Chickenpox vaccine in pregnancy

What women should know about chickenpox, vaccination, and pregnancy | Your Pregnancy Matters

Chickenpox may not be as common as it once was, but it can still present a risk to pregnant women who have not had the virus or the vaccine.

Before a vaccine became available in 1995, chickenpox was almost considered a childhood rite of passage. But while many people have tales of chickenpox parties – purposely infecting kids to “get it out of the way” – it’s important to remember this isn’t an entirely harmless disease. In the early 1990s, up to 13,000 people were hospitalized due to the virus and 100 to 150 people died each year.

It’s estimated that in the U.S., more than 3.5 million cases of chickenpox, 9,000 hospitalizations, and 100 deaths are prevented by the chickenpox vaccine each year. Chickenpox is still with us, and it can have devastating consequences, particularly for pregnant women and their babies.

In 2021, a woman in Illinois contracted chickenpox early in pregnancy and gave birth to a premature baby who died shortly after delivery. It was confirmed the baby had congenital varicella syndrome – chickenpox in utero.

The Centers for Disease Control and Prevention (CDC) recommends that all adults be assessed for immunity to chickenpox. So, don’t be surprised if your healthcare provider asks you about chickenpox if you are pregnant or are thinking about becoming pregnant. As always, we just want to keep you and your baby as safe and healthy as possible.

Potential complications of chickenpox in pregnancy

Chickenpox is a highly contagious disease caused by the varicella-zoster virus. Chickenpox generally causes an itchy, blister-like rash. But pregnant women are at risk for more serious complications, particularly pneumonia, because changes in the immune system during pregnancy make them more susceptible to infection.

Pregnant women also can pass the virus to their babies. Much like rubella or Zika, if a woman gets chickenpox in her first or early second trimester, the virus can cause birth defects. Symptoms of congenital varicella syndrome can include:

Arm and leg abnormalities
Eye abnormalities
Low birth weight
Microcephaly, a condition in which a baby’s head is significantly smaller than expected
Premature birth
Scarring on the skin from chickenpox lesions

If a woman develops chickenpox shortly before going into labor, the newborn is at risk of being born with chickenpox. While such complications are rare, it’s important to take steps to prevent them, to be aware of their potential, and be on the lookout for chickenpox during pregnancy.

Are you at risk for chickenpox?

While the chickenpox vaccine has been around since 1995, there is still a population of women who are susceptible to the disease. This includes women who:

Didn’t have access to the vaccine, perhaps because they come from a country without a robust childhood immunization program
Were not vaccinated due to their parents’ choice
Thought they had chickenpox as children but actually didn’t

For the last several decades, about 90% of children have gotten vaccinated against chickenpox, which means 1 in 10 of our younger pregnant patients may not be immune to the virus.

If you don’t have documentation of being diagnosed with or vaccinated against chickenpox as a child, your healthcare provider may suggest blood testing to determine whether you have antibodies to the varicella-zoster virus. If you don’t, we recommend you get two doses of the chickenpox vaccine before pregnancy or after delivery.

If you were born before 1980, you are presumed to be immune to chickenpox due to the number of circulating viruses when you were young. However, women who are immunocompromised, pregnant, or a healthcare provider should get tested for antibodies due to increased risks of getting or spreading the virus if they do not have good records of having received the vaccine.

Related reading: Why we discuss vaccines, maternal health during pregnancy

Can you get the chickenpox vaccine during pregnancy?

The chickenpox vaccine contains a live attenuated (inactive) virus – similar to the measles, mumps, and rubella vaccine (MMR) – so you cannot get vaccinated if you are currently pregnant. However, we will strongly suggest you get a first dose of the vaccine after you give birth to protect you, your baby, and future pregnancies. The vaccine is safe for breastfeeding women and babies.

If you know you haven’t had chickenpox or the vaccine and you’re thinking about having a baby, talk to your healthcare provider about getting and finishing the vaccine series at least three months before you start trying to get pregnant. This is the best way to protect yourself and your baby from chickenpox.

Related reading: Which prenatal vitamins should I take?

One more note: The varicella vaccine also potentially protects you from shingles, another painful adult virus. Shingles is a reactivation of the chickenpox virus, and it can cause a painful rash along with headache, chills, upset stomach, and eye problems. If you’re vaccinated against chickenpox and never get the disease, you’re protected against shingles as well.

