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Shingles in pregnancy - that's how dangerous it is!

introduction

Shingles, also called zoster, is triggered by the varicella-zoster virus. This virus is also responsible for causing chickenpox disease, which usually occurs in childhood. The rate of infection of the population with this pathogen, that is, how many percent are infected with the virus, is regionally up to 90% after childhood. Chickenpox (varicella) is not a dangerous disease for children. However, an outbreak is a sign that the virus has invaded the body and remains in the host until the end of its life. The viruses settle in nerve cells and can be reactivated in a weakening of the immune system - a shingles breaks out.

The role of shingles in an expectant mother depends on the immune status of the pregnant woman. Own shingles or contact with ill persons can be completely harmless for the mother and the unborn child, but if there is no immunization of the mother, they can be very dangerous for both.

Is it dangerous?

If the pregnant woman becomes infected at an early stage of pregnancy, this can lead to damage in the development of the fetus: the skin, extremities and brain can be affected.

Almost all pregnant women are immune to varicella-zoster virus, if they have had childhood chickenpox infection or if they have been vaccinated against varicella. If a shingles occurs during pregnancy, this is a sign of a reactivation of the virus from the nerve root and not a sign of a new infection. This reactivation is usually not dangerous for the child.
However, if there is no adequate immune system, a primary infection with varicella-zoster virus may occur during pregnancy. Both chickenpox and shingles can not only be dangerous to the mother, but can also be very harmful to the unborn child. In adulthood, complications rarely occur but are possible in principle.
There is a risk of pneumonia and otitis, inflammation of the kidneys (nephritis) but also involvement of the nervous system in the form of meningoencephalitis (inflammation of the brain and its meninges) or neuritis.

In some cases (1 - 2%), fetal varicella syndrome may develop in the unborn child if the mother becomes infected at the beginning of the pregnancy.
The syndrome involves damaging changes in the skin, limb and brain developmental deficits and unhealthily low birth weight.
Often, the infection leads to miscarriage in the early phase of pregnancy ( abortion ). For most of the pregnancy the child is protected from the virus by the mother's immune system.

Infection around the birth becomes critical. In this period, the nest protection, which is ensured by maternal antibodies is missing.
If signs of varicella infection are detected at birth or shortly thereafter, antivirals must be given prophylactically.

If such an infection has broken out, the mortality rate among newborns is 30% - this explains the efforts to immunize against the varicella zoster virus as part of the sixfold vaccine.

General transmission and illness

Ersterkrankung: The varicella zoster virus is very easily transmitted in existing chickenpox disease. The viruses are highly contagious and often trigger small epidemics when, for example, the disease has broken out in a kindergarten. The pathogens are transmitted via droplet infection, which allows for very easy infection and spread. For children, chickenpox is a harmless disease, which disappears through spontaneous healing, that is defended by the own body. Against varicella (chickenpox) immunity is formed after a single outbreak of each child, which excludes a repeated illness. However, the viruses do not disappear: in the so-called viral ascension, the pathogens migrate along the nerve channels down to the deep-lying nerve nodes and remain there for life. They can trigger a second infection in the form of shingles or remain there forever as a dumb infection.

Secondary disease: After the initial infection, there is a period of rest or latency followed by no signs of a virus attack. By weakening the immune system, the remaining viruses can multiply again and trigger another noticeable infection - the shingles. The blueprints for the antibodies to the virus are stored for life and can be accessed quickly upon reactivation. This leads to a sudden mass production of these, whereby a spread of the virus is largely prevented. Only very rarely does it come to a third disease, which otherwise would also manifest as shingles.

Shingles in pregnancy in terms of immune status

The contents of the fluid-filled vesicles are infectious. If the pregnant woman comes into contact with it, it can be dangerous for both the expectant mother and the fetus.

If a pregnant woman is suffering from shingles, it means that she is already immune to the varicella-zoster virus. This can be done by having undergone chickenpox disease or a vaccine. There is no increased risk for the child or the expectant mother. Since zoster breaks out only in immunosuppressed patients, ie people with a weakened immune system, various complications can occur, as with any shingles. But even these are rare and therefore mostly irrelevant, as far as the health of the child is concerned. Contact with persons who currently suffer from shingles is equally harmless. Infection by the virus already present in one's own body is unlikely, since this is only possible through direct contact with the wound fluid of the blisters. And even with contagion, it comes again to the automatic defense of the pathogens by the rapid activation of the immune system.

Since people who have not yet had contact with the varicella-zoster virus can not develop shingles, the connection between pregnancy and shingles must be made by a third person. Some women are not yet immune to the virus in their pregnancy, which is often surprising in such cases - they have neither been vaccinated nor have they survived a disease. Now the shingles begin to be dangerous: if the pregnant woman comes into contact with the contents of the fluid-filled vesicles, she can become infected - not with zoster, but with varicella, the chicken pox. Chickenpox can be dangerous to both adults and fetuses, causing serious complications.

