{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:03:44Z","timestamp":1791302624446,"version":"4.1.0"},"reference-count":66,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T00:00:00Z","timestamp":1676851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Europe has faced a massive spread of the varicella-zoster virus through the years. Since the introduction of an effective vaccine, complications and severe forms of chickenpox have been restricted. Nevertheless, among the population, some categories need specific care, such as pregnant women, who present one of the most fragile conditions facing this infection, both for the mother and the fetus. In this review, we highlight how the varicella-zoster virus can be dangerous during pregnancy, underlining the problem of treatment and vaccination, and collect information about the European epidemiology among this particular category of women.<\/jats:p>","DOI":"10.3390\/life13020593","type":"journal-article","created":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T02:30:35Z","timestamp":1676946635000},"page":"593","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Varicella-Zoster Virus Prevalence among Pregnant Women: A European Epidemiological Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Anna","family":"Bertelli","sequence":"first","affiliation":[{"name":"Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia-ASST Spedali Civili, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1054-1348","authenticated-orcid":false,"given":"Valentina","family":"Carta","sequence":"additional","affiliation":[{"name":"Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia-ASST Spedali Civili, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Mangeri","sequence":"additional","affiliation":[{"name":"Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia-ASST Spedali Civili, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaldo","family":"Caruso","sequence":"additional","affiliation":[{"name":"Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia-ASST Spedali Civili, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2221-6286","authenticated-orcid":false,"given":"Maria Antonia","family":"De Francesco","sequence":"additional","affiliation":[{"name":"Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia-ASST Spedali Civili, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1128\/CMR.9.3.361","article-title":"Varicella-zoster virus","volume":"9","author":"Arvin","year":"1996","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1038\/nrmicro3215","article-title":"Molecular mechanisms of varicella zoster virus pathogenesis","volume":"12","author":"Zerboni","year":"2014","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.ejogrb.2021.01.009","article-title":"Varicella Zoster in pregnancy","volume":"258","author":"Nanthakumar","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_4","first-page":"95","article-title":"Varicella-zoster virus infection: Natural history, clinical manifestations, immunity and current and future vaccination strategies","volume":"41","author":"Freer","year":"2018","journal-title":"New Microbiol."},{"key":"ref_5","first-page":"917","article-title":"Varicella -Zoster virus tranfer to skin by T cells and modulation of viral replication by epidermal cell interferon-alpha","volume":"7","author":"Ku","year":"2002","journal-title":"J. Exp. Med."},{"key":"ref_6","unstructured":"Bhavsar, S.M., and Mangat, C. (2022, December 27). Congenital Varicella Syndrome [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK568794\/."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.reprotox.2005.04.011","article-title":"Chickenpox in pregnancy: Revisited","volume":"21","author":"Tan","year":"2006","journal-title":"Reprod. Toxicol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"16","DOI":"10.5455\/msm.2012.24.s16-s17","article-title":"Varicella Pneumonia in a 39-year-old Female in Third Trimester Twin Pregnancy","volume":"24","author":"Baljic","year":"2012","journal-title":"Mater. Sociomed."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1086\/338832","article-title":"Risk Factors and Outcome of Varicella-Zoster Virus Pneumonia in Pregnant Women","volume":"185","author":"Harger","year":"2002","journal-title":"J. Infect. Dis."},{"key":"ref_10","first-page":"1133","article-title":"Herpes zoster during pregnancy","volume":"57","author":"Pupco","year":"2011","journal-title":"Can. Fam. Physician"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1038\/sj.jid.5700052","article-title":"Massive recruitment of type I interferon producing plasmacytoid dendritic cells in varicella skin lesions","volume":"126","author":"Gerlini","year":"2006","journal-title":"J. Investig. