| Varicella (chickenpox) |
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| Affliction Issues |  | Vaccine Prophylactic | | | | | Vaccine Recommendations | | Varicella Zoster Immune Globulin | | | | | Scheduling Vaccines | | Storage and Handling | | | | | Contraindications and Precautions | | | |
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| Disease Issues |
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| How serious a disease is varicella (chickenpox)? |
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| Prior to the availability of varicella vaccine there were approximately iv one thousand thousand cases of varicella a year in the U.South. Though usually a mild disease in healthy children, an estimated 150,000 to 200,000 people developed complications, well-nigh 11,000 people required hospitalization and 100 people died each year from varicella. Varicella tends to be more than severe in adolescents and adults than in young children. The nigh mutual complications from varicella include bacterial superinfection of skin lesions, pneumonia, fundamental nervous system interest, and thrombocytopenia. |
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| How is varicella transmitted and for how long is an infected person contagious? |
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| The varicella zoster virus (VZV) spreads from person to person by direct contact or through the air past coughing or sneezing. Information technology is highly contagious. Information technology can too be spread through directly contact with fluid from a cicatrice of a person infected with varicella, or from directly contact with a skin lesion from a person with zoster (shingles). People with varicella are infectious 1 to 2 days before pare lesions appear until all lesions have crusted over, ordinarily four to 7 days after the advent of skin lesions. |
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| What tin be washed to protect a patient without testify of immunity who is exposed to varicella and is at loftier risk for severe affliction and complications? |
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| These patients should receive varicella zoster immune globulin (VariZIG, Saol Therapeutics). VariZIG given upward to 10 days after an exposure tin modify or prevent clinical varicella illness. See the Varicella Zoster Immune Globulin section below, and www.cdc.gov/mmwr/pdf/wk/mm6228.pdf, pages 574–6). for more information on this topic. |
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| What practice you lot give to a child younger than 1 year of age if they were exposed to the chickenpox or zoster virus? |
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| The minimum age for varicella vaccine is 12 months. Vaccination is not recommended for infants younger than 12 months of age even as post-exposure prophylaxis. CDC recommends that a healthy infant should receive no specific handling or vaccination after exposure to VZV. The kid can be treated with an appropriate antiviral medication if chickenpox occurs. |
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| Run across the Varicella Zoster Allowed Globulin section below for details on the recommended use of VariZIG in immunocompromised children, infants exposed to varicella around the fourth dimension of birth and some hospitalized preterm infants. |
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| Vaccine Recommendations | Back to summit | |
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| What varicella vaccines are available in the Us? |
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| Two vaccines containing varicella virus are licensed for use in the U.s.a.. Both vaccines contain alive, attenuated varicella zoster virus (VZV) derived from the Oka strain. |
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| • | | Varivax (VAR, Merck) contains just varicella vaccine virus. | | | | | • | | ProQuad (MMRV, Merck) is a combination measles, mumps, rubella, and varicella vaccine. | |
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| Both vaccines are administered past subcutaneous injection. VAR is approved past the Food and Drug Administration (FDA) for people 12 months of age and older. MMRV is approved for people 12 months through 12 years of age. MMRV should non be administered to people age 13 years or older. |
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| Who is recommended to be vaccinated confronting varicella? |
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| All children, beginning at age 12 months, likewise as adults without other prove of immunity (come across side by side question) should be vaccinated with ii doses of varicella vaccine. Special consideration should exist given to vaccinating adults who (1) have shut contact with people at loftier risk for astringent disease (e.1000., healthcare workers and family contacts of immunocompromised people), or (2) are at loftier adventure for exposure or transmission (e.yard., teachers of immature children; child care employees; residents and staff members of institutional settings, including correctional institutions; college students; war machine personnel; adolescents and adults living in households with children; non-pregnant women of childbearing age; and international travelers). |
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| What are the criteria for testify of amnesty to varicella? |
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| The Advisory Committee on Immunization Practices (ACIP) considers evidence of immunity to varicella to exist: |
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| • | | Written documentation of 2 doses of varicella vaccine given no earlier than age 12 months with at least 4 weeks between doses. | | | | | • | | U.S.-built-in before 1980* | | | | | • | | A healthcare provider'due south diagnosis of varicella or verification of history of varicella illness | | | | | • | | History of herpes zoster, based on healthcare provider diagnosis | | | | | • | | Laboratory testify of immunity or laboratory confirmation of disease | | | | | | *Note: year of nascency is not considered as evidence of amnesty for healthcare personnel, immunosuppressed people, and pregnant women. | |
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| Does ACIP recommend giving varicella vaccine to infants before age 1 yr if they are traveling internationally? |