Chickenpox is not as common as it used to be, but it’s still around – and it’s still potentially dangerous. The good news is there are ways we can protect ourselves and our children. Talk with your healthcare provider about your chickenpox history and whether you should get the varicella vaccine before or after pregnancy.

For more information about the varicella vaccine and whether you need it, call 214-645-8300 or request an appointment online.

Chickenpox during pregnancy | March of Dimes

Chickenpox is an infection caused by a virus. If you get it during pregnancy, it can cause problems for you and your baby.

You’re probably safe from chickenpox if you’ve had it before or if you’ve had the vaccine. Both of these help make you immune to chickenpox.

Talk to your health care provider to make sure you’re immune to chickenpox before you get pregnant or early in pregnancy.

What is chickenpox?

Chickenpox is an infection caused by a virus called the varicella-zoster virus. Chickenpox used to be a common infection, especially in children under age 12. It’s less common now because a vaccine is available to help prevent it. A vaccine is medicine that makes you immune to certain diseases.

Chickenpox usually isn’t dangerous in children. But some people are at higher risk for complications from chickenpox, including pregnant people and newborns.

The chances of getting chickenpox during pregnancy are low. Most pregnant people are immune to chickenpox because they’ve had the infection before or they’ve been vaccinated against it. Talk with your health care provider to make sure you’re immune to chickenpox before you get pregnant or early in pregnancy.

What are the symptoms of chickenpox?

Chickenpox causes an itchy rash that turns into blisters and then scabs. The rash usually starts on the chest, back, and face and spreads all over the body. The rash appears about 10 to 21 days after you’re infected and can last 5 to 10 days.

Other symptoms can include fever, headache, being tired and not being hungry. These symptoms may appear 1 to 2 days before the rash.

How does chickenpox spread?

If you’re not immune to chickenpox, you can get it easily by being in contact with someone who has the infection. A person with chickenpox can spread the infection starting about 2 days before the rash appears and until all the blisters are covered by scabs. It can spread through:

Droplets in the air when someone with chickenpox coughs or sneezes
The saliva (spit) or mucus of someone with chickenpox
Touching a chickenpox rash

If you’re not immune to chickenpox, you can also get it through close contact with someone who has shingles. Shingles is an infection caused by the same virus that causes chickenpox. If you’ve had chickenpox before, the virus stays in your body and can come back later as shingles. Shingles causes a painful rash on one side of the face or body. People with shingles can spread chickenpox to other people, but they can’t spread shingles to other people.

Can chickenpox during pregnancy cause problems for you and your baby?

Yes. Having chickenpox during pregnancy can increase your risk of getting pneumonia and can even be life-threatening. Pneumonia is a lung infection that can be very serious. The symptoms of pneumonia include cough, chest pain when you breathe or cough, fever, fatigue (being very tired) and shortness of breath.

Chickenpox during pregnancy can cause these problems for your baby:

If you get chickenpox during the first 20 weeks of pregnancy, your baby may have an increased risk for congenital varicella syndrome. This is a rare group of serious birth defects that can cause:

Scars on the skin
Problems with the arms, legs, brain and eyes
Gastrointestinal complications
Low birthweight. This is when a baby is born weighing less than 5 pounds, 8 ounces.

If you get chickenpox between 2 weeks before birth to 2 weeks after birth, you can pass the infection to your baby. If this happens, the infection in your baby usually is mild.

If you get chickenpox immediately before or right after birth (5 days before birth to 2 days after birth), your baby may have an increased risk for a serious infection called neonatal varicella. This infection can be life-threatening, but treatment is helping more babies survive.

If you have a preterm birth, your newborn may be at higher risk of complications from chickenpox. Preterm birth is birth that happens before 37 weeks of pregnancy.

Can you prevent chickenpox?

Yes. The varicella vaccine can protect you from chickenpox. In fact, this vaccine prevents more than 3.5 million cases of chickenpox each year. But the vaccine is not safe to get during pregnancy.

Talk to your provider if you’re pregnant or planning a pregnancy and you’re not sure if you've had the vaccine or had chickenpox before. Your provider can do a blood test to find out if you’re immune.

If you aren’t immune, how can you protect yourself from chickenpox during pregnancy?

