Who is at highest risk for suffering complications from chickenpox?

Individuals considered most at risk for developing complications from chickenpox include: 

• Pregnant women who are not immune to the infection. Pregnant women may be at higher risk of developing complications, especially pneumonia. Infants born to women who develop chickenpox during the first or early part of the second trimester have a rare chance of developing congenital varicella disease (CVD), which may result in low birth weight, scarring of the skin, and brain, limb, and eye abnormalities.  CVD, however, is so rare that two large studies on the impact of varicella disease during pregnancy showed no increase in congenital anomalies when compared with control groups. 
• Newborn infants whose mothers developed chickenpox five days before to two days following delivery. Infants exposed to chickenpox at birth or shortly after are at a higher risk for developing neonatal chickenpox. Neonatal chickenpox complications can be severe or even fatal.
• Hospitalized premature infants born at or more than 28 weeks gestation to mothers who are not immune to chickenpox.
• Hospitalized premature infants born before 28 weeks gestation.
• Persons who are immunocompromised and lack immunity. This includes:
  • Individuals with immune system disorders, including cellular immune-deficiencies;
  • Persons taking immunosuppressive medications including chemotherapeutic agents or high-dose steroids;
  • Individuals with lymphoma or leukemia.

Persons with compromised immune systems who develop chickenpox may be at risk of visceral dissemination (chickenpox involving the internal organs), a complication which may lead to encephalitis, hepatitis, pneumonia, and disseminated intravascular coagulopathy (DIC). Immunocompromised individuals may also be at risk of having chickenpox for a longer period of time with a greater number of lesions, with lesions that may bleed. 

Children who are HIV-positive may develop an atypical chickenpox rash which might persist for weeks or even months.  Further, HIV-positive children are at high risk of shingles and recurrent chickenpox illness. Most HIV-positive adults, however, have previously been exposed to chickenpox illness, and as a result, the infection is not commonly found in this population. When it does occur, complications such as hepatitis and encephalitis, may be more severe. 

IMPORTANT NOTE: NVIC encourages you to become fully informed about Chickenpox and the Chickenpox vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

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