Last update: Feb. 11, 2020

Varicella-Zoster virus (VZV) maternal infection

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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After causing chickenpox, the Varicella-Zoster virus (VZV) resides for life in the nerve cells of the anterior horn of the spinal cord and can, months or years later, reactivate and cause a zoster or shingles.

Chickenpox is contagious from 1 to 3 days before the rash appears (Karabayir 2015, Daley 2008), hence the futility of isolating the infant from his newly diagnosed mother.
There is no reason to separate the mother and infant or interrupt breastfeeding (Karabayir 2015, Sendelbach 2012).

VZV DNA has been found in breastmilk (Yoshida 1992), but it has not been possible to be cultivated or to reliably demonstrate the transmission of the disease through breastmilk (Lawrence 2017 p458).

If maternal chickenpox appears from 5 days before delivery (the newborn will have received a low rate of antibodies through the placenta) until 2 days after delivery (the newborn has still been able to receive the virus through the placenta), the newborn can suffer severe chickenpox, so some authors (Lawrence 2017 p458, SoB 2012) recommend separating the mother from the newborn until she stops being contagious (when all the lesions are in the crust phase and no new ones appear, about 5 to 6 days after the onset of the rash).
Other authors do not see separation as necessary and recommend the administration to the newborn of a dose of anti-varicella-zoster immunogammaglobulin (Shrim 2018, Red Book 2012) or, failing that, standard immunoglobulin (Sendelbach 2012) or oral acyclovir (Karabayir 2015, Daley 2008), take prophylactic measures to avoid contact with the lesions and monitor the newborn.
In hospital, joint admission into an isolation room with negative air pressure is indicated (Karabayir 2015).

Postnatal chickenpox after the first 3 weeks is usually not serious, especially if the mother has previously had chickenpox, since she will have transmitted antibodies transplacentally during pregnancy.

In an immunocompromised infant, the administration of anti-varicella-zoster immunogammaglobulin is a priority.

A reduction of the duration of lesions in an adult and a child treated with the oral administration of breastmilk (Verd 2012) has been reported.

Breastfeeding mothers who are seronegative for the varicella-zoster virus should be vaccinated for chickenpox (Daley 2008); the chickenpox vaccine virus has not been found in breastmilk (Bohlke 2003).

In the case of a zoster or shingles, hygienic measures (hand washing) should be taken and contact with lesions should be avoided. Breastfeeding would be contraindicated if the zoster had spread to the chest area. An infant refused to breastfeed from a breast where a zoster appeared 5 days later (Mathers 2007). Zosters can cause nonpuerperal galactorrhea in the affected breast (Bhattacharya 1976).


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References

  1. Shrim A, Koren G, Yudin MH, Farine D. No. 274-Management of Varicella Infection (Chickenpox) in Pregnancy. J Obstet Gynaecol Can. 2018 Aug;40(8):e652-e657. Abstract
  2. Lawrence RA, Lawrence RM. Breastfeeding. A guide for the medical profession. Eighth Edition. Philadelphia: Elsevier; 2016
  3. Karabayir N, Yaşa B, Gökçay G. Chickenpox infection during lactation. Breastfeed Med. 2015 Jan-Feb;10(1):71-2. Abstract
  4. Sendelbach DM, Sanchez PJ. Varicella, influenza: not necessary to separate mother and infant. Pediatrics. 2012 Aug;130(2):e464; author reply 465-6. Abstract
  5. Lanari M, Sogno Valin P, Natale F, Capretti MG, Serra L. Human milk, a concrete risk for infection? J Matern Fetal Neonatal Med. 2012 Abstract
  6. Verd S, López E. Management of chickenpox with frozen mother's milk. J Altern Complement Med. 2012 Aug;18(8):808-10. Abstract
  7. Red Book. Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, Red Book 2012
  8. SoB - Section on Breastfeeding.. Breastfeeding and the use of human milk. Pediatrics. 2012 Mar;129(3):e827-41. Abstract
  9. Daley AJ, Thorpe S, Garland SM. Varicella and the pregnant woman: prevention and management. Aust N Z J Obstet Gynaecol. 2008 Feb;48(1):26-33. Abstract
  10. Mathers LJ, Mathers RA, Brotherton DR. Herpes zoster in the T4 dermatome: a possible cause of breastfeeding strike. J Hum Lact. 2007 Feb;23(1):70-1. Abstract
  11. Bohlke K, Galil K, Jackson LA, Schmid DS, Starkovich P, Loparev VN, Seward JF. Postpartum varicella vaccination: is the vaccine virus excreted in breast milk? Obstet Gynecol. 2003 Nov;102(5 Pt 1):970-7. Abstract
  12. Yoshida M, Yamagami N, Tezuka T, Hondo R. Case report: detection of varicella-zoster virus DNA in maternal breast milk. J Med Virol. 1992 Oct;38(2):108-10. Abstract
  13. Bhattacharya SK, Girgla HS. Lactation associated with herpes zoster pectoralis. J Trop Med Hyg. 1976 May;79(5):94-6. Abstract

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