If you’re planning a pregnancy and the blood test shows you’re not immune, get vaccinated. You get the vaccine in two doses. It’s best to wait 3 months after the second dose before getting pregnant.

If you’re already pregnant, don’t get the vaccine until after you give birth. In the meantime, stay away from anyone who has chickenpox or shingles.

Tell your provider right away if you’re pregnant and you come into contact with someone who has chickenpox. Your provider can treat you with medicine that has chickenpox antibodies. Antibodies help the body fight infections. It’s important to get treatment within 10 days after you’ve come into contact with chickenpox to help prevent the infection or make it less serious. And tell your provider if you come in contact with a person who has shingles. Your provider can decide if you need treatment to help prevent you from getting infected.

How is chickenpox diagnosed?

Your provider can tell you if you have chickenpox by doing a physical exam. Your provider may do a blood test or take a swab of the rash and send it to a laboratory for testing to be sure it’s chickenpox.

How is chickenpox treated during pregnancy?

If you get chickenpox during pregnancy, your provider may give you an antiviral medicine such as acyclovir or valacyclovir. An antiviral is a medicine to treat infections caused by viruses. These medicines are safe to use during pregnancy. They work best when given within 24 hours of the chickenpox rash appearing.

If you have chickenpox and develop signs or symptoms of pneumonia, your provider may want you to stay in the hospital and be treated with acyclovir through an IV (through a needle into a vein).

If you get chickenpox during pregnancy, how is your baby treated after birth?

If you have chickenpox during pregnancy, your baby’s provider may treat your baby right after birth with medicine that has chickenpox antibodies. The medicine can help prevent chickenpox in your baby or make it less dangerous. If your baby gets chickenpox in the 2 weeks after birth, your baby may also be treated with antiviral medicine.

Can you get chickenpox from someone who has gotten the vaccine?

Yes, but it’s rare. If a vaccinated person gets chickenpox, they can still spread it to others. But the vaccine is more than 90 percent effective at preventing chickenpox. Providers recommend that children get their first dose of the varicella vaccine at 12 to 15 months of age and the second dose at age 4 to 6.

Last reviewed: May 2021

Chickenpox vaccination

02. Chickenpox vaccination

The normative documentation of the Russian Federation and international recommendations were used to compile the answers.

Prevention of chicken pox is not a topic for distance consultation. The best solution is to contact a full-time specialist.

Why should you get vaccinated against chickenpox? Maybe it's better to get sick?

This is a dangerous delusion that has developed from the situation of the past years, when there was no vaccine against chickenpox in the USSR and Russia, and it was impossible to effectively prevent the disease. At the same time, varicella vaccines were developed abroad in the mid-70s, recommended for use in individual countries since the mid-80s, and have been widely used since the beginning of 90-s.

Chickenpox is not a harmless disease, a certain percentage of various complications are recorded, including those requiring subsequent hospitalization. Moreover, this is observed in children under the age of 15 with normal immunity. With age, the risk of complications and mortality can increase up to 50%, provided that the affected adult did not have chickenpox before or was not vaccinated. Often, secondary skin infection, pneumonia, varicella encephalitis, cerebellar ataxia, damage to the facial nerve, and eye damage are recorded as complications. Mortality averages 1 in 60,000.

In addition, in 10-20% of those who have been ill, the varicella-zoster virus remains in the nerve ganglia for life and subsequently causes another disease that can manifest itself at an older age - herpes zoster or herpes ( Herpes zoster ). Herpes zoster is characterized by prolonged and excruciating neuralgic pains, and also has a number of complications in the form of lesions of the nervous system and internal organs - paralysis, visual impairment. People with herpes zoster can be a source of chickenpox infection.

Chickenpox can also cause damage to the fetus or newborn when a woman develops chickenpox in the first 20 weeks of pregnancy or in the last days before delivery.

Vaccination against varicella in children and adults provides an opportunity to prevent these consequences.

What varicella vaccines are available in Russia?

Two vaccines against varicella are registered in the Russian Federation.

Is it possible to get chickenpox from the chickenpox vaccine?

No. The vaccine uses a weakened virus.

There is a small risk of developing a post-vaccination infection in people with severe immunodeficiency (oncohematology, etc.), but in any case, vaccination of these people against chickenpox in developed countries is carried out as a standard procedure for preventing severe chickenpox.

At what age can you be vaccinated against varicella and how long does immunity last after vaccination?

