What is the risk for a pregnant woman whose husband has shingles (Herpes Zoster)?

Risk for a Pregnant Woman Whose Husband Has Shingles

A pregnant woman whose husband has shingles faces minimal risk to herself and her fetus, as maternal herpes zoster does not result in adverse fetal or neonatal outcomes, and transmission from a person with shingles to a pregnant woman is unlikely if proper precautions are taken. 1

Understanding the Risk

Shingles (herpes zoster) is caused by reactivation of the varicella-zoster virus (VZV) that remains dormant in sensory nerve ganglia after a primary chickenpox infection. The risk assessment depends on several factors:

For the Pregnant Woman:

• If the pregnant woman has had chickenpox in the past (is VZV-seropositive), she is protected against new infection and faces no risk from her husband's shingles 2
• If the pregnant woman has never had chickenpox (is VZV-seronegative), she could potentially contract chickenpox (not shingles) through contact with her husband's shingles lesions 2

For the Fetus:

• Maternal herpes zoster (shingles) during pregnancy does not increase risk to the fetus 3, 1
• The congenital varicella syndrome, which can occur if a seronegative mother contracts primary varicella (chickenpox) during pregnancy, is not associated with exposure to someone with shingles 1

Preventive Measures

If the pregnant woman is VZV-seropositive (has had chickenpox):

• No special precautions are needed

If the pregnant woman is VZV-seronegative (has never had chickenpox):

• Avoid direct contact with the shingles rash/lesions until they are completely crusted over 2
• The husband should keep lesions covered with clean, dry bandages
• Both should practice good hand hygiene
• The husband should avoid sharing personal items that might have come into contact with the lesions

Management Recommendations

1. Determine VZV immunity status of the pregnant woman if unknown (through history of prior chickenpox or serologic testing)

2. For VZV-seronegative pregnant women with significant exposure:

   • Varicella zoster immune globulin (VZIG) should be administered within 96 hours of exposure 2
   • Consider oral acyclovir if VZIG is not available, though data on effectiveness are limited 2

3. For the husband with shingles:

   • Prompt treatment with oral antiviral medications (acyclovir, valacyclovir, or famciclovir) to reduce viral shedding and accelerate healing 4
   • Cover lesions until completely crusted over
   • Maintain good hygiene practices

Important Considerations

• The risk of transmission from shingles is much lower than from chickenpox because the virus is less widespread in the body
• Transmission occurs through direct contact with fluid from shingles vesicles, not through airborne spread (unless the husband has disseminated shingles, which is rare in immunocompetent individuals)
• Shingles itself cannot be transmitted - only the virus that can cause chickenpox in a non-immune person

When to Seek Medical Attention

The pregnant woman should contact her healthcare provider if:

• She develops a rash or fever within 21 days after exposure
• She has never had chickenpox and has had significant exposure to her husband's shingles lesions
• Her husband develops disseminated shingles (lesions outside a single dermatome)

Remember that while precautions are important, the overall risk to a pregnant woman and her fetus from a household member with localized shingles is quite low when appropriate preventive measures are taken.