Chickenpox (varicella) in pregnant adults who are immunocompetent

Chickenpox (varicella) is caused by a primary infection with varicella zoster virus (VZV). Management of chickenpox depends on the patient’s age, comorbidities, and clinical presentation.

Consider antiviral therapy for immunocompetent pregnant adults with chickenpox, regardless of varicella immunisation status. If possible, start antiviral therapy within 24 hours of rash onset for maximum benefitBalfour, 2001Center for Disease Control (CDC), 2022; useAustralian Society for Infectious Diseases (ASID), 2022:

aciclovir 800 mg orally, 5 times daily for 7 days. For dosage adjustment in adults with kidney impairment, see aciclovir oral dosage adjustment. aciclovir aciclovir aciclovir

Limited data suggest that valaciclovir (a prodrug of aciclovir) is safe in pregnancy, and some prescribers prefer it because it has a more convenient (8-hourly) dosing regimenAustralian Society for Infectious Diseases (ASID), 2022. There are insufficient data to support the use of famciclovir in pregnancyAustralian Society for Infectious Diseases (ASID), 2022.

For management of chickenpox in pregnant adults with immune compromise or complications of chickenpox (eg pneumonitis, encephalitis, hepatitis), see here.

Supportive care for patients with chickenpox includes:

  • keeping fingernails short to avoid excoriation and secondary bacterial infection
  • managing pruritus with an oral antihistamine
  • relieving discomfort with paracetamol; managing fever with paracetamol is not routinely required.

Secondary bacterial infection of chickenpox skin lesions with Streptococcus pyogenes (group A streptococcus [GAS]) or Staphylococcus aureus can occur and should be treated as for cellulitis. If other organisms are identified on culture, alternative antimicrobials may be required.

See the Australasian Society for Infectious Diseases (ASID) Management of Perinatal Infections guidelines for detailed advice on:

  • additional management of chickenpox in pregnancy
  • management of immunocompetent pregnant adults exposed to varicella zoster virus (VZV)
  • management of infants born to a birthing parent (eg mother) with perinatal chickenpox.

See the Australian Immunisation Handbook for detailed information about the varicella vaccine and high-titre varicella-zoster immunoglobulin (ZIG).