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| No. ACIP recommends giving a dose of MMR to infants age 6 through 11 months before international travel, only not varicella vaccine. Varicella vaccine is neither approved nor recommended for children younger than age 12 months in any situation. |
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| Can varicella vaccine be used as postexposure prophylaxis for a 9-calendar month-old who was exposed to herpes zoster? |
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| Varicella vaccine is neither canonical nor recommended for children younger than historic period 12 months. Assuming that the child is not immunocompromised, varicella zoster allowed globulin (VariZIG) is also not recommended. If the child had a condition which was considered to identify the child at greater risk for complications than the general population, and so VariZIG could be considered (see the Varicella Zoster Immune Globulin section below and www.cdc.gov/mmwr/pdf/wk/mm6228.pdf, page 574–6). |
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| ACIP does not have a recommendation for acyclovir for varicella postexposure prophylaxis. The American University of Pediatrics provide some guidance on this result in the electric current edition of the Reddish Book. |
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| If a healthcare worker does non have a history of varicella vaccination or illness but has had a clinically diagnosed case of shingles, does she or he even so demand varicella vaccination? |
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| No. A healthcare provider'southward diagnosis or verification of a history of shingles is acceptable evidence of immunity to varicella. According to ACIP, acceptable prove of varicella immunity in healthcare personnel includes (1) documentation of 2 doses of varicella vaccine given at to the lowest degree 28 days apart, (2) history of varicella or herpes zoster based on clinician diagnosis, (3) laboratory bear witness of immunity, or (4) laboratory confirmation of affliction. |
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| I have a patient who is 62 years old and is immigrating to the U.S. She received a dose of live zoster vaccine at age 60. The immigration requirements state she should receive 2 doses of varicella vaccine. Does she need additional varicella vaccine? |
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| To meet the immigration requirements, the dose of live zoster vaccine counts as the first dose of the varicella vaccine series. You should give a dose of varicella vaccine now since it has been more than iv weeks since the dose of live zoster vaccine. The varicella vaccine dose may not be needed, simply information technology will not be harmful and will allow your patient to meet the regulatory requirement. Note that if the vaccine she received was recombinant zoster vaccine (RZV, Shingrix, GlaxoSmithKline) it does NOT count as the kickoff of ii doses of varicella vaccine. |
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| Concerning the recommendation for a second dose of varicella vaccine, does CDC recommend that a teen who received only one varicella vaccine when they were preschool age get a second dose at present? |
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| Aye. The current recommendation is for two doses regardless of historic period, for anyone school age and older without evidence of immunity. For anybody whose varicella amnesty is based on vaccination, 2 doses of varicella vaccine are recommended. |
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| Originally, ACIP just recommended ane dose of varicella vaccine for children. Why did ACIP later revise its recommendations to add a second dose of varicella vaccine for all children? |
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| In the ten years post-obit vaccine licensure in 1995, in that location was a significant decline in varicella affliction, as well equally varicella-related hospitalizations and deaths. Although a 1-dose regimen was estimated to be lxxx% to 85% effective, breakthrough disease was still occurring in highly vaccinated populations. A two-dose regimen was adopted in 2006 to further reduce the gamble of disease among vaccinated people whose numbers would accumulate over time, which could lead to varicella disease later on in life when it can exist more severe. |
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| Should a child who has had chickenpox prior to the beginning altogether become the commencement dose of varicella vaccine at age 1 year? |
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| If the child had confirmed varicella disease or laboratory evidence of prior affliction, information technology is not necessary to vaccinate regardless of age at infection. If there is any doubtfulness that the disease was actually varicella, the child should be vaccinated. |
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| How important is it to vaccinate older children and adults? |
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| Information technology is disquisitional to vaccinate susceptible older children and adults whenever the opportunity arises. With younger children being routinely vaccinated, the chance of being exposed to cases of chickenpox is decreasing. Older children, adolescents, and adults who have non had chickenpox now accept a greater chance of remaining susceptible. These older individuals, when they contract chickenpox, are more likely to become seriously ill and have affliction complications than younger children. |
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| If an adult or child has non had documented chickenpox merely has had shingles, is varicella vaccination recommended? |
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| No. Shingles is caused by varicella zoster virus, the same virus that causes chickenpox. A history of shingles based on a healthcare provider diagnosis is evidence of amnesty to chickenpox. A person who has had shingles does not demand to be vaccinated against varicella. He/she should notwithstanding receive zoster vaccine, nevertheless, if it is not contraindicated and he/she is age 50 or older. |
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| Tin we have receipt of a unmarried documented dose of live zoster vaccine as proof of varicella immunity in a healthcare employee who has no other evidence of immunity? |
