Chickenpox (Varicella) Vaccine – Administration, Contraindications and Precautions - Immunization
 
CHICKENPOX OR VARICELLA VACCINE
Last Updated : 2/1/2016
Sayenna Uduman
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Vaccine immunogenicity & efficacy for ACIP recommended vaccine products
Immunogenicity:
Approximately 76% to 85% of immunized healthy children older than 12 months develop a humoral immune response to VZV at levels considered associated with protection after a single dose of varicella vaccine . Sero-protection rates are significantly higher , approaching 100% after 2 doses. Cell-mediated immune response also is higher after 2 doses.
Efficacy:
Highly effective (97% or greater) in preventing severe varicella . Recipients of 2 doses of varicella vaccine are 3.3-fold less likely to have breakthrough varicella ( refer below ) as compared with recipients of 1 dose during the first 10 years after immunization.

Simultaneous Administration with Other Vaccines or Antiviral Agents
• Varicella-containing vaccines may be administered simultaneously with other childhood immunizations recommended for children 12 through 15 months of age and 4 through 6 years of age
• Because of susceptibility of vaccine virus to acyclovir, valacyclovir, or famciclovir, these antiviral agents usually should be avoided from 1 day before to 21 days after receipt of a varicella-containing vaccine.

Contraindications and Precautions:
As with other vaccines, varicella vaccine should not be administered to people who have moderate or severe illnesses, with or without fever.

HIV infection : Varicella vaccine has been shown to protect these children not only against varicella but also against developing herpes zoster, Screening for HIV infection is not indicated before routine VZV immunization. Monovalent varicella vaccine should be considered for HIV-infected children without evidence of immunity and with a CD4+ T-lymphocyte percentage of 15% or greater, especially if they are receiving antiretroviral therapy
Eligible children should receive 2 doses of monovalent varicella vaccine with a 3-month interval between doses and return for evaluation if they experience a postimmunization varicella-like rash.
Children receiving corticosteroids
Varicella vaccine should not be administered to people who are receiving high doses of systemic corticosteroids (2 mg/kg per day or more of prednisone or its equivalent or 20 mg/day of prednisone or its equivalent) for 14 days or more. The recommended interval between discontinuation of corticosteroid therapy and immunization with varicella vaccine is at least 1 month. Varicella vaccine may be administered to individuals receiving inhaled, nasal, and topical steroids.
Children with nephrotic syndrome
Based on very limited data that 2 doses of the varicella vaccine generally are well tolerated and immunogenic, including children receiving low-dose, alternate-day prednisone.
Households with potential contact with immunocompromised people
Household contacts of immunocompromised people should be immunized if they have no evidence of immunity to decrease the likelihood that wild-type VZV will be introduced into the household.
Pregnancy and Lactation
• Varicella vaccine should not be administered to pregnant women, because the possible effects on fetal development are unknown, although no cases of congenital varicella syndrome or patterns of malformation have been identified after inadvertent immunization of pregnant women.
• When post pubertal females are immunized, pregnancy should be avoided for at least 1 month after immunization.
• A pregnant mother or other household member is not a contraindication for immunization of a child in the household.
• Nursing mothers: Varicella vaccine should be administered to nursing mothers who lack evidence of immunity. No evidence of excretion of vaccine strain in human milk or of transmission to infants who are breastfeeding.

Immunization of Immunocompromised Patients
Varicella vaccine should not be administered routinely to children who have congenital or acquired T-lymphocyte immunodeficiency, including people with leukemia, lymphoma, and other malignant neoplasms affecting the bone marrow or lymphatic systems, as well as children receiving long-term immunosuppressive therapy. An exception includes certain children infected with HIV, as discussed below.
Recommendations for vaccination of recipients of hematopoietic stem cell or bone marrow transplant include optional administration of varicella vaccine 24 months after transplantation. However, nonimmune family members, close contacts, and health care workers associated with the patient should be immunized.

References

Contributor Information and Disclosures

Sayenna Uduman
Sayenna A Uduman MD, FAAP
Visiting Professor, Infection Control Committee & ID Division of the KIMS
Thiruvananthapuram, Kerala, India


First Created : 1/3/2001
Last Updated : 2/1/2016

References

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