NHS FORTH VALLEY. Varicella Care Pathway for GPs

Transcription

1 NHS FORTH VALLEY Date of First Issue 01/04/2006 Approved 05/05/2012 Current Issue Date 28/04/2014 Review Date 28/04/2016 Version 1.2 EQIA Yes 01/04/2012 Author / Contact Debbie Forbes Group Committee Unit Clinical Governance Final Approval This document can, on request, be made available in alternative formats Version th April 2014 Page 1 of 6

2 Consultation and Change Record Contributing Authors: Consultation Process: Debbie Forbes Circulation to all Midwives, Obstetricians, Supervisors Of Midwives, Team Leaders, Clinical Shift Co-ordinators, Department Managers,, Unit Service Manager and Head of Midwifery, GP Stakeholders Distribution: Midwives, Obstetricians, Supervisors Of Midwives, Team Leaders, Clinical Shift Co-ordinators, Department Managers, and Head of Midwifery Change Record Date Author Change Version Kirsty MacInnes Dosage change highlighted in blue 1.2 Version th April 2014 Page 2 of 6

3 Women & Children s Unit 1 A pregnant woman who gives a history of contact with chickenpox or shingles When contact occurs with chickenpox or shingles, a careful history must be taken to confirm the significance of the contact and the susceptibility of the patient. Chickenpox is infective from 2 days before the appearance of the rash until the lesions have crusted. What is close contact? Contact in the same room for 15 minutes or more Face-to-face contact Contact in the setting of a large open ward Susceptibility of the patient If woman is certain that she has had chicken pox in past she can be reassured. (90% of the adult UK population is immune). If woman is uncertain then she should be tested by urgent serology (turn-around time usually hours) to check for IgG antibody to varicella zoster. This can be assessed on saved booking blood which is usually retained in the lab. If woman is immune she should be reassured. If woman is non immune she should be given varicella zoster immune globulin (VZIG) Dosage 1000mg = 4 vials as soon as possible, ideally within 3 days but within 10 days maximum The outcome in pregnant women is not adversely affected if administration of VZIG is delayed up to ten days after initial contact. There is still time to test for VZ antibody even when the woman presents relatively late after contact If a second exposure to chickenpox occurs three weeks or more after the first dose of VZIG, a second dose is required. If VZIG is administered, the pregnant women should be regarded as potentially infectious from 8-28 days after VZIG Patients should be advised to contact the GP if a rash subsequently develops. Contraindication to the use of VZIG Hypersensitivity to any of the components. Hypersensitivity to human immunoglobulins. Version th April 2014 Page 3 of 6

4 Women & Children s Unit 2 Method of administration VZIG should be administered via the intramuscular route. If a large volume (or>5 ml for adults) is required, it is recommended to administer this in divided doses at different sites. If intramuscular administration is contraindicated (bleeding disorders), the injection can be administered subcutaneously. Administration of VZIG should be documented in patient s hand held notes. Place for administration The on-call public health consultant should always be contacted to be notified of a non-immune pregnant women s exposure to chicken pox. The woman with exposure to chickenpox or shingles should visit her GP. The GP practice should fax a signed request for VZIG to pharmacy store at Forth Valley Royal Hospital fax The pharmacy department in FVRH routinely stock VZIG and will deliver it to GP practice as soon as possible. At weekends, or on a public holiday, arrangements should be made through the Out of Hours service, in liaison with the hospital pharmacist for the VZIG to be supplied and administered, in an appropriate Out of Hours department. (Or on call pharmacist if out-with pharmacy hours). The VZIG should be prescribed by the GP or obstetric medical staff as appropriate. Pregnant women, who have been exposed to chickenpox, should not be sent to the maternity services to receive VZIG because of risk of spreading infection. Management of pregnant patient with chicken pox Pregnant women who develop the rash of chickenpox should immediately contact their GP. Diagnosis can be made clinically in most instances. Women should avoid contact with susceptible individuals; that is, other pregnant women and neonates, until the lesions have crusted over. This is usually about 5 days after the onset of the rash. Symptomatic treatment and hygiene is advised to prevent secondary bacterial infection of the lesions. Oral acyclovir (800 mg five times a day for 7 days) should be prescribed for pregnant women with chickenpox if they present within 24 hours of the onset of the rash and if they are more than 20 weeks gestation. Version th April 2014 Page 4 of 6

5 Women & Children s Unit 3 Acyclovir should be used cautiously before 20 weeks of gestation. Women should be informed of the potential risk and benefits of treatment with acyclovir. VZIG has no therapeutic benefit once chickenpox has developed. Hospital referral in severe cases Pneumonia, encephalitis, hepatitis are more common in adults with chickenpox. Women in late pregnancy are at an additionally increased risk of severe morbidity & death. Pneumonia occurs in up to10% of women with chickenpox in pregnancy & bleeding, thrombocytopaenia & DIC may also occur. Appropriate treatment should be decided in consultation with a multidisciplinary team: obstetrician or fetal medicine specialist, virologist and neonatologist. Women with following symptoms should be referred immediately to a hospital Chest symptoms Neurological symptoms Haemorrhagic rash or bleeding A dense rash with or without mucosal lesions Women with significant immunosuppression If the woman smokes cigarettes, has chronic lung disease, is taking corticosteroids or is in the latter half of pregnancy, a hospital assessment should be considered, even in the absence of complications. Women hospitalised with varicella should be nursed in isolation from babies or potentially susceptible pregnant women or non-immune staff. Fetal Risks There is a risk of Fetal Varicella Syndrome up to 28 weeks gestation. This is rare but consultant referral is indicated after recovery from the acute illness. Risk to Neonate if a sibling has chickenpox in the first 7 days of life VZIG should be administered to the baby if; The mother is non-immune The baby was born before 28 weeks or the birthweight was <1kg. Version th April 2014 Page 5 of 6

6 Publications in Alternative Formats NHS Forth Valley is happy to consider requests for publications in other language or formats such as large print. To request another language for a patient, please contact For other formats contact , text , fax or - [email protected] Version th April 2014 Page 6 of 6