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| No. Receipt of alive zoster vaccine is not proof of prior varicella illness. According to CDC, adequate prove of varicella immunity in healthcare personnel includes (one) documentation of ii doses of varicella vaccine given at to the lowest degree 28 days apart, (2) history of varicella or herpes zoster based on clinician diagnosis, (three) laboratory evidence of immunity, or (4) laboratory confirmation of affliction. If a healthcare employee has received a dose of live zoster vaccine in the past but has no other evidence of immunity to varicella, the alive zoster dose can be considered the kickoff dose of the 2-dose varicella series. Notation that recombinant zoster vaccine (RZV, Shingrix) cannot be counted as the first dose in a 2-dose varicella vaccination series. |
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| Should a person who received 2 doses of varicella vaccine be vaccinated for canker zoster when they turn 50? |
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| In its 2018 recommendations for the prevention of herpes zoster, ACIP states that Shingrix may be used in adults age 50 years or older irrespective of prior receipt of varicella vaccine or live zoster vaccine (Zostavax, Merck). For details, see www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6703a5-H.pdf. |
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| If a child has a very mild case of chickenpox (for example, just five to 10 pox), is s/he immune or should south/he be vaccinated? |
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| A mild case of chickenpox produces immunity to varicella every bit does a moderate or severe case. A child with a reliable history of chickenpox does not need to receive varicella vaccine. However, if in that location is any dubiousness that the mild illness actually was chickenpox, it is best to vaccinate the kid. There is no harm in vaccinating a kid who is already immune. |
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| I empathise that varicella vaccine can exist used in postexposure settings. How soon subsequently exposure does the vaccine need to be administered? |
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| Varicella vaccine is effective in preventing chickenpox or reducing the severity of the illness if used inside 72 hours (three days), and possibly up to 5 days after exposure. Still, not every exposure to varicella leads to infection, and then for future immunity, varicella vaccine should be given, fifty-fifty if more than 5 days have passed since an exposure. |
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| A healthcare worker with no history of chickenpox, and unknown serologic immunity, was exposed to a patient with zoster. She received varicella vaccine 2 days later. She developed a pruritic maculopapular rash 11 days afterwards vaccination. Is the rash from the vaccine or from her zoster exposure? |
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| The simply manner to determine whether the rash is acquired by wild-type varicella or vaccine virus is to attempt to isolate virus from the rash and send it to a laboratory that is capable of differentiating wild and vaccine-type virus. This is mostly not practical. Given the history, the bourgeois approach is to assume she has an active example of chickenpox and deed according to your infection control guidelines. |
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| Does varicella vaccine affect tuberculosis peel test readings in the same way that MMR does? |
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| There is currently no information on the result of varicella vaccine on reactivity to a tuberculin skin examination (TST). Until data is available, it is prudent to apply the aforementioned rules to varicella vaccine as are practical to MMR: a TST (i.east., PPD) may exist applied before (preferably) or simultaneously with varicella vaccine. If vaccine has been given, delay the TST for at least 4 weeks. |
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| How has widespread use of varicella vaccine in children impacted disease? |
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| Substantial reductions in varicella morbidity and bloodshed have occurred following the licensure of vaccine. Reported cases of varicella have fallen more than 95%. For more information on the impact of varicella vaccination meet the CDC varicella webpage at www.cdc.gov/chickenpox/surveillance/monitoring-varicella.html. |
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| What are the recommendations for varicella vaccination before and after pregnancy? |
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| Live varicella vaccine should non 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, two doses of vaccine should exist given, spaced 4 to 8 weeks apart. Pregnant women should be assessed for show of varicella amnesty and if not-immune, should receive the first dose of varicella vaccine post-obit completion of the pregnancy and prior to hospital discharge. A second dose should be given four to 8 weeks later. |
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| 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 failing titer, thus making her susceptible to the virus over again? |
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| People with a reliable history of varicella can be considered to exist immune. A reliable history for healthcare personnel consists of (1) a healthcare provider's diagnosis of varicella or verification of history of varicella disease; (two) a history of canker zoster, based on healthcare provider diagnosis; or (3) laboratory testify of immunity or laboratory confirmation of disease. Immunity following disease or vaccination is probably life-long. More one primary infection with varicella is unusual. |
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| Should all pregnant women have serology screening for varicella? |
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| No. Serologic testing for varicella should exist considered only for women who exercise not have prove of immunity (reliable history of chickenpox or documented vaccination). Once a person has been plant to be seropositive, information technology is not necessary to exam again in the time to come. |
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| If a woman receives varicella vaccine, how long should she look before becoming meaning? |
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| Reverse to the information provided in the vaccine packet insert, which states that pregnancy should be avoided for 3 months, the ACIP recommends that a expect of 1 month is sufficient. |
