A Stepwise Household Transmission of Vaccine-Strain Varicella-Zoster Virus Resulting in Neonatal Varicella.

We describe a rare case of neonatal varicella from sequential household transmission of varicella-zoster virus. A vaccinated sibling developed herpes zoster before delivery, followed by maternal varicella and neonatal infection at 20 days of life. The infant showed generalized vesiculopustular eruptions with mild respiratory symptoms. Polymerase chain reaction confirmed infection presumed to be caused by the vaccine strain because the sibling had no history of natural varicella and there were no other exposure sources. Intravenous acyclovir was administered with good response. The patient recovered fully. This case reminds clinicians to consider vaccine-strain transmission in families with a non-immune mother.