Charlier Caroline, Le Mercier Delphine, Salomon Laurent J, Ville Yves, Kermorvant-Duchemin Elsa, Frange Pierre, Postaire Martine, Lortholary Olivier, Lecuit Marc, Leruez-Ville Marianne
Université Paris Descartes Sorbonne Paris Cité, AP-HP, hôpital Necker-Enfants-Malades, service de maladies infectieuses et tropicales, centre d'infectiologie Necker-Pasteur, institut Imagine, 149, rue de Sèvres, 75015 Paris, France; Institut Pasteur, Unité de biologie des infections, Inserm U1117, centre national de référence Listeria, Centre collaborateur OMS Listeria, 75015 Paris, France.
Université Paris Descartes Sorbonne Paris Cité, AP-HP, hôpital Necker-Enfants-Malades, service d'obstétrique, 75015 Paris, France.
Presse Med. 2014 Jun;43(6 Pt 1):665-75. doi: 10.1016/j.lpm.2014.04.001. Epub 2014 May 23.
The incidence of varicella is low in pregnant women, and estimated around 1/1000 pregnancies. Vaccination is the cornerstone of prevention, but is contraindicated during pregnancy. Varicella is more severe in pregnant women. The risk of viral pneumonia is not increased, but VZV-associated pneumonia is usually more severe in pregnant women. Infection between 0-20 WG is associated with a 2 % risk of congenital varicella syndrome. Infection between D-5 and D+2 of delivery is associated with high risk of severe neonatal infection. Non-immune pregnant women with significant exposure to VZV require post-exposure prophylaxis with specific anti-VZV immunoglobulins that should be administered ideally within 4 days post-exposure and maximum within 10 days of exposure. Anti-VZV immunoglobulins are available in France in the context of an approved expanded access to an investigational new drug. Pregnant women with varicella should receive within 24 hours antiviral treatment based either on valaciclovir or, in case of severe infection, intravenous aciclovir. Both drugs were shown safe during pregnancy, even during the first trimester. Neonates born from mothers who developed varicella between D-5 and D+2 of delivery should also receive as soon as possible specific anti-VZV immunoglobulins.
孕妇中水痘的发病率较低，估计约为每1000次妊娠中有1例。接种疫苗是预防的基石，但在孕期禁忌接种。水痘在孕妇中病情更严重。病毒性肺炎的风险并未增加，但水痘带状疱疹病毒（VZV）相关肺炎在孕妇中通常更严重。妊娠0至20周期间感染，先天性水痘综合征的风险为2%。分娩前5天至产后2天之间感染，严重新生儿感染的风险很高。有显著VZV暴露史的非免疫孕妇需要在暴露后使用特异性抗VZV免疫球蛋白进行暴露后预防，理想情况下应在暴露后4天内给药，最迟在暴露后10天内给药。在法国，抗VZV免疫球蛋白可在获批扩大使用研究性新药的情况下获得。患水痘的孕妇应在24小时内接受基于伐昔洛韦的抗病毒治疗，如感染严重，则接受静脉注射阿昔洛韦治疗。这两种药物在孕期均显示安全，甚至在孕早期也是如此。分娩前5天至产后2天之间患水痘的母亲所生新生儿也应尽快接受特异性抗VZV免疫球蛋白治疗。
