Vaccines and Preventable Diseases. Section Navigation. Facebook Twitter LinkedIn Syndicate. Varicella Vaccination Information for Healthcare Professionals. Minus Related Pages. Varicella Vaccine Recommendations. However, not every exposure to varicella leads to infection, so for future immunity, varicella vaccine should be given, even if more than 5 days have passed since an exposure.
A healthcare worker with no history of chickenpox, and unknown serologic immunity, was exposed to a patient with zoster. She received varicella vaccine two days later. She developed a pruritic maculopapular rash 11 days after vaccination. Is the rash from the vaccine or from her zoster exposure? The only way to determine whether the rash is caused by wild-type varicella or vaccine virus is to try to isolate virus from the rash and send it to a laboratory that is capable of differentiating wild and vaccine-type virus.
This is generally not practical. Given the history, the conservative approach is to assume she has an active case of chickenpox and act according to your infection control guidelines. Does varicella vaccine affect tuberculosis skin test readings in the same way that MMR does?
There is currently no information on the effect of varicella vaccine on reactivity to a tuberculin skin test TST. Until information is available, it is prudent to apply the same rules to varicella vaccine as are applied to MMR: a TST i. If vaccine has been given, delay the TST for at least 4 weeks.
How has widespread use of varicella vaccine in children impacted disease? Substantial reductions in varicella morbidity and mortality have occurred following the licensure of vaccine. For more information on the impact of varicella vaccination see the CDC varicella webpage at www. What are the recommendations for varicella vaccination before and after pregnancy?
Live varicella vaccine should not be given to a woman who is known to be pregnant or who plans to become pregnant within one month. If a woman who is planning to become pregnant in the future comes in for a visit or an annual exam, her varicella history should be obtained and if indicated, 2 doses of vaccine should be given, spaced 4 to 8 weeks apart. Pregnant women should be assessed for evidence of varicella immunity and if non-immune, should receive the first dose of varicella vaccine following completion of the pregnancy and prior to hospital discharge.
A second dose should be given 4 to 8 weeks later. Can a pregnant healthcare worker with a history of varicella infection care for a patient with varicella? Is it possible for her to have a declining titer, thus making her susceptible to the virus again? People with a reliable history of varicella can be considered to be immune. A reliable history for healthcare personnel consists of 1 a healthcare provider's diagnosis of varicella or verification of history of varicella disease; 2 a history of herpes zoster, based on healthcare provider diagnosis; or 3 laboratory evidence of immunity or laboratory confirmation of disease.
Immunity following disease or vaccination is probably life-long. More than one primary infection with varicella is unusual. Should all pregnant women have serology screening for varicella?
Serologic testing for varicella should be considered only for women who do not have evidence of immunity reliable history of chickenpox or documented vaccination. Once a person has been found to be seropositive, it is not necessary to test again in the future. If a woman receives varicella vaccine, how long should she wait before becoming pregnant?
Contrary to the information provided in the vaccine package insert, which states that pregnancy should be avoided for 3 months, the ACIP recommends that a wait of 1 month is sufficient.
If a woman receives varicella vaccine and subsequently finds out that she is pregnant, what should she be told about the risk to the fetus? To date, no adverse outcomes of pregnancy or in a fetus have been reported among women who inadvertently received varicella vaccine shortly before or during pregnancy.
The risk of congenital varicella syndrome following varicella disease is small, so the risk of congenital anomalies following vaccination with live attenuated varicella zoster virus VZV -containing vaccine is probably very small.
Merck and the Centers for Disease Control and Prevention CDC jointly operated a pregnancy registry for women exposed to VZV-containing vaccines for seventeen years after the licensure of varicella vaccine.
The registry was discontinued in , having found no signals to indicate a risk of Congenital Varicella Syndrome or pattern of birth defects related to vaccination with VZV-containing vaccines. Healthcare providers may continue to report exposure to VZV-containing vaccines within 3 months of conception or during pregnancy by contacting Merck's call center at Scheduling Vaccines Back to top What is the recommended schedule for vaccinating a child?
What about adults? For children, the first dose should be given at age 12 months with a second dose given at age 4 through 6 years. The second dose could be given earlier, if necessary, as long as there is a 3-month interval between doses. All children age 13 years and older as well as adults without evidence of immunity should also have documentation of 2 doses of varicella vaccine, separated by a minimum interval of 4 weeks.
Some children in my practice have had only 1 dose of varicella vaccine. Is there a problem waiting until the to year-old visit to give them the second dose? Don't delay giving the second dose of varicella vaccine. Give the second dose the next time the child is in your office. In what circumstances should I obtain a varicella titer after vaccination? Postvaccination serologic testing is not recommended in any group, including healthcare personnel.
A child received only one dose of varicella vaccine and subsequently tests positive for varicella IgG antibody. Does the child still need a second dose of varicella vaccine? If a person tests positive for varicella antibody 28 days or more after vaccination, the Advisory Committee on Immunization Practices ACIP considers the person to be immune.
CDC prefers that the child receive a second dose to assure long-term immunity, but doing so is not absolutely necessary.
