Overview
Varicella-zoster virus (VZV) causes chickenpox (primary infection) and shingles (reactivation). Primary infection during pregnancy can lead to congenital varicella syndrome and maternal complications, highlighting the importance of seroprevalence awareness, especially in unvaccinated populations like reproductive-age women in Iran 1.Diagnosis
Serological testing for VZV IgG antibodies to confirm immunity or past infection 1.
Clinical presentation of vesicular rash characteristic of chickenpox or shingles aids in diagnosis 1.Management
Primary Infection (Chickenpox): Symptomatic treatment with antipyretics and hydration; acyclovir (8 mg/kg every 8 hours for 7-10 days) can reduce duration and severity in immunocompromised individuals 1.
Reactivation (Shingles): Antiviral therapy with acyclovir (800 mg five times daily for 7-10 days), valacyclovir (1 g three times daily for 7 days), or famciclovir (500 mg three times daily for 7 days) to shorten duration and reduce complications 1.Special Populations
Pregnancy: Primary VZV infection poses risks including congenital varicella syndrome; passive immunization with varicella zoster immune globulin may be considered post-exposure 1.
Reproductive-age Women (Iran): High seroprevalence awareness is crucial due to lack of national varicella vaccination, potentially leaving many susceptible 1.Key Recommendations
Screen reproductive-age women for VZV immunity, especially in regions without national vaccination programs, to identify those at risk 1 (Evidence: Moderate).
Administer antiviral therapy (acyclovir, valacyclovir, famciclovir) to immunocompromised individuals with primary VZV infection and to all patients with shingles to reduce disease duration and complications 1 (Evidence: Strong).
Consider passive immunization with varicella zoster immune globulin for pregnant women exposed to VZV if primary infection is suspected 1 (Evidence: Expert opinion).References
1 Pourahmad M, Tarrahi MJ, Momenzadeh M, Shahzamani K, Jahromi AS, Farajzadegan Z et al.. Varicella-zoster virus seroprevalence among reproductive-age women in Iran: a meta-analysis and implications for targeted immunization. BMC infectious diseases 2025. link