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| If a woman receives varicella vaccine and subsequently finds out that she is meaning, what should she be told nigh the risk to the fetus? |
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| To date, no adverse outcomes of pregnancy or in a fetus have been reported among women who inadvertently received varicella vaccine before long before or during pregnancy. The risk of congenital varicella syndrome following varicella affliction is small-scale, and then the hazard of congenital anomalies following vaccination with live attenuated varicella zoster virus (VZV)-containing vaccine is probably very small. |
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| Merck and the Centers for Illness 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 2013, having found no signals to indicate a gamble of Congenital Varicella Syndrome or pattern of birth defects related to vaccination with VZV-containing vaccines. Healthcare providers may go on to report exposure to VZV-containing vaccines within 3 months of conception or during pregnancy by contacting Merck's call center at 1-877-888-4231. |
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| How has widespread use of varicella vaccine in children impacted disease? |
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| Substantial reductions in varicella morbidity and mortality have occurred following the licensure of vaccine. Reported cases of varicella have fallen more than 95%. For more than data on the impact of varicella vaccination encounter the CDC varicella webpage at www.cdc.gov/chickenpox/surveillance/monitoring-varicella.html. |
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| Scheduling Vaccines | Back to summit | |
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| What is the recommended schedule for vaccinating a child? What about adults? |
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| For children, the kickoff dose should be given at historic period 12 months with a second dose given at age 4 through 6 years. The 2d dose could be given earlier, if necessary, every bit long as there is a three-month interval between doses. All children age 13 years and older as well every bit adults without prove of immunity should as well accept documentation of 2 doses of varicella vaccine, separated by a minimum interval of 4 weeks. |
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| Some children in my practice have had merely 1 dose of varicella vaccine. Is there a problem waiting until the xi- to 12-twelvemonth-quondam visit to give them the 2d dose? |
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| Don't delay giving the second dose of varicella vaccine. Give the second dose the next fourth dimension the child is in your role. The recommendation to routinely give a second dose at age 4 through half-dozen years is intended to provide improved protection in the xv% to 20% of children who do not adequately respond to the first dose. |
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| In what circumstances should I obtain a varicella titer later on vaccination? |
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| Postvaccination serologic testing is non recommended in any group, including healthcare personnel. |
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| A child received merely 1 dose of varicella vaccine and subsequently tests positive for varicella IgG antibody. Does the child nevertheless need a 2d dose of varicella vaccine? |
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| 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 2nd dose to assure long-term immunity, but doing and so is not absolutely necessary. You can access the ACIP varicella vaccine recommendations, which include evidence of immunity (page 16) at www.cdc.gov/mmwr/pdf/rr/rr5604.pdf. |
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| Should I test women for varicella amnesty at their first prenatal visit? |
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| Examination pregnant women who lack either (1) documentation of receipt of 2 doses of varicella vaccine or (ii) healthcare provider diagnosis or verification of varicella or herpes zoster illness. Women who are not allowed should brainstorm the 2-dose vaccination serial immediately postpartum. |
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| What is the advisable lab examination to utilise to determine whether in that location has been previous chickenpox illness? |
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| Commercially available laboratory tests for varicella antibody are normally 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 more often than not not sensitive enough to find vaccine-induced antibody. The more sensitive assays needed to detect vaccine-induced antibody are not widely available. This is why CDC does not recommend antibiotic testing after varicella vaccination. |
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| I piece of work in employee health. Several hospital employees take told me they have had chickenpox, simply their titers evidence no antibodies. Should I offer varicella vaccination to them even though they insist they've had the illness? |
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| If yous cannot verify a healthcare employee's history of chickenpox, the employee should receive 2 doses of varicella vaccine at least 4 weeks apart. For details, refer to pages sixteen and 26 of the CDC recommendations Prevention of Varicella at www.cdc.gov/mmwr/pdf/rr/rr5604.pdf. |
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| A nursing student received 2 valid, documented doses of varicella vaccine. For whatever reason, she afterward had a titer drawn. The titer was negative. Practise yous recommend revaccination with 2 doses of varicella vaccine? |
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| No. Documented receipt of two doses of varicella vaccine supersedes results of subsequent serologic testing. Nigh commercially bachelor tests for varicella antibody are not sensitive plenty to discover vaccine-induced antibiotic, which is why CDC does non recommend mail service-vaccination testing. For more than information, meet page 24 of ACIP'due south Immunization of Wellness-Intendance Personnel, available at world wide web.cdc.gov/mmwr/pdf/rr/rr6007.pdf. |
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| A child in our practice received her start dose of varicella vaccine when she was 12 months old and her 2d dose when she was 14 months old. The second dose was but 2 months afterward the first. Is the second dose valid or does it need to be repeated? |