You can access the ACIP varicella vaccine recommendations, which include evidence of immunity page 16 at www. Should I test women for varicella immunity at their first prenatal visit? Test pregnant women who lack either 1 documentation of receipt of 2 doses of varicella vaccine or 2 healthcare provider diagnosis or verification of varicella or herpes zoster disease.
Women who are not immune should begin the 2-dose vaccination series immediately postpartum. What is the appropriate lab test to use to determine whether there has been previous chickenpox disease? Commercially available laboratory tests for varicella antibody are usually based on a technique called EIA enzyme immunoassay. Though these tests are sufficiently sensitive to detect antibody resulting from varicella zoster virus infection, they are generally not sensitive enough to detect vaccine-induced antibody.
The more sensitive assays needed to detect vaccine-induced antibody are not widely available. This is why CDC does not recommend antibody testing after varicella vaccination. I work in employee health. Several hospital employees have told me they have had chickenpox, but their titers show no antibodies. Should I offer varicella vaccination to them even though they insist they've had the illness? If you cannot verify a healthcare employee's history of chickenpox, the employee should receive 2 doses of varicella vaccine at least 4 weeks apart.
A nursing student received 2 valid, documented doses of varicella vaccine. For whatever reason, she subsequently had a titer drawn. The titer was negative. Do you recommend revaccination with 2 doses of varicella vaccine?
Documented receipt of 2 doses of varicella vaccine supersedes results of subsequent serologic testing. Most commercially available tests for varicella antibody are not sensitive enough to detect vaccine-induced antibody, which is why CDC does not recommend post-vaccination testing. A child in our practice received her first dose of varicella vaccine when she was 12 months old and her second dose when she was 14 months old.
The second dose was only 2 months after the first. Is the second dose valid or does it need to be repeated? The recommended minimum interval between two doses of varicella vaccine for children 12 months through 12 years of age is 12 weeks.
However, the second dose of varicella vaccine does not need to be repeated if it was separated from the first dose by at least 4 weeks. See www. Contraindications and Precautions Back to top What are the precautions and contraindications to varicella vaccine?
For information on vaccine components, refer to the manufacturer's package insert www. What are the recommendations for the use of varicella vaccine in children with HIV or other immunodeficiencies? The ACIP General Best Practice Guidelines for Immunization section on altered immunocompetence recommends varicella vaccination of children with humoral but not cellular immunodeficiencies.
Eligible children should receive 2 doses of varicella vaccine with a 3-month interval between doses. Additional details of these recommendations can be found in table and associated footnotes at www. We have a 40 lb six-year-old patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can we give the child MMR and varicella vaccine based on this methotrexate dosage? Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage can be reduced.
The IDSA definition of low-level immunosuppression for methotrexate is a dosage of less than 0. I had an year-old in the clinic today for varicella vaccination. He reports having antiphospholipid syndrome being treated with rituximab a drug that affects the function of lymphocytes.
The next dose of rituximab will be in 2 weeks. He has also had 12 immune globulin IG injections in the last year. The IDSA guidelines indicate that persons receiving rituximab should be considered to have high-level immunosuppression.
Both inactivated and live vaccines should be withheld at least 6 months following treatment with lymphocyte depleting medications such as rituximab. As for the IG, the interval to live vaccination depends on the dose. This interval could be as long as 11 months, depending on the dose he receives. Recently we had a one-year-old with congenital heart disease and who is on chronic aspirin therapy in for a well-child check and routine vaccination.
Are there any recommendations regarding varicella vaccine being given to children who are on chronic aspirin therapy? The ACIP's varicella vaccine recommendations state that no adverse events associated with the use of salicylates after varicella vaccination have been reported, however, the vaccine manufacturer recommends that vaccine recipients avoid using salicylates for 6 weeks after receiving varicella vaccines because of the association between aspirin use and Reye syndrome after varicella disease chickenpox.
Vaccination with subsequent close monitoring should be considered for children who have rheumatoid arthritis or other conditions requiring therapeutic aspirin. The risk for serious complications associated with aspirin is likely to be greater in children in whom natural varicella develops than it is in children who receive the vaccine containing attenuated varicella zoster virus.
In other words, the benefit of varicella vaccine likely outweighs the theoretical risk of Reye syndrome. See the ACIP varicella recommendations at www. After receiving varicella vaccine, should healthcare personnel avoid contact with immunocompromised patients?
Merck does not review or control the content at the site to which this link connects. Merck makes no representation with respect to the content of any non-Merck site. Skip to content. Do not administer this product intravascularly or intramuscularly. Discard if reconstituted vaccine is not used within 30 minutes.
Use a sterile syringe free of preservatives, antiseptics, and detergents for each reconstitution and injection of VARIVAX because these substances may inactivate the vaccine virus. To reconstitute the vaccine, first withdraw the total volume of provided sterile diluent into a syringe. Inject all of the withdrawn diluent into the vial of lyophilized vaccine and gently agitate to mix thoroughly.
A dose of recombinant herpes zoster vaccine Shingrix administered instead of varicella vaccine does not count as a dose of varicella vaccine. People who got the recombinant herpes zoster vaccine should be monitored for any serious adverse reactions. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Vaccines and Preventable Diseases. Section Navigation. Facebook Twitter LinkedIn Syndicate.
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