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1093\/infdis\/154.3.422","article-title":"Early immune response in healthy and immunocompromised subjects with primary varicella-zoster virus infection","volume":"154","author":"Arvin","year":"1986","journal-title":"J. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jcv.2016.12.001","article-title":"A systematic review and meta-analysis of seroprevalence of varicella zoster virus: A nationwide population-based study","volume":"87","author":"Amjadi","year":"2017","journal-title":"J. Clin. Virol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1093\/infdis\/147.4.737","article-title":"Evaluation of varicella-zoster immune globulin: Protection of immunosuppressed children after household exposure to varicella","volume":"147","author":"Zaia","year":"1983","journal-title":"J. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S0022-3476(84)80112-2","article-title":"Mucosal cell-mediated immunity to varicella zoster virus: Role in protection against disease","volume":"105","author":"Bernstein","year":"1984","journal-title":"J. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"15016","DOI":"10.1038\/nrdp.2015.16","article-title":"Varicella zoster virus infection","volume":"1","author":"Gershon","year":"2015","journal-title":"Nat. Rev. Dis. Primer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1111\/1346-8138.13733","article-title":"Incidence of serum antibody titers against varicella zoster virus in Japanese patients with herpes zoster","volume":"44","author":"Miyachi","year":"2017","journal-title":"J. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1093\/ajcp\/73.5.699","article-title":"Rapid diagnosis of varicella-zoster virus infection by direct immunofluorescence","volume":"73","author":"Drew","year":"1980","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/0166-0934(89)90127-4","article-title":"A simple and sensitive assay for varicella-zoster virus","volume":"23","author":"Ilobi","year":"1989","journal-title":"J. Virol. Methods"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3290","DOI":"10.1128\/JCM.43.7.3290-3296.2005","article-title":"Sensitive and rapid detection of herpes simplex virus and varicella-zoster virus DNA by loop-mediated isothermal amplification","volume":"43","author":"Kaneko","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1155\/2009\/380384","article-title":"Herpes zoster and postherpetic neuralgia: Past, present and future","volume":"14","author":"Bennett","year":"2009","journal-title":"Pain Res. Manag."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1007\/s12325-016-0355-0","article-title":"Real-World Effectiveness and Safety of a Live-Attenuated Herpes Zoster Vaccine: A Comprehensive Review","volume":"33","author":"Ansaldi","year":"2016","journal-title":"Adv. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E28","DOI":"10.1542\/peds.106.2.e28","article-title":"Chickenpox attributable to a vaccine virus contracted from a vaccinee with zoster","volume":"106","author":"Brunell","year":"2000","journal-title":"Pediatrics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1111\/j.1471-0528.2011.02983.x","article-title":"Varicella-zoster virus (chickenpox) infection in pregnancy: Chickenpox infection in pregnancy","volume":"118","author":"Lamont","year":"2011","journal-title":"BJOG"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"101016","DOI":"10.1016\/j.pmedr.2019.101016","article-title":"Varicella-zoster virus post-exposure management and prophylaxis: A review","volume":"16","author":"Lachiewicz","year":"2019","journal-title":"Prev. Med. Rep."},{"key":"ref_26","unstructured":"Centers for Disease Control and Prevention (CDC) (2013). Updated recommendations for use of VariZIG\u2014United States, 2013. MMWR, 62, 574\u2013576."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1503\/cmaj.100615","article-title":"Congenital varicella syndrome: The evidence for secondary prevention with varicella-zoster immune globulin","volume":"183","author":"Cohen","year":"2011","journal-title":"CMAJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e652","DOI":"10.1016\/j.jogc.2018.05.034","article-title":"Management of Varicella Infection (Chickenpox) in Pregnancy","volume":"40","author":"Shrim","year":"2018","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S51","DOI":"10.1093\/infdis\/166.Supplement_1.S51","article-title":"Therapeutic approaches to varicella-zoster virus infections","volume":"166","author":"Whitley","year":"1992","journal-title":"J. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"290","DOI":"10.3949\/ccjm.74.4.290","article-title":"Managing varicella zoster infection in pregnancy","volume":"74","author":"Gardella","year":"2007","journal-title":"Cleve Clin. