varicella Syndrome Case — Illinois, 2021. MMWR Morb Mortal Wkly Rep 2022;71:390–392. DOI: http://dx.doi.org/10.15585/mmwr.mm7110a5

Summary

On April 8, 2021, a newborn was delivered at 24 weeks’ gestation with congenital varicella syndrome after the mother contracted varicella at 12 weeks’ gestation. The fetus exhibited multiple abnormalities, and labor was induced due to poor prognosis. The newborn died shortly after delivery. The mother, born outside the U.S., had no history of varicella disease or vaccination. This case underscores the importance of varicella vaccination and prenatal assessment for varicella immunity.

Methods

The case was identified through routine prenatal care and confirmed by a positive varicella-zoster virus (VZV) polymerase chain reaction test of the amniotic fluid. Maternal varicella was diagnosed based on clinical presentation and serologic testing for VZV IgM.

Discussion

This case highlights the severe consequences of varicella infection during pregnancy, including congenital varicella syndrome, which can result in significant birth defects. The U.S. varicella vaccination program has greatly reduced the incidence of varicella, but cases like this emphasize the need for continued vigilance and vaccination efforts, particularly among non-immune adults and women of childbearing age.

Conclusion

This case serves as a reminder of the importance of assessing varicella immunity in adults, vaccinating nonimmune persons, and ensuring prenatal assessment and postpartum vaccination for susceptible women. It also highlights the need for timely administration of varicella-zoster immune globulin (VariZIG) to exposed pregnant women to prevent severe maternal disease.

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