AtRisk Groups

Nonimmune individuals are at risk of acquiring disease. Approximately 10% of the adult population born in the United Kingdom and less than 5% of adults in the United States fall into this category. Therefore, it is more likely that if chicken pox is encountered in the custodial setting, it will involve people born outside the United Kingdom (particularly South East Asia) or individuals who are immunocompromised and have lost immunity. Nonimmune pregnant women are at risk of developing complications.

Pneumonia can occur in up to 10% of pregnant women with chicken pox, and the severity is increased in later gestation (34). They can also transmit infection to the unborn baby (35). If infection is acquired in the first 20 weeks, there is a less than 3% chance of it leading to congenital Varicella syndrome. Infection in the last trimester can lead to neonatal Varicella, unless more than 7 days elapse between onset of maternal rash and delivery when antibodies have time to cross the placenta leading to either mild or inapparent infection in the newborn. In this situation, Varicella immunoglobulin (VZIG) should be administered to the baby as soon as possible after birth (36).

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