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1002\/bdra.20013","article-title":"Pregnancy outcomes following systemic prenatal acyclovir exposure: Conclusions from the international acyclovir pregnancy registry, 1984\u20131999","volume":"70","author":"Stone","year":"2004","journal-title":"Birth Defects Res. A Clin. Mol. Teratol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1001\/jama.2010.1206","article-title":"Use of acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and the risk of birth defects","volume":"304","author":"Pasternak","year":"2010","journal-title":"JAMA"},{"key":"ref_33","first-page":"7","article-title":"Acyclovir in pregnancy registry: Six years\u2019 experience. The Acyclovir in Pregnancy Registry Advisory Committee","volume":"79","author":"Andrews","year":"1992","journal-title":"Obstet. Gynecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/j.1479-828X.2007.00797.x","article-title":"Varicella and the pregnant woman: Prevention and management","volume":"48","author":"Daley","year":"2008","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_35","first-page":"885","article-title":"Acyclovir transport by the human placenta","volume":"120","author":"Henderson","year":"1992","journal-title":"J. Lab. Clin. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"187","DOI":"10.7326\/0003-4819-112-3-187","article-title":"Acyclovir-resistant varicella zoster virus infection after chronic oral acyclovir therapy in patients with the acquired immunodeficiency syndrome (AIDS)","volume":"112","author":"Jacobson","year":"1990","journal-title":"Ann. Intern. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2879","DOI":"10.1001\/jama.1988.03410190127035","article-title":"Continuous varicella-zoster infection associated with acyclovir resistance in a child with AIDS","volume":"260","author":"Pahwa","year":"1988","journal-title":"JAMA"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"119","DOI":"10.7326\/0003-4819-115-1-19","article-title":"Foscarnet therapy in five patients with AIDS and acyclovir-resistant varicella-zoster virus infection","volume":"115","author":"Safrin","year":"1991","journal-title":"Ann. Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1002\/jmv.1890410527","article-title":"Review of research leading to new anti-herpesvirus agents in clinical development: Valaciclovir hydrochloride (256u, the L-valyl ester of acyclovir) and 882c, a specific agent for varicella zoster virus","volume":"41","author":"Purifoy","year":"1993","journal-title":"J. Med. Virol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2747","DOI":"10.1128\/AAC.36.12.2747","article-title":"Mode of antiviral action of penciclovir in MRC-5 cells infected with herpes simplex virus type 1 (HSV-1), HSV-2, and varicella-zoster virus","volume":"36","author":"Earnshaw","year":"1992","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1128\/AAC.33.10.1765","article-title":"Selection of an oral prodrug (BRL 42810; famciclovir) for the antiherpesvirus agent BRL 39123 [9-(4-hydroxy-3-hydroxymethylbut-l-yl)guanine; penciclovir]","volume":"33","author":"Sutton","year":"1989","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"358","DOI":"10.7326\/0003-4819-117-5-358","article-title":"Treatment of adult varicella with oral acyclovir. A randomized, placebo-controlled trial","volume":"117","author":"Wallace","year":"1992","journal-title":"Ann. Intern. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0163-4453(98)80156-4","article-title":"Varicella infections in pregnancy and the newborn. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection","volume":"36","author":"Nathwani","year":"1998","journal-title":"J. Infect."},{"key":"ref_44","unstructured":"(2022, December 27). Chickenpox in Pregnancy (Green-top Guideline No. 13) RCOG. Available online: https:\/\/www.rcog.org.uk\/guidance\/browse-all-guidance\/green-top-guidelines\/chickenpox-in-pregnancy-green-top-guideline-no-13\/."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/S0140-6736(89)90547-3","article-title":"Outcome in newborn babies given anti-varicella-zoster immunoglobulin after perinatal maternal infection with varicella-zoster virus","volume":"2","author":"Miller","year":"1989","journal-title":"Lancet"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2222","DOI":"10.1016\/j.vaccine.2010.06.004","article-title":"Kinetics of maternal antibodies against rubella and varicella in infants","volume":"29","author":"Leuridan","year":"2011","journal-title":"Vaccine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1007\/s00404-012-2398-z","article-title":"Immunity to varicella-zoster virus in Croatian women of reproductive age targeted for serology testing","volume":"286","author":"Kolaric","year":"2012","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/j.1471-0528.2004.00320.x","article-title":"Seroprevalence, incidence of prenatal infections and reliability of maternal history of varicella zoster virus, cytomegalovirus, herpes simplex virus and parvovirus B19 infection in South-Western