Varicella immunoglobulin 250mg solution for injection vials

Infection by the varicella-zoster virus (VZV) during pregnancy is uncommon but clinically relevant, since it may compromise both the mother and the fetus. Although varicella is generally benign and self-limited in childhood, the physiological and immunological changes in pregnancy predispose individuals to more severe forms of the disease, with pneumonia representing the main maternal complication and a leading cause of morbidity and mortality. Vertical transmission may result in congenital varicella syndrome, the most severe fetal consequence, whose risk is greatest between the 13th and 20th weeks of gestation, or in severe neonatal varicella when maternal infection occurs in the peripartum period. This article presents a narrative review of the literature. To enhance methodological transparency and reproducibility, key principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were applied to the literature search and study selection process. Searches were conducted in the PubMed/MEDLINE and SciELO databases, and 32 studies were included in the narrative synthesis. The review addresses the virology, pathophysiology, and epidemiology of VZV infection, including differences between temperate and tropical regions, as well as its clinical manifestations and maternal, fetal, and neonatal complications. Diagnosis is predominantly clinical, with the polymerase chain reaction being the most sensitive and specific confirmatory method and serology being useful mainly for the assessment of maternal immunity. Management encompasses the assessment of susceptibility, post-exposure prophylaxis according to current guideline recommendations, and early antiviral treatment of established infection. Preconception and postpartum vaccination remain the main preventive strategies. Despite recent advances, important gaps persist regarding prophylactic strategies and the long-term safety of antivirals during pregnancy.

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Two-dose childhood vaccination against measles, mumps, rubella, and varicella is widely recommended. Quadrivalent (MMRV) vaccines can be used for one or both immunizations against these diseases. In some countries, e.g. the United States, only one MMRV vaccine is licensed. Availability of another MMRV vaccine could strengthen supply resilience, optimal vaccine coverage, and disease control. In this phase II, single-blind, multi-country study, healthy children aged 4-6 y, previously primed with a first dose of any combination of measles/mumps/rubella/varicella-containing vaccine(s) in their second year of life, were randomized 2:2:2:1:1 to receive one dose of a GSK investigational MMRV (MMRVNS; three formulations) or a licensed MMRV vaccine (two lots). Immunogenicity was assessed at Day 43 post-vaccination. Adverse events (AEs) were recorded up to Day 4 (solicited administration-site and systemic AEs), Day 43 (solicited systemic and unsolicited AEs), and Day 181 (serious AEs [SAEs]) post-vaccination. Of 801 participants enrolled, 796 were vaccinated and 765 completed the study. Antigen-specific antibody geometric mean concentrations and seroresponse rates were generally comparable between MMRVNS (regardless of formulation) and MMRV recipients. Administration-site pain (29.0%-39.0% of participants) and systemic drowsiness (9.0%-15.9%) were the most common solicited AEs. Unsolicited AEs (mostly upper respiratory tract infections) were reported in 18.5%-27.2% of participants. At least one SAE (none considered vaccine-related) occurred in each group. Except for one reported fatality, all SAEs resolved. Compared to the licensed standard-of-care MMRV vaccine, the investigational MMRVNS formulations generated comparable immune responses and had a similarly acceptable safety profile, when administered as second dose. These results support further clinical development of MMRVNS.

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IntroductionAcute transverse myelitis (ATM) is a rare inflammatory disorder that affects the spinal cord, leading to sudden weakness, sensory deficits, and bowel/bladder dysfunction. Also rare, this condition can be caused by infections such as the Varicella-zoster virus (VZV) or can occur as a complication of systemic lupus erythematosus (SLE). It has been reported to be more prevalent in SLE patients compared to VZV infections. We present a case of a patient with a history of SLE and evidence of vesicular rash from VZV infection.Case reportA 61-year-old female presented with progressive weakness in her lower limbs. Two weeks before, she had developed a vesicular rash due to a VZV infection in the T6-T9 dermatomes, which was followed by paraparesis, sensory loss, and urinary retention. She also had a history of SLE. During the physical examination, muscle strength and sensation were decreased in the lower limbs. MRI revealed central myelopathy from T6 to T10. In laboratory tests, VZV PCR was positive, and Aquaporin-4 was also negative. The patient was treated with IV corticosteroid pulse and ganciclovir, followed by plasma exchange. resulted in partial recovery.ConclusionsThis case highlights VZV-induced TM (VZV-TM) in an immunocompromised patient with underlying SLE. Despite overlapping etiologies, a thorough clinical, radiologic, and laboratory evaluation, including a positive CSF VZV PCR and the absence of a SLE flare, supported VZV-TM as the final diagnosis. Prompt antiviral therapy and escalation to plasma exchange led to substantial neurological recovery.

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