Transcript Varicella Voice Over PowerPoint

REDUCING VARICELLA
COMPLICATIONS IN WOMEN OF
CHILDBEARING AGE
Lynn M. Scott, RN, IBCLC
SUNYIT, NUR 490
November 12, 2013
BACKGROUND
Varicella, a predominantly childhood disease that is
known as chickenpox, is highly contagious and caused
by the varicella zoster virus (VZV).
 If VZV is contracted during the 5th and 24th week of
pregnancy, the mother may miscarry or go into
premature labor. The risk to the newborn baby is
infection with varicella pneumonia, neonatal herpes
zoster (shingles), or Congenital Varicella Syndrome
(CVS).

BACKGROUND (CONT’D)

Documented as 14 in 2,000 cases, CVS can present
with the following abnormalities: limb shortening or
malformation, central nervous system and cognitive
impairment, seizures, or growth deficiency. CVS
carries a 30% mortality rate in the early newborn
period.
BACKGROUND (CONT’D)

In 2005, the Advisory Committee on Immunization
Practices (ACIP) recommended routine screening
during pregnancy to assess for evidence of immunity
to varicella. The following are considered proof of
immunity:
 History of chickenpox or herpes zoster;
 Documentation of 2 doses, 4 weeks apart, of the
varicella vaccine, or;
 Laboratory confirmation of immunity as
evidenced by a positive IgG ELISA titer.
OBJECTIVES
(PICO QUESTION)

Taking into consideration the pros and cons of administering the
varicella vaccine, will vaccinating women in the immediate
postpartum period decrease the reportable incidences of mortality and
morbidity from complications of varicella in childbearing-aged women
and, subsequently, their newborns?

Population: Women of childbearing age during the immediate
postpartum period;

Intervention: Vaccination with the varicella vaccine;

Comparison: Pros and cons of vaccination, and;

Outcome: A decrease in the reportable incidences of mortality and
morbidity from complications of varicella in childbearing-aged women
and, subsequently, their newborns.
NURSING THEORY

Thielen (2012) reminds us that pregnancy is not a state
of illness, nor is it a disease state; pregnancy should be
viewed as a state of wellness. Nola J. Pender’s nursing
theory of Health and Wellness Promotion most aligns
itself with the importance of educating and
encouraging non-immune childbearing-aged women
about the necessity of being immunized against
varicella.
EVALUATION STRATEGY
Pros/Cons Ratio
Most Important Pro

Vaccine
Pros 70%: Cons 30%
Pros
Cons
The most important pro
for vaccination is that
varicella-related
morbidity and mortality
have dramatically
declined in countries
that vaccinate for
varicella.
Research Evidence
• Because the number of VZV cases has
declined, women of childbearing age have
had decreased exposure but increased
susceptibility to the virus.
• If exposed to VZV during the low-risk
period of gestation, pregnant women should
receive VariZIG®, a post-exposure
prophylaxis, with follow up of varicella
immunization at the completion of the
pregnancy.
• Newborns exposed to infected mothers
between 5 days before and 2 days after
delivery are at high risk for severe
complications from varicella.
RESEARCH EVIDENCE
(CONT’D)
Contraindications to receiving the varicella vaccine
are a history of allergy or anaphylactic reaction to
components of varicella vaccine, pregnancy, certain
malignant conditions, steroid therapy, low CD4 and Tlymphocyte counts, or a family history of congenital
or hereditary immunodeficiency in a first degree
relative.
 Precautions to receiving the varicella vaccine are the
receipt of antibody-coating blood products in the last
11 months and moderate to severe acute illness with or
without fever.

CONCLUSIONS



The prevention of VZV infection in pregnant women
through the vaccination of women of childbearing age is
key to the continuation of the documented reduction in
varicella-related maternal and neonatal morbidity.
Varicella vaccination is safe and effective in preventing
VZV infections and complications in childbearing-aged
women with 99% immunity protection via two doses of
VARIVAX®, 4 weeks apart, in postpartum women.
As a result of the information obtained through the research
contained herein, policy, protocol, and standing orders on
Varicella Vaccine for Postpartum Women will be created
for this author’s employer under the advisement of the
institution’s Executive Director.
REFERENCES
Centers for Disease Control and Prevention (2013). MMWR: Updated
recommendations for use of VariZIG® - United States, 2013. Retrieved
on 10/23/13 from http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm6228a4.htm.
FDA.gov (2010). Patient information about Varivax®. Retrieved on 10/23/13
from http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/
ApprovedProducts/UCM165651.pdf.
Guido, M., Tinelli, A., DeDonno, A., Quattrochi, M., Malvasi, A.,
Camplilongo, F., & Zizza, A. (2012). Susceptibility to varicella zoster
among pregnant women in the province of Lecce, Italy. Journal of Clinical
Virology, 53, 72-76, doi: 10.1016/j.jcv2011.10.007.
Hackley, B. (2008). Incorporating immunization services into reproductive
healthcare. Journal of Midwifery & Women’s Health, 53(3), 175-187.
doi: 10.1016/j.jmwh.2008.01.002.
Hambleton, S., Steinberg, S. P., LaRussa, P. S., Shapiro, E. D., & Gershon, A. A. (2008). Risk
of herpes zoster in adults immunized with varicella vaccine. The Journal of Infectious
Diseases, 197, S196-S199. doi: 10.1086/522131.
REFERENCES (CONT’D)
Hendriksz, T. (2011). Vaccines for measles, mumps, rubella, varicella, and herpes zoster:
Immunization guidelines. Journal of the American Osteopathic Association, 111(10), S10S12.
Immunization Action Coalition (2013). Standing orders for administering varicella
(chickenpox) vaccine to adults. Retrieved on 10/01/13 from
http://www.immunize.org/catg.d/p3080.pdf.
Kett, J. C. (2013). Perinatal varicella. Pediatrics in Review, 34(1), 49-51. doi:
10.1542/pir.34-1-49.
Picone, O., Vauloup-Fellous, C., Senat, M. V., Frydman, R., & Grangeot-Keros, L. (2008).
Maternal varicella infection during pregnancy in a vaccinated patient. Prenatal Diagnosis,
28, 971-972. doi: 10.1002/pd.2083.
PubMed.gov (2005). Chickenpox vaccines: New drugs. A favourable risk-benefit balance in
some situations. Prescrire International, 14(77), 85-91.
Thielen, K. (2012). Exploring the group prenatal care model: A critical review of the literature.
The Journal of Perinatal Education, 21(4), 209-218, doi:
http://dx.doi.org/10.1891/1058-1243.21.4.209.
Wilson, E., Goss, M. A., Marin, M., Shields, K. E., Seward, J. F., Rasmussen,
S. A., & Sharrar, R. G. (2008). Varicella vaccine: Exposure during
pregnancy. The Journal of Infectious Diseases, 197, S178-S184. doi:
10.1086/522136.