Question
A 34 week pregnant nurse comes in contact with a patient with chickenpox at her workplace. She has never had chickenpox in the past and is unvaccinated. The best option for her is:
| A. |
Varicella zoster immunoglobulin to be given within 7 days
|
| B. |
Vaccinate for chicken pox
|
| C. |
Start oral acyclovir
|
| D. |
Wait and watch
|
Show Answer
|
Correct Answer » A
Explanation
|
|
The patient is:
- Pregnant (34 weeks gestation)
- Non-immune to varicella
- Exposed to chickenpox
Pregnancy is a high-risk state for severe varicella infection, which can lead to:
- Varicella pneumonia
- Maternal morbidity
- Neonatal varicella
Therefore, post-exposure prophylaxis is required.
Explanation of the Correct Answer
A. Varicella-Zoster Immunoglobulin (VZIG) within 7 days
Indications for VZIG:
- Significant exposure to varicella
- Pregnant woman without immunity
VZIG:
- Reduces severity of maternal infection
- May reduce complications
Timing:
- Best given within 96 hours
- Can be administered up to 10 days after exposure
- Many exam-oriented references mention within 7 days
Hence this is the best option.
Why Other Options Are Incorrect
B. Vaccinate for chickenpox — Incorrect
- Varicella vaccine is a live attenuated vaccine.
- Contraindicated during pregnancy.
Vaccination should be given:
- Postpartum if non-immune.
C. Start oral acyclovir — Incorrect
- Acyclovir is used:
- After onset of infection
- In symptomatic disease
- Not the primary post-exposure prophylaxis in a non-immune pregnant woman.
D. Wait and watch — Incorrect
- Pregnant women are at high risk for severe disease.
- Passive immunization is indicated.
