People at High Risk for Complications

Immunocompromised Persons

Immunocompromised persons who get varicella are at risk of developing visceral dissemination (VZV infection of internal organs) leading to pneumonia, hepatitis, encephalitis, and disseminated intravascular coagulopathy. They can have an atypical varicella rash with more lesions, and they can be sick longer than immunocompetent persons who get varicella. New lesions may continue to develop for more than 7 days, may appear on the palms and soles, and may be hemorrhagic.

 

People with HIV or AIDS

Children with HIV infection tend to have atypical rash with new crops of lesions presenting for weeks or months. The lesions may initially be typical maculopapular vesicular lesions but can later develop into non-healing ulcers that become necrotic, crusted, and hyperkeratotic. This is more likely to occur in HIV-infected children with low CD4 counts.

Some studies have found that VZV dissemination to the visceral organs is less common in children with HIV than in other immunocompromised patients with VZV infection. The rate of complications may also be lower in HIV-infected children on antiretroviral therapy or HIV-infected persons with higher CD4 counts at the time of varicella infection. Retinitis can occur among HIV-infected children and adolescents.

Most adults, including those who are HIV-positive have already had varicella disease and are VZV seropositive. As a result, varicella is relatively uncommon among HIV-infected adults.

For more information about vaccinating immunocompromised persons, including some groups with HIV-infection, see Special Considerations.

For more information about prevention measures in people with HIV infections or AIDS, see Chickenpox and HIV/AIDS.

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Pregnant Women

Pregnant women who get varicella are at risk for serious complications; they are at increased risk for developing pneumonia, and in some cases, may die as a result of varicella. Some studies have suggested that both the frequency and severity of VZV pneumonia are higher when varicella is acquired during the 3rd trimester although other studies have not supported this observation.

If a pregnant woman gets varicella in her 1^st or early 2^nd trimester, her baby has a small risk (0.4 – 2.0 percent) of being born with congenital varicella syndrome. The baby may have scarring on the skin; abnormalities in limbs, brain, and eyes; and low birth weight.

If a woman develops varicella rash from 5 days before to 2 days after delivery, the newborn will be at risk for neonatal varicella. Historically, the mortality rate for neonatal varicella was reported to be about 30% but the availability of VZV immune globulin and intensive supportive care have reduced the mortality to about 7%.

The vaccine is contraindicated for pregnant women. See Guidelines for Vaccinating Pregnant Women: Varicella.

For information about prevention, see Chickenpox and Pregnancy.

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