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| 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 offset dose by at least 4 weeks. Meet world wide web.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html, Table three-1. |
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| Contraindications and Precautions | Dorsum to top | |
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| What are the precautions and contraindications to varicella vaccine? |
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| Precautions: |
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| • | | Recent receipt (within the previous xi months) of antibody-containing blood product (specific interval depends on product) | | | | | • | | Moderate or severe acute illness with or without fever | | | | | • | | Utilise of aspirin or aspirin-containing products | | | | | • | | Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours earlier vaccination (avoid use of these antiviral drugs for 14 days after vaccination) | |
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| Contraindications: |
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| • | | history of a serious allergic reaction (e.k., anaphylaxis) after a previous dose of varicella vaccine or to a varicella vaccine component. For information on vaccine components, refer to the manufacturer'due south package insert (www.immunize.org/fda) or become to world wide web.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-tabular array-2.pdf. | | | | | • | | meaning now or may get significant within ane calendar month | | | | | • | | known severe immunodeficiency (east.thou., from hematologic and solid tumors, receipt of chemotherapy, built immunodeficiency, long-term immunosuppressive therapy [eastward.g., two weeks or more of daily receipt of twenty mg or more than, or 2 mg/kg body weight or more than, of prednisone or equivalent] or patients with HIV infection who are severely immunocompromised [a child historic period 1 through 5 years with CD4+ T-lymphocyte per centum less than fifteen% or a person age half-dozen years or older with a CD4+ T-lymphocyte count less than 200 cells per microliter]) | | | | | • | | family history of built or hereditary immunodeficiency in commencement-degree relatives (east.g., parents, siblings) unless the immune competence of the potential vaccine recipient has been clinically substantiated or verified by a laboratory | | | | | • | | for combination MMRV only (approved only for children 1 through 12 years of age), main or acquired immunodeficiency, including immunosuppression associated with AIDS or other clinical manifestations of HIV infections, cellular immunodeficiency, hypogammaglobulinemia, and dysgammaglobulinemia. | |
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| For additional information, see the ACIP General Best Practice Guidelines for Immunization department on contraindications and precautions, table 4–1 and associated footnotes, at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html or consult IAC'south "Guide to Contraindications and Precautions to Commonly Used Vaccines" at www.immunize.org/catg.d/p3072a.pdf. |
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| What are the recommendations for the use of varicella vaccine in children with HIV or other immunodeficiencies? |
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| The ACIP General Best Exercise Guidelines for Immunization section on contradistinct immunocompetence recommends varicella vaccination of children with humoral (but not cellular) immunodeficiencies. In add-on, single-antigen varicella vaccine should be considered for HIV-infected children historic period ane through v years with CD4+ T-lymphocyte percentages greater than or equal to fifteen% for at to the lowest degree 6 months or for children historic period 6 years and older with CD4+ T-lymphocytes count greater than or equal to 200 cells per microliter for at to the lowest degree 6 months. Eligible children should receive two doses of varicella vaccine with a 3-calendar month interval between doses. Boosted details of these recommendations tin can be plant in tabular array 8-1 and associated footnotes at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html. |
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| We have a 40 lb six-year-erstwhile patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can we requite the child MMR and varicella vaccine based on this methotrexate dosage? |
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| Based on the weight and dosage provided (40 lbs and 15 mg/week), the child is currently receiving more than 0.4 mg/kg/calendar week of methotrexate. This meets the Communicable diseases Society of America (IDSA) definition of high-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time every bit the methotrexate dosage can be reduced. The 2013 IDSA definition of low-level immunosuppression for methotrexate is a dosage of less than 0.4 mg/kg/week. For boosted details, encounter the 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early/2013/eleven/26/cid.cit684.full.pdf. |
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| I had an 18-twelvemonth-sometime in the clinic today for varicella vaccination. He reports having antiphospholipid syndrome beingness treated with rituximab (a drug that affects the function of lymphocytes). The adjacent dose of rituximab will be in 2 weeks. He has also had 12 immune globulin (IG) injections in the final twelvemonth. Should he become the varicella vaccine at all with this condition, and if and then, what time frame do nosotros demand to be concerned with in relation to the rituximab treatment and/or IG? |
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| The IDSA guidelines indicate that persons receiving rituximab should exist considered to have high-level immunosuppression. Both inactivated and live vaccines should be withheld at least vi months following treatment with lymphocyte depleting medications such equally rituximab. As for the IG, the interval to live vaccination depends on the dose. For guidance, please refer to the Timing and Spacing of Immunobiologics section of the ACIP'south General Best Practices Guidelines for Immunization, table 3–5: "Recommended intervals between assistants of antibody-containing products and measles- or varicella-containing vaccine, by product and indication for vaccination" at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html. This interval could exist equally long as xi months, depending on the dose he receives. |
