Pictures in Practice - Common Conditions with a Difference
By Nerys Hairon
Every first-time pregnant mother should be screened for varicella immunity and vaccinated if unprotected, new research recommends.
The study, submitted to the Joint Committee on Vaccination and Immunisation, found the strategy was likely to save money by preventing child-to-mother transmission.
Researchers advised verbally screening all first-time mothers, serologically testing those with uncertain or negative
history and vaccinating unprotected women after they had given birth.
Their economic model predicted that in UK-born women this would prevent 714 varicella infections – 18 of them in pregnancy – per 100,000 women screened. It would save the NHS £148,000 per 100,000 screens.
Vaccinating Bangladesh-born women, who are at high risk of chickenpox infection, would prevent 2,397 varicella infections, 59 in pregnancy, and save around £257,000 per 100,000 women screened.
Professor Judy Breuer, professor of virology at Barts and the London School of Medicine and Dentistry, said: ‘I do think it should be seriously considered by the JCVI. Pregnant women are fairly often exposed to chickenpox from their own children. If they do not know or cannot remember having chickenpox, they need investigation.
‘Immunisation of these women would reduce the workload of GPs and midwives. GPs bear much of the brunt of this [work] as they deal with many of the pregnant women who are in contact with chickenpox.'
RCGP vice chair Dr Graham Archard, a GP in Christchurch, Dorset, said: ‘If this is relatively cost-effective and we can reduce varicella in pregnancy, I think it should be seriously considered.'
Dr David Elliman, a consultant in community child health at Great Ormond Street Hospital, said: ‘It would cut anxiety in mothers and GP workload.'
The study, to be published in Vaccine, found serologically screening all women in their first pregnancy would not be viable, but when preceded by verbal screening was cost-saving for all those under 33 (see graph, below).firstname.lastname@example.org