The UK NSC policy on Varicella susceptibility screening in pregnancy
Varicella zoster virus (VZV) is the virus which causes chickenpox. In the UK chickenpox mostly occurs in children less than 10 years of age, causing a mild infection. A more serious infection is seen in adults and those with compromised immune systems. In the UK approximately 90% of women of childbearing age are protected against chickenpox.
Chickenpox acquired for the first time during pregnancy can result in serious maternal illness. It can also adversely affect the fetus and the risk of this happening depends upon the point at which maternal infection is acquired. However this remains very rare.
Current immunisation policy is to vaccinate non-immune healthcare workers. Varicella vaccine is also recommended for healthy susceptible close household contacts of immunocompromised patients.
The policy for management of varicella in pregnancy is set by the Department of Health’s ‘Green Book’.
The RCOG also issued a green top guideline, ‘Chickenpox In Pregnancy’, in 2007.
The HPA included varicella in its guidelines on the management of rash illness in pregnancy, 2002.
In the context of the current primary prevention strategy of targeted immunisation to high risk groups there is insufficient evidence to recommend the introduction of routine antenatal screening for VZV susceptibility in the UK.
This policy was reviewed in Oct 2009 but no significant changes were made. It is due to be considered again in 2012/13, or earlier if significant new evidence emerges.
Evidence Supporting the Policy
Recommendations arising from the last UK NSC policy review (which can be downloaded below):
- as VZV infection in pregnancy can be serious, it is recommended that all steps be undertaken to
- increase awareness and training amongst health professionals of existing guidelines for the management of pregnant women exposed to VZV.
- ensure pregnant women are made aware of the risks associated with exposure to VZV and the need to seek immediate health advice.
- systematic follow up of pregnant women who receive post exposure prophylaxis with VZIG in the UK should be considered.
- a systematic review of treatments for VZV exposure and VZV infection in pregnancy is recommended and would be timely given concerns about the future supply of Varicella Zoster Immune globulin (VZIG) which is currently the mainstay of management of women exposed to VZV infection in pregnancy.
The stakeholder groups will be involved when the policy is next reviewed. If you think your organisation should be added, please contact us.