According to the instructions for use, children can be vaccinated against varicella from the age of 12 months.

Having been vaccinated against chickenpox, is there a guarantee that the child will not get sick throughout his life?

100% - no. Cases of varicella-zoster virus infection in vaccinated individuals are estimated to be very rare, but mild to very mild varicella has been reported in this case, both in terms of general reactions (fever) and skin rashes ( a single number of emerging vesicles or their complete absence).

How soon after vaccination is the child no longer afraid to contact with chickenpox patients?

Immunity in vaccinated individuals begins to develop from the first day and is usually completed after 6 weeks.

Are there any reasons why varicella vaccination is contraindicated?

1). Pregnancy.

2). Primary and secondary immunodeficiency with a leukocyte level of less than 1200 cells / μl (for example, acute myeloid leukemia, T-cell leukemia, or malignant lymphoma).

A list of contraindications (temporary and permanent) is given in the instructions for the specific varicella vaccine.

For example:

Persons with elevated body temperature (from 37.5ºС and above, when measured in the armpit) - until the temperature and clinical picture normalize.

Persons with acute illness - up to 2-4 weeks after recovery. And in mild SARS, acute intestinal diseases, etc. - until the temperature returns to normal

In severe acute diseases of the nervous system, for example, meningococcal meningitis - until the expiration of a longer period (up to 6 months from the onset of the disease) after stabilization of residual changes.

During an exacerbation of a chronic disease before the onset of a complete or maximum achievable remission, including against the background of maintenance treatment (except immunosuppressive).

For upcoming elective surgery within a month before the date of surgery.

When undergoing immunosuppressive therapy.

What are the adverse reactions after varicella vaccines?

Possible reactions are described in the instructions for use of the specific vaccine. Expected local reactions are pain or redness at the injection site; general reactions may include fever and malaise. Occasionally, healthy children and adults may develop a rash 1-3 weeks after vaccination. These symptoms usually disappear on their own within a few days.

As with any drug or food product, the introduction of vaccines can very rarely be accompanied by an allergic reaction.

How soon can pregnancy be planned after varicella vaccination?

After varicella vaccination, pregnancy should be avoided for 3 months.

If an adult did not have chickenpox as a child, should they be vaccinated?

Yes. Complications and mortality from chickenpox disease are the most common cause in adults than in children, the incidence of adults is 5% of cases, but it is in adults that deaths account for 35% (in adults, the fatality rate is 25 times higher than in children). It is also recommended to vaccinate women planning pregnancy and people in contact with sick immunodeficiency states (so as not to become a source of infection).

Conventional varicella vaccines are not used to vaccinate the elderly. In North America, a special ostavax vaccine is used to vaccinate the elderly against herpes zoster ( Herpes zoster ) (not available in the Russian Federation).

Can varicella vaccine be combined on the same day with other vaccines during routine vaccination?

Yes, except for the BCG vaccine. With routine vaccination on the same day as the varicella vaccine, you can administer any vaccine (in different places and with different syringes), excluding the BCG vaccine.

Unless the varicella vaccine was given at the same time as other vaccines, inactivated (killed) vaccines can usually be given at any time, and other live vaccines at least one month later.

Please refer to the instructions for use of specific vaccines for further information.

What is the emergency prophylaxis after contact with a chickenpox patient?

Emergency vaccination in previously unill and unvaccinated persons may be effective within usually 72 hours after exposure (sometimes up to 96 hours).

But even after more time, it is recommended to be vaccinated, because in this case the chickenpox disease proceeds in a milder form, both in terms of general reactions (fever) and in relation to skin rashes (a single number of vesicles that occur).

If more than 72-96 hours have passed since exposure to a person with chickenpox, would it make sense to get vaccinated today?

Yes. Although this vaccine will most likely be useless as an emergency vaccination, it can be given as a routine vaccination to prevent the disease in the future (if you are not infected now). The next contact with a person with chickenpox can happen at any time. Even if infection has occurred, the vaccination does not worsen the disease process, and theoretically it can even alleviate it.

Can I get vaccinated if I have been in contact with someone who has an infectious disease?

It is possible, it is not a withdrawal.

