Varicella Vaccine

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
1. Contraindicated in pregnancy
2. May be safe in Lactation (see below)
Safe in mildly Immunocompromised children
1. Children with Leukemia
2. Marrow transplant recipient once recovered Immunity
3. Children with Human Immunodeficiency Virus

Absolute
1. Pregnancy
2. Serious illness
3. Severe Immunodeficiency
4. First degree relative with Immunodeficiency
  1. Transmission is rare (transmitted to 3 household contacts 1995-2005)
5. Active Tuberculosis
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 [PubMed]
3. Anaphylactic reaction previously to neomycin
Conditions not contraindicating Vaccine
1. Pregnant family member
2. Low grade fever
3. Diarrhea
4. Otitis Media or Upper Respiratory Infection

Underused Vaccine
1. Universal Vaccination is key
2. 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

Local injection site reaction (erythema, pain, swelling, Pruritus at Vaccination site)
1. Occurs in 17% of children (24% of teens and adults)
Fever (11.4 per 100,000 doses)
Varicella-like rash
1. Vesicular rash (~5 Vesicles) onset 7-21 days after Vaccination
2. Localized Varicella-Like Rash (at injection site): 3% of children
3. Generalized Varicella-Like Rash: 37 case reports (1995 to 2005 in U.S.)
4. 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
1. Pneumonia (5 total case reports)
2. Encephalitis (12 total case reports 1995 to 2005, U.S.)
3. Hepatitis
4. Mortality (2 case reports in history of Varicella Vaccine)

Two dose protocol regardless of age at first dose
Primary Series
1. Dose 1: Age 12 to 15 months
2. Dose 2: Age 4 to 6 years
Catch-up
1. Administer 2 doses at 3 months apart (interval may be as short at 4-8 weeks)
2. Consider checking Immune Status prior to administer
References
1. Kuter (2004) Pediatr Infect Dis 23:132-7 [PubMed]
2. Vasquez (2004) JAMA 291:851-5 [PubMed]