Shingles During Pregnancy - It's That Dangerous!

introduction

Shingles, also known as zoster, is caused by the varicella zoster virus. This virus is also responsible for causing the chickenpox disease, which mostly occurs in childhood. The infection rate of the population with this pathogen, i.e. the percentage of the virus infected (carrying it), is up to 90% regionally after childhood. Chickenpox (varicella) is not a dangerous disease for children. However, an outbreak is a sign that the virus has attacked the body and remains in the host until the end of its life. The viruses establish themselves in nerve nodes and can be reactivated if the immune system is weakened - shingles breaks out.

The role of shingles for an expectant mother depends on the immune status of the pregnant woman. Your own shingles or contact with sick people can be completely harmless for the mother and the unborn child, but if the mother is not immunized it guarantees great dangers for both.

Is that dangerous?

Almost all pregnant women are immune to the varicella zoster virus, namely if they had a chickenpox infection in childhood or if they are vaccinated against varicella. If shingles then occurs during pregnancy, this is a sign of reactivation of the virus from the nerve roots and not a sign of a new infection. This reactivation is usually not dangerous for the child.
However, if there is no adequate immune defense, an initial infection with varicella-zoster viruses can occur during pregnancy. Both chickenpox and shingles can be dangerous not only for the mother, but also very harmful for the unborn child. Complications rarely occur in adulthood, but are in principle possible.
There is a risk of pneumonia (pneumonia) and an ear infection (Otitis), an 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 nerve inflammation.

In some cases (1 - 2%) the "fetal varicella syndrome"Train in the unborn child if the mother becomes infected early in pregnancy.
The syndrome includes harmful changes to the skin, limb and brain development deficits, and an unhealthily low birth weight.
The infection often leads to miscarriage in the early stages of pregnancy (Abortion). During most of the pregnancy, the child is protected from the viruses by the mother's immune system.

If an infection occurs around the due date, it becomes critical. During this period there is no nest protection, which is guaranteed by maternal antibodies.
If signs of a varicella infection can be seen at birth or shortly afterwards, antivirals should be used immediately as a prophylactic.

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 six-fold vaccination.

Read more on the topic: Infections in pregnancy

General transmission and disease

First illness: Of the Varicella zoster virus will with existing chickenpox- Disease transmitted very easily. The Viruses are highly contagious and often trigger small epidemics if the disease has broken out, for example in a kindergarten. The pathogens are over Droplet infection transmitted, which enables very easy infection and spread. For children Chickenpox is one harmless Disease caused by spontaneous healing disappears, i.e. is fended off by your own body. Against varicella (chickenpox), after a single outbreak, each child has one immunity trained, which excludes a repeated illness. However, the viruses do not go away: in so-called virus ascension, the pathogens migrate along the nerve pathways down to the deep ones Nerve nodes and stay there lifelong. From there you can trigger a second infection in the form of shingles or remain forever as a silent infection.

Second illness: After the initial infection, one closes Rest or latency period at, in the no signs a virus attack are noticeable. Through the Weakening of the immune system the remaining viruses can multiply again and trigger another noticeable infection - the Shingles. The blueprints for the antibodies against the virus are saved for a lifetime and can be downloaded from reactivation can be called quickly.This leads to a sudden mass production of these, which largely prevents the virus from spreading. Just very rarely there is a third diseasewhich would otherwise also manifest as shingles.

Shingles in pregnancy regarding the immune status

Get sick Pregnant women on Shinglesso it means that she is already immune to the varicella zoster virus. This can be gone through by one chickenpoxDisease or a vaccination have happened. There is no increased risk for the child or the mother-to-be. Because zoster only occurs in immunocompromised patients, i.e. people with weakened immune system, breaks out, various complications can occur, as with any shingles. But even these are Rare and therefore mostly irrelevant as far as the child's health is concerned. Contact with people currently suffering from shingles is also harmless. Infection by the viruses already present in your own body is unlikely, as this only occurs through direct contact with the Wound fluid of the vesicles is possible. And even in the event of infection, the pathogens are automatically warded off again through the rapid activation of the Immune system.

Since people who have not yet had contact with the varicella zoster virus cannot develop shingles, the connection between pregnancy and shingles must be established through a third person. Some women are still not immune to the virus during their pregnancy, which in such cases often came about as a surprise - they have neither been vaccinated nor have they survived an illness. Now shingles is starting to get dangerous: If the pregnant woman comes into contact with the contents of the fluid-filled blisters, she can become infected - not with zoster, but with varicella, the chickenpox. Chickenpox can affect adults as well as fetuses dangerous and cause serious complications.