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| Recently we had a one-yr-old with congenital centre disease and who is on chronic aspirin therapy in for a well-kid check and routine vaccination. Are there whatsoever recommendations regarding varicella vaccine existence given to children who are on chronic aspirin therapy? |
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| The ACIP'due south varicella vaccine recommendations state that no adverse events associated with the utilise of salicylates after varicella vaccination have been reported, however, the vaccine manufacturer recommends that vaccine recipients avoid using salicylates for half dozen weeks after receiving varicella vaccines because of the association between aspirin use and Reye syndrome after varicella affliction (chickenpox). Vaccination with subsequent shut monitoring should be considered for children who take rheumatoid arthritis or other conditions requiring therapeutic aspirin. The risk for serious complications associated with aspirin is likely to exist 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 do good of varicella vaccine probable outweighs the theoretical risk of Reye syndrome. Encounter the ACIP varicella recommendations at www.cdc.gov/mmwr/PDF/rr/rr5604.pdf, folio 29. |
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| Afterwards receiving varicella vaccine, should healthcare personnel avoid contact with immunocompromised patients? |
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| This is not necessary unless the person who was vaccinated develops a rash. |
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| Is in that location any concern when giving varicella vaccine to a child who lives with a susceptible pregnant woman or an immunocompromised individual? |
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| ACIP recommends varicella vaccine for healthy household contacts of significant women and immunosuppressed people. Although there may be a small take chances of manual of varicella vaccine virus to household contacts, the take a chance is much greater that the susceptible kid volition exist infected with wild-blazon varicella, which could present a more serious threat to household contacts. |
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| A pediatric surgeon'due south 12-calendar month-old kid received the varicella vaccine and 2 weeks after developed a varicella-like rash. The surgeon had chickenpox as a child and had a positive varicella titer several years ago. Is it okay for the surgeon to continue to run into patients? Also, is the varicella virus in the rash that develops following vaccination as virulent as the wild-type virus? |
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| Considering the surgeon is immune, the child's rash is not a problem and there is no demand for the surgeon to restrict activity. In comparing a vaccine rash to wild-type chickenpox infection, transmission is less likely with a vaccine rash and, in general, in that location are fewer peel lesions. |
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| If a patient is breast-feeding her half dozen-month-erstwhile baby, can she receive varicella vaccine without the run a risk of transmitting the vaccine virus to her baby? |
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| There has been only one published report of mother to child transmission of varicella vaccine virus. If the susceptible adult female were to be infected with wild varicella virus, the gamble of manual to the infant would be much higher. Breastfeeding is non a contraindication or a precaution to varicella vaccination of the mother when vaccination is indicated. |
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| A 10-year-old girl came to our immunization dispensary, and the nurse noted crusted lesions on her arms and legs. The parent said the child had had chickenpox a week earlier. The girl was not ill, and so we vaccinated her. Merely at present I wonder if her recent example of chickenpox might interfere with her allowed response to vaccines. |
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| A previous history of chickenpox disease, even recent disease, is non known to interfere with the immune response to different vaccines. To review the true contraindications and precautions to vaccination, consult IAC's "Guide to Contraindications and Precautions to Commonly Used Vaccines" at www.immunize.org/catg.d/p3072a.pdf. |
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| Some other helpful resource is ACIP'southward Full general All-time Practice Guidelines for Immunization. It contains a useful tabular array titled "Weather condition incorrectly perceived every bit contraindications or precautions to vaccination (i.eastward., vaccines may be given under these atmospheric condition)". The table is bachelor at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/contraindications.html, Tabular array iv-2. |
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| Nosotros accept a patient who has selective IgA deficiency. We also have patients with selective IgM deficiency. Tin MMR or varicella vaccine be administered to these patients? |
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| There is no known run a risk associated with MMR or varicella vaccination in someone with selective IgA or IgM deficiency. It is possible that the allowed response may be weaker, but the vaccines are probable effective. |
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| Vaccine Safety | Back to meridian | |
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| How condom is varicella vaccine? |
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| Varicella vaccine is very safe. Most twenty% of vaccine recipients will accept minor injection site complaints, such as pain, swelling, or redness. Fewer than 5% of recipients develop a localized or generalized varicella-like rash v to 26 days after vaccination. These rashes have an average of two to five lesions, and may be maculopapular rather than vesicular. Fever post-obit varicella vaccine is uncommon. |
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| If a child had one varicella vaccination and developed a vesicular (chickenpox-like) rash at the vaccination site 7 to 10 days after vaccination, does the patient still need the second dose? What if the rash covered the entire trunk? |
