5/9/05njm

**Q. What are the main risks for expectant mothers in day care
settings?**

A. The perinatal pathogens of concern are cytomegalovirus and parvovirus
B19. See details

The most common possible perinatal pathogens are cytomegalovirus (CMV),
(usually exposing preschool day care workers), and parvovirus B19
(usually exposing lower grades school teachers). About half of adults
are already immune to both of these viruses (but the other halves, along
with their fetuses, are of course susceptible).

See the details below, but in general pregnant women should not change
the diapers of preschoolers and should not be an \'all day in the same
room\' contact of a kid with \'slapped cheeks disease\' (parvovirus).

Pregnant women could have blood tests drawn to see if they are already
immune to CMV, parvovirus, and varicella if they are going to have
unavoidable contacts. 

**Parvovirus B19 infection during pregnancy**

<http://www.uptodateonline.com/application/topic.asp?file=viral_in/12853&type=A&selectedTitle=27~62>

**Cytomegalovirus infection in pregnancy**

<http://www.uptodateonline.com/application/topic.asp?file=viral_in/23892&type=A&selectedTitle=12~62>

There are many other potentially worrisome conditions for pregnant women
in the day care setting. Luckily these have little direct risk to the
fetus:

Hepatitis (A, B, C), acute diarrhea, conjunctivitis, adenovirus,
rhinovirus, Bordetella Pertussis, giardia, just to name a few.

**Specific pathogens**

A.) Hand/foot/mouth is not a common pathogen but is best avoided if
possible. (see FAQ below)

**FAQ: Hand foot and mouth disease in pregnancy**

**Q.** How does one manage possible exposure to hand foot and mouth
disease in pregnancy?

 **A.**  With reassurance, unless the mother has a febrile illness
during the last week of pregnancy.

[[http://www.ihs.gov/MedicalPrograms/MCH/M/documents/HFM13005.doc]{.underline}](https://mail.southcentralfoundation.com/exchweb/bin/redir.asp?URL=http://www.ihs.gov/MedicalPrograms/MCH/M/documents/HFM13005.doc)

B.) Chicken pox (varicella) can affect the fetus but most adults are
immune (95%) and most children are now being vaccinated and are immune.

**Chickenpox in pregnancy - Perinatology Corner module**

[[http://www.ihs.gov/MedicalPrograms/MCH/M/VC01.cfm]{.underline}](https://mail.southcentralfoundation.com/exchweb/bin/redir.asp?URL=http://www.ihs.gov/MedicalPrograms/MCH/M/VC01.cfm)

**Patient education resources: Varicella** (two examples below)

**Otis**

<http://www.ctispregnancy.org/pdf/chickenpox.pdf>

**Obstetrics & Gynecology Specialists, P.C**.

<http://www.obgyngroup.com/Library/preg-v101.html>

**Medformation.com**

[[http://www.medformation.com/ac/crswa.nsf/file/crs-wha-obg_torch.syndrome.caused.by.varicella-zoster.virus]{.underline}](https://mail.southcentralfoundation.com/exchweb/bin/redir.asp?URL=http://www.medformation.com/ac/crswa.nsf/file/crs-wha-obg_torch.syndrome.caused.by.varicella-zoster.virus)

C.) Impetigo and strep don\'t have untoward implications for the fetus
for congenital transmission, but Group B Strep has implications at the
time of delivery, please see

**Group B Streptococcal disease in the perinatal period: Perinatology
Corner Module**

<http://www.ihs.gov/MedicalPrograms/MCH/M/DP41.asp#top>

D.) Head lice do not affect the fetus.

Please note most IHS sites have already switched to non-lindane
containing products as first line treatment of scabies and lice and only
use lindane products as second-line therapy.** ** There are several
different of medications that can be used for the treatment of scabies
and lice.  Which medications are available at particular Indian Health
Service or Tribal sites is a decision made by the local hospital or
clinic Pharmacy and Therapeutics Committee.  Health care providers and
pharmacists are well aware of the risks and benefits of topical lotions
and shampoos containing Lindane and the need to properly education
patients and caregivers about the appropriate use of these products.

Lindane is FDA Pregnancy Class C (table)

**UpToDate: Pediculosis (Head lice)**

<http://www.uptodateonline.com/application/topic.asp?file=pri_derm/6311&type=A&selectedTitle=5~12>

**American Hospital Formulary 2005**

**[Scabicides\*]{.underline}**

Benzyl Benzoate 28% Lotion

Crotamiton 10% Cream or lotion (Eurax)

Lindane 1% lotion

Permithrin 1% Cream Rinse (Nix)

**[Pediculicides (Lice)]{.underline}**

Lindane 1% Shampoo

Malathion 0.5% lotion (Ovide)

Permithrin 5% cream (Acricin or Elimite)

Pyrethrins 0.3% with Piperonyl Butoxide 3% or 4% (RID Mousse, Tisit Blue
Gel, Tisit Shampoo, A-200 Lice Killing Shampoo, etc)

If your site has not yet reviewed this issue and made changes to your
local formulary, then go here for information.
<http://www.fda.gov/cder/drug/infopage/lindane/default.htm>

 

![](media/image1.png){width="5.021527777777778in"
height="2.9694444444444446in"}

**Other**

**2 examples of Chickenpox Patient Education Resources**

#1

**CHICKENPOX**

** **

**Chickenpox and Pregnancy**

Varicella infection or chickenpox is the second most commonly reported
infectious disease in the United States. It has a high attack among
children, therefore, most adults are immune. Prior infection confers
lifelong immunity. Occasionally latent infection may be reactivated,
resulting in cutaneous eruptions called shingles or herpes zoster.
Shingles is usually self-limited and of no perinatal significance.

