What is the initial management step for primary Varicella Zoster Virus (VZV) in pregnancy?

The initial management step for primary Varicella Zoster Virus (VZV) in pregnancy involves starting oral acyclovir within 24 hours of the rash appearing. The rationale behind this is that early antiviral therapy has been shown to reduce the severity of the disease and its associated complications, both for the mother and the fetus.

In cases of primary VZV infection during pregnancy, particularly when the infection is in the first or second trimester, there is a risk of severe illness that can lead to complications such as pneumonia, neonatal varicella, and other adverse outcomes. Therefore, prompt administration of oral acyclovir is critical, as it can mitigate the impact of the virus on both maternal health and fetal development.

Intravenous acyclovir is generally reserved for severe cases, such as when a pregnant woman is severely ill or has pneumonia, rather than for initial management of primary infection. Providing varicella zoster immune globulin (VZIG) is an important consideration for certain patients who are immunocompromised or who were exposed to VZV but not for those who already have the infection. Monitoring maternal symptoms closely is necessary, but it does not serve as the primary management strategy; instead, it should accompany other treatment