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| If y'all believe the child had varicella disease (that is, breakthrough varicella) after the start dose, the child does not need another dose. If you are uncertain whether the kid had varicella, the second dose should be administered on schedule. If in doubt, give the second dose. If this was a case of breakthrough varicella, a 2d dose will not be harmful. |
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| If a child breaks out in five to ten maculopapular spots 2 weeks post-obit varicella vaccination, can s/he become to school? |
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| Transmission of varicella vaccine virus is a rare event, and appears to occur only when the vaccinated person develops a vesicular rash. A maculopapular rash 2 weeks after varicella vaccine may not accept been caused by the vaccine. If the rash were caused past the vaccine, the risk of transmission is very small; however, the child should avoid close contact with people who do non have evidence of varicella immunity and who are at high risk of complications of varicella, such as immunocompromised people, until the rash has resolved. |
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| If a vaccinated child gets 5 to 10 vesicular lesions 2 weeks after vaccination, tin due south/he attend school? |
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| You lot cannot distinguish a mild case of varicella disease from a rash caused by the vaccine. The child may take been infected with varicella at nearly the same time s/he was vaccinated. The conservative approach would be to treat the child as if south/he had chickenpox and restrict her/his activities until all the lesions chaff. |
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| If a child gets quantum varicella infection, about l lesions, tin can s/he go to schoolhouse? |
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| Breakthrough varicella represents replication of wild varicella virus in a vaccinated person. Although most breakthrough illness is very balmy, the kid is contagious and activities should be restricted to the aforementioned extent as an unvaccinated person with varicella affliction. |
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| Can a immature kid, who was recently vaccinated for chickenpox, spread the vaccine virus to other household members? |
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| Available information suggest that healthy children are unlikely to transmit vaccine virus. Transmission of vaccine virus to a household contact has rarely been documented. Information technology appears that transmission of vaccine occurs mostly, or perhaps even exclusively, when the vaccinated person develops a rash following vaccination. |
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| If a person develops a rash later on receiving varicella vaccination, does he need to be isolated from susceptible people who are either significant or immunosuppressed? |
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| Transmission of varicella vaccine virus is rare. All the same, if a pregnant or immunosuppressed household contact of a vaccinated person is known to be susceptible to varicella, and if the vaccinee develops a rash 7 to 21 days following vaccination, information technology is prudent that they avoid prolonged close contact with the susceptible person until the rash resolves. |
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| An 8-calendar month-old was erroneously given varicella vaccine. What might the consequences be? What should we do now? |
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| An 8-month-old is likely to take residual passive varicella antibody from his or her female parent. The vaccine probably will take no effect, and no activity is necessary. The dose should not be counted, and the kid should exist revaccinated on schedule at 12 through 15 months of age. |
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| Varicella Zoster Immune Globulin | Back to height | |
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| What is varicella zoster immune globulin? |
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| Varicella zoster allowed globulin (VariZIG, Saol Therapeutics) is a homo blood product prepared from plasma obtained from good for you, volunteer blood donors identified by routine screening to have high antibiotic titers to varicella-zoster virus. The first varicella zoster immune globulin, VZIG, became available in 1978. In a study of immunocompromised children who were administered VZIG within 96 hours of exposure, approximately i in five exposed children developed clinical varicella, and one in 20 adult subclinical disease compared with 65%—85% attack rates amid historical controls. In 2006, VZIG was discontinued and a new product, VariZIG, became bachelor. |
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| In what circumstances should I consider giving VariZIG? |
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| According to CDC the decision to administer VariZIG depends on three factors: 1) whether the patient lacks evidence of amnesty to varicella, 2) whether the exposure is likely to effect in infection, and 3) whether the patient is at greater take chances for varicella complications than the general population. For high-gamble patients who have boosted exposures to varicella-zoster virus 3 weeks or longer after initial VariZIG assistants, another dose of VariZIG should be considered. The most recent recommendations for the utilise of VariZIG were published in 2013 and are available at www.cdc.gov/mmwr/pdf/wk/mm6228.pdf, pages 574–half dozen. |
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| What groups of patients are eligible for VariZIG? |
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| VariZIG is recommended for patients without evidence of immunity to varicella who are at loftier risk for astringent varicella and complications, who have been exposed to varicella or herpes zoster, and for whom varicella vaccine is contraindicated. Patient groups recommended by CDC to receive VariZIG include the following: |
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| • | | Immunocompromised patients without evidence of immunity | | | | | • | | Newborn infants whose mothers take signs and symptoms of varicella around the time of delivery (i.e., 5 days earlier to 2 days after) | | | | | • | | Hospitalized preterm infants born at 28 weeks or more than of gestation whose mothers do not have evidence of immunity to varicella | | | | | • | | Hospitalized preterm infants born at less than 28 weeks of gestation or who counterbalance 1,000 grams or less at birth, regardless of their mothers' show of immunity to varicella | | | | | • | | Significant women without show of immunity | |