 

**How contagious is chickenpox?**

Chickenpox is highly contagious and a susceptible individual has a 60%
to 90% chance of infection when coming in contact with the virus. The
incubation time is 11-21 days. Symptoms include a fever, malaise, and
very typical vesicular skin lesions which are very pruritic. The
vesicles subsequently break open, then crust over, resulting in a rash
that lasts for 7-10 days.

 

**What are the risks and complications to pregnancy?**

Varicella in the first trimester has been associated with birth defects.
These defects have included arm and leg defects,skin scars, cataracts,
and brain abnormalities. The risk appears to be low, and we have
insufficient information to give an accurate assessment of risk. High
resolution ultrasound may be able to spot some, but not all of these
changes. Infection in the second trimester may carry a higher risk of
severe maternal infection such as varicella pneumonia. Supportive
medical care can reduce the risks of complications. Sometimes treatment
with immune globulin is indicated to reduce the severity of the
infection. Severe infection can also result in premature birth..

If the mother develops chickenpox around the time of labor, the infant
may develop neonatal varicella. In other words, the infant receives the
virus from the mother, but no antibody to protect it. Since the infant
is not proficient at producing antibodies, an overwhelming, even fatal,
newborn infection may occur. Treatment of the infant with immune
globulin is indicated and life saving.

 

**What can be done for prevention? **

Most pregnant women are immune to chickenpox and exposure for them is no
risk.. If there is a question of immunity, serologic testing to
determine immunity can be done. For those individuals not immune from
past infection and not pregnant, immunization is now available. This
involves a shot followed by a booster shot sometime later.

#2

**Chickenpox (Varicella) During Pregnancy**

**What is chickenpox (varicella)?**

Chickenpox is a viral infection that a baby can get from the mother
before or during birth. If a baby becomes infected, it can harm the
baby.

Chickenpox is also called varicella.

**How does it occur?**

Chickenpox is caused by a virus called Varicella zoster. The virus is
spread by through the air by infected people when they sneeze or cough.
The disease also spreads through contact with infected chickenpox
blisters.

If you have chickenpox when you are pregnant, the virus can infect the
baby. It is very dangerous to the baby if you get the disease early in
pregnancy and close to the time of delivery.

If you have already had chickenpox, you are probably immune. This means
that if you are exposed to chickenpox again, your body can fight off the
infection and you will not have chickenpox again. However, once you have
had chickenpox, the virus stays in your body and can later cause another
disease called shingles, or herpes zoster. If you have shingles while
you are pregnant, the disease will not harm the baby.

**What are the symptoms?**

Chickenpox is contagious for several days before symptoms appear.
Symptoms usually appear 10 to 21 days after exposure to the virus.

Symptoms of chickenpox include:

-   itchy, blisterlike spots on the skin, which later break open and
    form a crust (scab)

-   tiredness

-   fever

-   aches and pains.

When you have shingles, a group of sores forms on the skin. The sores
may be very painful, but there are few other symptoms.

A newborn exposed to chickenpox during pregnancy may have such birth
defects as deformed arms and legs, scars on the skin, eye problems,
brain damage, or a small brain. In some cases the baby may die.

**How is it diagnosed?**

Your health care provider will ask about your symptoms and examine you.
You may have a blood test. Currently there is no sure way of determining
whether the baby has been infected until after the baby is born.

**How is it treated?**

There are no reliable treatments if you have chickenpox while you are
pregnant. If you develop life-threatening complications from chickenpox,
you may be hospitalized and given antiviral medicine. There is also no
specific treatment for babies who are born infected with chickenpox.

**How long do the effects last?**

If the baby is infected with the virus early during your pregnancy or
around the time of delivery, the baby may have severe problems. Some of
these problems may be lifelong. Possible problems include:

-   skin scarring

-   weak arms and legs

-   eye problems.

If you have chickenpox within 5 days before delivery or within 2 days
after your child\'s birth, the baby may get very sick and may die.

**What can be done to prevent chickenpox?**

If you are pregnant, avoid contact with children with chickenpox unless
you know you are immune. If you aren\'t immune and you\'re exposed to
the virus, you can be treated with a shot of varicella zoster immune
globulin (VZIG) while you are pregnant.

If you develop a chickenpox rash 5 days before or 2 days after the birth
of your baby, the baby may be given VZIG within 72 hours of birth. The
vaccine might prevent the baby from becoming severely infected.