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Question 723
Obstetric infection → Viral
Classification
Question
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Duration of infectivity in maternal chickenpox
Question Stem
A pregnant woman develops uncomplicated chickenpox. She asks when she may resume contact with potentially susceptible pregnant women and neonates. What is the most appropriate advice?
Options
A
As soon as she has been afebrile for 24 hours
B
Twenty-four hours after starting oral aciclovir
C
Three days after the first vesicle appears
D
When all lesions have crusted over
E
Only 28 days after onset of the rash
Explanation
A woman with chickenpox should avoid contact with potentially susceptible individuals, including other pregnant women and neonates, until the lesions have crusted over. This usually occurs about 5 days after onset of the rash. Clinical improvement or initiation of antiviral therapy alone does not define the end of infectivity.
Option Validity
A) absence of fever does not establish that VZV is no longer infectious.
B) starting antiviral therapy does not immediately end infectivity.
C) lesions may still be active at 3 days.
E) a fixed 28-day isolation period is not required for established chickenpox.
Further Reading
RCOG Green-top Guideline No. 13, Chickenpox in Pregnancy, section 5.2.