Symptoms of shingles in pregnancy

A shingles is the same in pregnancy as in other people dar. Since the virus in certain nerve nodes, the symptoms occur only in the corresponding dermatomes in appearance. These are skin areas, which are sensitively supplied by the nerves, which have their origin in the affected nerve knot. In the diseased dermatome there is initially an unpleasant over-sensitivity or hypersensitivity of the skin. A few days later, a rash develops relatively quickly, which is characterized by its blistering and unusually severe limitation. A general feeling of sickness occurs, which is accompanied by fever and headache. It can lead to lymph node swelling in the area of ​​the rash. If a cranial nerve ganglion, ie a nerve node, which is connected to the hearing or optic nerve, for example, has more specific symptoms, such as tinnitus or tears.

Treatment of shingles in pregnancy

Mostly, younger women tend to get pregnant. In patients under the age of 50, anti-viral therapy must be carefully discussed as it is not needed in most cases. Only painkillers ( analgesics ) can be taken in case of particularly severe pain in the area of ​​the rash. It is also important to pay attention to the side effects during pregnancy, with paracetamol being the safest analgesic here. For the antiviral treatment of shingles, various drugs have been developed. Aciclovir or Zovirax, but also famciclovir, valacyclovir or brivudin are traditionally prescribed. The use of antivirals can alleviate the pain and make the use of analgesics unnecessary. Pregnant women who have a negative immune status and come into contact with viruses or even become ill must always be treated with antiviral therapy. In this way, an attempt is made to avert an infection of the unborn child.

What is the risk of transmission during pregnancy to my baby?

Usually a shingles during pregnancy is safe for the baby. A shingles will cause another infection with the varicella-zoster virus. Since the body has after the first contact (usually by the chickenpox) already formed antibodies against this virus. These antibodies cross the placenta into the unborn child's blood to protect it from infection. The situation is different when a pregnant woman gets chickenpox. In this case, it is a first contact with the varicella-zoster virus. This can lead to malformations in the unborn child (varicella syndrome). A shingles does not hurt the baby.

I have shingles and want to get pregnant - should I wait?

Yes! If you have a shingles infection (= infection with the varicella-zoster virus) you usually have to take different medications. These are on the one hand strong analgesics and on the other a drug against the virus (usually acyclovir). There are several publications on acyclovir intake during pregnancy. Here one could prove no increased risk for malformations in the baby. However, shingles is usually a disease that heals quickly (3-5 weeks) with the right treatment. Therefore, one would always recommend from a medical point of view to wait.

Dangers in the workplace / school

Teachers and teachers are constantly and excessively exposed to the diseases of children and adolescents. Not infrequently it happens that this professional group is affected by the seasonal circulating diseases. So it is synonymous with chickenpox in the absence of immunization of the staff. A particularly great danger here is for pregnant women who are not immune to the virus or do not know about their own immune status. In case of an outbreak of varicella at school, it is in this case the task of the school management to arrange an occupational medical examination. This should clarify the immune status of the staff in order to reduce existing risks. As long as there is no information to guarantee a safe stay for the pregnant teacher, she has to leave the workplace. Temporarily limited possibilities are a secondment to another school institution, the transfer of the activities out of the classroom or a temporary job ban.

Prophylaxis of shingles in pregnancy

At the latest before pregnancy a vaccination should be carried out, so that a danger of both the pregnant woman and the child is prevented.

The vaccination of children against the varicella zoster virus is officially recommended by the Robert Koch Institute.
The immunization consisting of two partial vaccinations avoids infection with chickenpox and the emergence of a very dangerous situation - a negative immune status during pregnancy.
At the latest before a pregnancy, the vaccination should urgently be carried out - for the benefit of the mother, as well as the child.

If there was a risk of exposure to viruses, people without adequate immunization would be able to receive immunoglobulins. This form of active immunization protects directly against the virus and is used in newborns (if infected 7 days before or 2 days after birth) and in pregnant women (up to 2 days after contact).

Shingles and breastfeeding - is that possible?

Pregnancy and childbirth are associated with great efforts for the mother's body. A mild immune deficiency can be the result, which makes the outbreak of a shingles, already prevalent chickenpox infection, more likely. This is why it is not uncommon for mothers, who are just beginning to breast feed their newborn, to suffer from the onset of shingles. Basically, however, you do not have to worry about a slight course of the disease. As a precaution, the affected skin area should be covered before breastfeeding, as only the fluid contained in the blisters is contagious. If the course is more severe, doctors may recommend discontinuing breastfeeding to minimize the risk of infection to the baby.

Homeopathy in case of shingles in pregnancy

The treatment of shingles is based on two pillars. For one, this is the pain therapy. On the other hand, medicines must be taken for the virus. A homeopathic treatment that complements conventional medicine may be useful. The proven homeopathic remedies include Mezereum, Rhus toxicodendron, Ranunculus bulbosus and Arsenicum album. However, which drug to take in which dosage should be discussed with an experienced homeopath.

Home remedy for a shingles during pregnancy

If you have a shingles disease you should definitely take painkillers and an antiviral (= a drug against the virus). Supportive, you can also apply home remedies. This is usually a symptomatic therapy. Some apply natural yoghurt on the affected skin. This relieves the itching. Cabbage rolls are a good way to dry out the bubbles. In addition, it makes sense to strengthen your own immune system. For this purpose, preparations with vitamin C and zinc are suitable.

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