Guidelines MU 3.3.1.1123-02 "Monitoring of post-vaccination complications and their prevention" (approved by the Chief State Sanitary Doctor of the Russian Federation on May 26, 2002)

“Clause 9.10. Vaccination of people who had contact with an infectious patient against the background of its possible incubation, it should not cause concern. In light of this, the withdrawal from vaccination of a child who could be in the incubation period of the infection cannot be considered justified. Taking into account the relevant WHO recommendation, Order of the Ministry of Health of Russia N 375 does not include contact with an infectious patient among the contraindications for vaccination.

If during the period after vaccination there was contact with some sick person and developed, for example, SARS, will this affect the effectiveness and safety of vaccination?

It won't affect. ARVI in the post-vaccination period does not affect the formation of immunity. Vaccination against chickenpox also does not affect the severity of SARS.

How long after tuberculin test (Mantoux test) can I vaccinate against varicella?

This can be done already on the day of checking the Mantoux reaction.

If the varicella vaccine is given first and then tuberculin tests are planned, how often should they be given?

After vaccination, the Mantoux reaction can be done no earlier than 1 month later.

Is it necessary to conduct a laboratory examination after vaccination against chickenpox to determine whether protective antibodies have been developed or not?

This is not necessary, as standard laboratory tests detect the presence of antibodies not to the vaccine component, but only to the wild varicella virus.

According to special scientific studies, chickenpox vaccines are highly immunogenic.

When can I travel to hot countries and bask in the sun after vaccinating against chickenpox?

There are no restrictions.

Is it possible to get chickenpox again if you have had it before?

Scientific publications say that recurrent cases of chickenpox have been reported in persons after bone marrow transplantation, and sometimes in other people with severe immunodeficiency.

Should I get vaccinated if I am trying to get pregnant?

Vaccines help protect against certain types of diseases by using weakened or dead bacteria and viruses that are given to the body through injections, nasal sprays, or tablets. Vaccines usually contain a small portion of a bacterium or virus in a softened but viable or dead form. For example, the varicella (chickenpox) vaccine is an injection that contains highly attenuated particles of the chickenpox virus. The virus in a vaccine is usually not strong enough to cause an infection, but it can stimulate the immune system to produce antibodies that can protect a person from future infections.

Why should I think about vaccinations if I'm interested in the question of conception?

Vaccination is designed to help prevent serious complications during the period of bearing a baby. For example, if an unvaccinated mother becomes infected with rubella during pregnancy, it can lead to miscarriage or serious birth defects in the unborn child. A common viral infection like the flu often also negatively affects both the mother and the baby. Getting the flu during pregnancy can lead to miscarriage, premature birth, pneumonia in the mother-to-be, or even death. Vaccination against these and other infections before pregnancy can protect the mother-to-be from getting the infection or prevent its serious consequences.

When is the best time to get vaccinated?

Some types of vaccination, such as hepatitis A or B, as well as the influenza virus, can be carried out even during pregnancy. Keep in mind that chickenpox or rubella vaccines contain weakened but live versions of viruses/bacteria and are best given one to three months before pregnancy. In any case, we advise you to consult with your doctor to make the right decision about the necessary vaccination.

What are the side effects of vaccination?

Most people experience little to no side effects after vaccination. However, sometimes after the vaccine is given, the patient may experience redness or swelling of the skin or muscle pain at the site of the intramuscular injection.

If you are allergic to certain drugs, certain foods, or other substances, discuss this with your doctor before getting vaccinated, as some vaccines may contain them.

I am taking corticosteroids to treat a medical condition that I have. Can I get vaccinated in this case?

Some vaccinations are not recommended for patients taking steroids or other drugs that affect the immune system. Be sure to discuss your situation with your doctor individually. At a consultation with a specialist, you must list all the drugs that you took before deciding to get vaccinated.

I am planning a trip to Asia/Africa soon and am trying to get pregnant at the same time. Should I get vaccinated?

Some diseases, such as jaundice or malaria, are more common outside of Russia. Certain viruses and infections can cause serious health problems for anyone, especially pregnant women. Some of the exotic disease vaccines are safe for use by pregnant women and women who are trying to get pregnant. But the advisability of vaccinations should definitely be discussed with a doctor who deals with the issue of vaccination of travelers.

Can vaccines cause autism or birth defects?

Currently, there is no medical evidence that vaccination can cause autism or other diseases in children whose mothers were vaccinated. Rather, on the contrary, the lack of proper vaccination can lead to serious health problems for both the mother and the child.