Symptoms of shingles during pregnancy

Shingles presents itself during pregnancy just like in other people. Since the viruses attach themselves to certain nerve nodes, the symptoms only appear in the corresponding dermatomes. These are skin areas that are sensitively supplied by the nerves that have their origin in the affected nerve node. In the diseased dermatome, there is initially an uncomfortably strong hypersensitivity or poor sensitivity of the skin. A few days later, a skin rash forms relatively quickly, which is characterized by its blistering and its unusually strong border. A general feeling of illness arises, which is accompanied by fever and headache. There may be swelling of the lymph nodes in the area of ​​the rash. When a cranial nerve ganglion is affected, i.e. a nerve node that is connected to the auditory or optic nerve, for example, more specific symptoms such as tinnitus or lacrimation occur.

Treatment of shingles during pregnancy

Most of the time, younger women are more likely to become pregnant. Antiviral therapy must be carefully discussed in patients under the age of 50, as in most cases it is not needed. Only pain medication (Analgesics) can be taken in the case of particularly severe pain in the area of ​​the rash. You should also pay attention to the side effects during pregnancy, with paracetamol being the safest analgesic. Various drugs have been developed for the antiviral treatment of shingles. Acyclovir or Zovirax are traditionally prescribed, but also famciclovir, valaciclovir or brivudine. The use of antivirals can alleviate the pain and make the use of analgesics superfluous. Pregnant women who have a negative immune status and who have come into contact with viruses or even become ill must always receive antiviral therapy. In this way an attempt is made to avert infection of the unborn child.

How high is the risk of transmission to my baby during pregnancy?

Shingles is usually safe for the baby during pregnancy. With shingles, there is a renewed infection with the varicella zoster virus. The body has already formed antibodies against this virus after the initial contact (usually due to the chickenpox). These antibodies pass with the blood via the placenta into the unborn child's circulation and thus protect it from infection. It looks different when a pregnant woman gets chickenpox. In this case, it is an initial contact with the varicella zoster virus. This can lead to deformities in the unborn child (varicella syndrome). However, shingles will not harm the baby.

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

Yes! If you suffer from shingles (= infection with the varicella-zoster virus) you usually have to take various medications. These are on the one hand strong pain relievers and on the other hand a drug against the virus (mostly acyclovir). There are several publications on the use of acyclovir during pregnancy. There was no evidence of an increased risk of malformations in babies. However, shingles is usually a disease that heals quickly (3-5 weeks) with the right treatment. Therefore, from a medical point of view, one would always recommend waiting.

Hazards in the workplace / school

Teachers are constantly and excessively exposed to the diseases of children and young people. It is not uncommon for this occupational group to be affected by the seasonal diseases. That's how it is chickenpox in the absence of immunization of the staff. There is a particularly great danger here for pregnant Forces that are not against the virus are immune or do not know about their own immune status. If there is an outbreak of varicella in the school, it is in this case the responsibility of the school management to company medical examination to cause. This is supposed to improve the immune status of the staff enlightento reduce existing risks. As long as no information is available that guarantees a safe stay for the pregnant teacher, she must Leave work. Temporary options include secondment to another school facility, relocation of activities out of the classroom or a temporary ban on professions.

Shingles prophylaxis during pregnancy

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

If there was a risk of having been exposed to the virus, people without adequate immunization can be given immunoglobulins. This form of active immunization protects directly against the viruses and is used both 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 take a lot of strain on the mother's body. A slight immune deficiency can be the result, which makes the outbreak of shingles more likely if you have already overcome chickenpox. It is therefore not uncommon for mothers who are just starting to breastfeed their newborns to suffer from an outbreak of shingles. In principle, however, you do not have to worry about a mild course of the disease. As a precautionary measure, the affected skin area should be covered before breastfeeding, as only the liquid contained in the blisters is contagious. If the course is more severe, doctors recommend stopping breastfeeding to minimize the risk of infection to the baby.

Homeopathy for shingles during pregnancy

The treatment of shingles is based on two pillars. On the one hand, there is pain therapy. On the other hand, drugs must be taken against the virus. A homeopathic treatment that complements conventional medicine can be useful. The tried and tested homeopathic medicines include Mezereum, Rhus toxicodendron, Ranunculus bulbosus and Arsenicum album. Which medication is to be taken in which dosage should, however, be discussed with an experienced homeopath.

Read more about the topic here: Homeopathy in Pregnancy

Home remedies for shingles during pregnancy

If you have shingles you should definitely take pain relievers and a virostat (= a drug against the virus). You can also use home remedies as a support. This is mostly symptomatic therapy. Some people apply natural yogurt to the affected areas of the skin. This will relieve the itching. Cabbage wraps are a great way to dry out the blisters. In addition, it makes sense to strengthen your own immune system. Preparations with vitamin C and zinc are suitable for this.