Varicella Vaccine

1. See Also
   1. Varicella Zoster Virus
2. Indications
   1. Every child over age 1 without prior infection
   2. Postexposure vaccination within 3-5 days
   3. Varicella outbreak control
   4. Women of childbearing age who are not immune
      1. Contraindicated in pregnancy
      2. May be safe in Lactation (see below)
   5. Safe in mildly immunocompromised children
      1. Children with Leukemia
      2. Marrow transplant recipient once recovered immunity
      3. Children with Human Immunodeficiency Virus
3. Contraindications
   1. Absolute
      1. Pregnancy
      2. Serious illness
      3. Severe Immunodeficiency
      4. First degree relative with Immunodeficiency
      5. Active Tuberculosis
   2. Relative
      1. Tuberculosis
      2. Lactation
         1. Study suggests no virus transmission in Lactation
         2. Consider for postpartum vaccination
         3. Bohlke (2003) Obstet Gynecol 102:970-7
      3. Anaphylactic reaction previously to neomycin
   3. Conditions not contraindicating Vaccine
      1. Pregnant family member
      2. Low grade fever
      3. Diarrhea
      4. Otitis Media or Upper Respiratory Infection
4. Pharmacokinetics
   1. Live virus Vaccine
   2. Must keep Vaccine frozen
5. Efficacy
   1. Underused Vaccine
      1. Universal vaccination is key
      2. Spotty vaccination will result in epidemic
   2. Protection against infection: 85-90%
   3. Protection against serious infection: 95%
   4. Breakthrough cases are more mild after Vaccine
   5. Decreased mortality in reactivated high risk patients
6. Adverse Effects (low Incidence)
   1. Local injection site reaction
   2. Fever
   3. Generalized Rash
   4. Herpes Zoster Infection (rare)
   5. Serious illness in severe Immunodeficiency
      1. Pneumonia
      2. Hepatitis
7. Dosage Protocol
   1. Two dose protocol regardless of age at first dose
   2. Primary Series
      1. Dose 1: 12 months old
      2. Dose 2: Age 5 years
   3. Catch-up
      1. Administer 2 doses 1 month apart
      2. Consider checking Immune status prior to administer
   4. References
      1. Kuter (2004) Pediatr Infect Dis 23:132-7
      2. Vasquez (2004) JAMA 291:851-5
8. Resources
   1. Inadvertent Varivax use: Pregnancy registry
      1. Phone: 800-986-8999
9. References
   1. Ampofo (2002) Clin Infect Dis 34:774-9
   2. Black (1999) Pediatr Infect Dis J 18:1041-6
   3. Seward (2001) Pediatr Infect Dis J 20:619-21