II. Indications
- Every child over age 1 without prior infection
- Postexposure Vaccination within 3-5 days
- Varicella outbreak control
- Women of childbearing age who are not immune
- Contraindicated in pregnancy
- May be safe in Lactation (see below)
- Safe in mildly Immunocompromised children
- Children with Leukemia
- Marrow transplant recipient once recovered Immunity
- Children with Human Immunodeficiency Virus
III. Contraindications
- Absolute
- Pregnancy
- Serious illness
- Severe Immunodeficiency
- First degree relative with Immunodeficiency
- Transmission is rare (transmitted to 3 household contacts 1995-2005)
- Active Tuberculosis
- Relative
- Tuberculosis
- Lactation
- Study suggests no virus transmission in Lactation
- Consider for postpartum Vaccination
- Bohlke (2003) Obstet Gynecol 102:970-7 [PubMed]
- Anaphylactic reaction previously to neomycin
- Conditions not contraindicating Vaccine
- Pregnant family member
- Low grade fever
- Diarrhea
- Otitis Media or Upper Respiratory Infection
V. Efficacy
- Underused Vaccine
- Universal Vaccination is key
- Spotty Vaccination will result in epidemic
- Protection against infection: 85-90% (prevents 3.5 million Varicella cases per year in U.S.)
- Protection against serious infection: 95%
- Breakthrough cases are more mild after Vaccine
- Decreased mortality in reactivated high risk patients
VI. Adverse Effects (low Incidence)
- Local injection site reaction (erythema, pain, swelling, Pruritus at Vaccination site)
- Occurs in 17% of children (24% of teens and adults)
- Fever (11.4 per 100,000 doses)
- Varicella-like rash
- Vesicular rash (~5 Vesicles) onset 7-21 days after Vaccination
- Localized Varicella-Like Rash (at injection site): 3% of children
- Generalized Varicella-Like Rash: 37 case reports (1995 to 2005 in U.S.)
- Small chance of transmission to others
- Herpes Zoster Infection (48 cases per 100,000 in 2008, U.S.)
- Anaphylaxis (rare, 76 total case reports)
- Serious illness in severe Immunodeficiency
- Pneumonia (5 total case reports)
- Encephalitis (12 total case reports 1995 to 2005, U.S.)
- Hepatitis
- Mortality (2 case reports in history of Varicella Vaccine)
VII. Dosage Protocol
- Two dose protocol regardless of age at first dose
-
Primary Series
- Dose 1: Age 12 to 15 months
- Dose 2: Age 4 to 6 years
- Catch-up
- Administer 2 doses at 3 months apart (interval may be as short at 4-8 weeks)
- Consider checking Immune Status prior to administer
- References
VIII. Resources
- CDC Immunization Schedules (last accessed 10/28/2020)