Lancet
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The Gaza Strip now has limited self-rule. Its people inherit a health-care system provided by four sectors--the Israeli government, the UN Relief and Works Agency, non-governmental organisations, and private facilities. They also inherit a legacy of health indices comparing unfavourably with those of Israel, huge numbers of refugees, a looming water crisis, civil unrest, and a health care expenditure bill (as a proportion of gross domestic product) that will be unsustainable. Four plans have been drawn up for health services in autonomous Gaza but none is exactly right.
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In a joint prospective study in Germany and the United Kingdom between 1980 and 1993, 1373 women who had varicella and 366 who had herpes zoster during the first 36 weeks of gestation were followed up. 9 cases of congenital varicella syndrome were identified, all occurring after maternal varicella during the first 20 weeks of gestation. The highest risk (2.0%) was observed between 13-20 weeks gestation, with 7 affected infants identified among 351 pregnancies (95% CI of risk 0.8-4.1%). Only 2 cases of congenital varicella syndrome were identified among 472 pregnancies in which maternal varicella occurred before 13 weeks (observed risk 0.4%, 95% CI 0.05-1.5%). ⋯ Our estimates provide a sound basis for counselling women with varicella in pregnancy. Although the risk of congenital varicella syndrome is small, the outcome for the affected infant is so serious that a reliable method of prenatal diagnosis would be valuable. In the long term, prevention of maternal varicella would be an option if a safe and effective vaccine were to become routinely available.