Finland","volume":"112","author":"Alanen","year":"2005","journal-title":"BJOG"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e271","DOI":"10.1017\/S0950268820002629","article-title":"Seroprevalences of antibodies against ToRCH infectious pathogens in women of childbearing age residing in Brazil, Mexico, Germany, Poland, Turkey and China","volume":"148","author":"Warnecke","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.jcv.2011.10.007","article-title":"Susceptibility to varicella-zoster among pregnant women in the province of Lecce, Italy","volume":"53","author":"Guido","year":"2012","journal-title":"J. Clin. Virol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"van Rijckevorsel, G.G.C., Bov\u00e9e, L.P.M.J., Damen, M., Sonder, G.J.B., Schim van der Loeff, M.F., and van den Hoek, A. (2012). Increased seroprevalence of IgG-class antibodies against cytomegalovirus, parvovirus B19, and varicella-zoster virus in women working in child day care. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-475"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Mirinaviciute, G., Barlinn, R., Gjeruldsen Dudman, S., and Flem, E. (2019). Immunity to varicella zoster virus among pregnant women in the Norwegian Mother and Child Cohort Study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0221084"},{"key":"ref_53","unstructured":"European Centre for Disease Prevention and Control (2015). Varicella Vaccination in the European Union, ECDC."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2666","DOI":"10.1017\/S0950268817001546","article-title":"A systematic review of varicella seroprevalence in European countries before universal childhood immunization: Deriving incidence from seroprevalence data","volume":"145","author":"Bollaerts","year":"2017","journal-title":"Epidemiol. Infect."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"3426","DOI":"10.1017\/S0950268816001485","article-title":"Varicella-zoster immunoglobulin treatment in pregnant women in Denmark from 2005 to 2015: Descriptive epidemiology and follow-up","volume":"144","author":"Jespersen","year":"2016","journal-title":"Epidemiol. Infect."},{"key":"ref_56","unstructured":"European Centre for Disease Prevention and Control (2010). Varicella Surveillance Report, EUVAC."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"7866","DOI":"10.1016\/j.vaccine.2007.07.036","article-title":"The comparative sero-epidemiology of varicella zoster virus in 11 countries in the European region","volume":"25","author":"Nardone","year":"2007","journal-title":"Vaccine"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"6086","DOI":"10.1016\/j.vaccine.2007.05.019","article-title":"Susceptibility to varicella in childbearing age women, Central Italy: Is there a need for vaccinating this population group?","volume":"25","author":"Alfonsi","year":"2007","journal-title":"Vaccine"},{"key":"ref_59","unstructured":"Arvin, A.M., and Gershon, A.A. (2000). Varicella and Herpes Zoster in Pregnancy and the Newborn, Cambridge University Press."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s00431-007-0424-0","article-title":"Varicella vaccination in Europe: Are we ready for a universal childhood programme?","volume":"167","author":"Sengupta","year":"2008","journal-title":"Eur. J. Pediatr."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1017\/S0950268807008497","article-title":"The seroepidemiology of varicella zoster virus among pregnant Bangladeshi and white British women in the London Borough of Tower Hamlets, UK","volume":"135","author":"Talukder","year":"2007","journal-title":"Epidemiol. Infect."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.1016\/j.vaccine.2015.03.055","article-title":"Varicella in Europe\u2014A review of the epidemiology and experience with vaccination","volume":"33","author":"Helmuth","year":"2015","journal-title":"Vaccine"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s10654-007-9136-z","article-title":"Seroprevalence of varicella antibodies among pregnant women in Lyon-France","volume":"22","author":"Mekki","year":"2007","journal-title":"Eur. J. Epidemiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/INF.0000000000002233","article-title":"Implementing Universal Varicella Vaccination in Europe: The Path Forward","volume":"38","author":"Spoulou","year":"2019","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_65","first-page":"E33","article-title":"Herpes Zoster: The rationale for the introduction of vaccination in Italy","volume":"56","author":"Paganino","year":"2015","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1093\/infdis\/jit143","article-title":"Waning of Maternal Antibodies Against Measles, Mumps, Rubella, and Varicella in Communities With Contrasting Vaccination Coverage","volume":"208","author":"Waaijenborg","year":"2013","journal-title":"J. Infect. 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