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| CDC recommends administration of VariZIG as soon as possible after exposure to varicella-zoster virus, ideally within 96 hours, up to x days after exposure. |
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| What is the recommended dosage of VariZIG? |
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| VariZIG is supplied in 125-IU vials and should be administered intramuscularly every bit directed by the manufacturer. The recommended dose is 125 IU/x kg of trunk weight, up to a maximum of 625 IU (five vials). The minimum dose is 62.v IU (0.5 vial) for patients weighing two.0 kg or less and 125 IU (1 vial) for patients weighing 2.1–10.0 kg. VariZIG is bachelor from Saol Therapeutics. For ordering information see varizig.com/liquid-product_info.html. |
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| A one-month-old baby was exposed for the last 6 days to chickenpox. What should be done to protect the exposed baby, who is also young to vaccinate? |
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| In that location is no testify that good for you full-term infants born to women in whom varicella occurs more than than 48 hours later commitment are at increased adventure for serious complications such as pneumonia or death. Varicella zoster immune globulin, VariZIG, tin can exist given up to 10 days after exposure but is only recommended for newborn infants whose mothers take signs and symptoms of varicella around the time of delivery (5 days before to 2 days after), hospitalized premature infants born at 28 or more weeks of gestation whose mothers practise not have evidence of immunity to varicella, or hospitalized premature infants born at less than 28 weeks of gestation or who counterbalance one,000 grams or less at nativity regardless of their mothers' evidence of amnesty to varicella. Assuming this is an baby at home, VariZIG would not exist recommended. Varicella, if it develops, would exist managed as for whatsoever child. |
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| Storage and Treatment | Back to summit | |
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| How should varicella vaccine be stored in my clinic? |
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| Live varicella-containing vaccines (varicella, MMRV) must be stored in a freezer at a temperature between -fifty°C and -15°C (between -58°F and +v°F) until reconstitution and assistants. These vaccines can deteriorate chop-chop later on they are removed from the freezer. A separate stand-lonely freezer should be used to store frozen vaccines that require storage temperatures between -l°C and -xv°C (betwixt -58°F and +5°F). A stand-alone storage unit that is frost-free or has an automated defrost bicycle is preferred. Frozen vaccines should not exist stored in the freezer compartment of a combination unit because household freezers cannot maintain proper storage temperatures for frozen vaccines. This applies to both temporary and long-term storage of frozen vaccines. The diluents should exist kept separately in the refrigerator or at room temperature. Alive varicella-containing vaccines must exist administered within 30 minutes of reconstitution. |
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| What happens if you put varicella vaccine in the refrigerator instead of the freezer? |
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| Vaccine will be damaged if non stored co-ordinate to the manufacturer'southward instructions. Yet, information technology may still be possible to use vaccine that has non been properly stored. Put the affected vaccine vials into the freezer afterward y'all have marked them so they are not confused with the unaffected vials, then call the manufacturer at 1-800-9-VARIVAX (ane-800-982-7482) for further guidance about whether the vaccine is still usable. Unreconstituted varicella vaccine may exist stored in the refrigerator for up to 72 hours earlier use. If refrigerated varicella vaccine is not used within 72 hours, information technology should exist discarded. |
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| If you have inadvertently left your vaccine at room temperature instead of in the freezer or have experienced a power failure, characterization the afflicted vaccine to keep information technology separated from unaffected vaccine and return it to recommended storage conditions in a freezer promptly, then contact the manufacturer for further guidance. Practise not administer the vaccine until y'all take consulted with Merck. |
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| How can I send varicella vaccine? What if I exercise not have access to a portable freezer? |
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| The vaccine manufacturer does non recommend transporting varicella-containing vaccines (varicella, MMRV). If these vaccines must exist transported (for example during an emergency), CDC recommends use of a portable vaccine freezer unit or qualified container and packout that maintains temperatures betwixt -50°C and -15°C (- 8°F and +v°F). Exercise non employ dry ice, even for temporary storage. Dry ice might expose the vaccines to temperatures colder than -l°C (-58°F). |
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| Follow these steps for transporting frozen vaccines: |
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| • | | Place a temperature monitoring device (preferably with a buffered probe) in the container as shut equally possible to the vaccines. | | | | | • | | Immediately upon arrival at the destination, unpack the vaccines and place them in a freezer at a temperature range betwixt -fifty°C and -xv°C (-58°F and +5°F) . Any stand-alone freezer that maintains these temperatures is acceptable. | | | | | • | | Record the time vaccines are removed from the storage unit of measurement and placed in the transport container, the temperature during transport, and the time at the end of transport when vaccines are placed in a stable storage unit. | |
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| If necessary, varicella-containing vaccines may exist transported or stored at refrigerator temperature between two°C and 8°C (between 36°F and 46°F) for up to 72 continuous hours prior to reconstitution. To do and so, follow the steps above using a portable vaccine refrigerator unit or a qualified container and packout designed to maintain vaccine storage temperatures betwixt 2°C and 8°C (between 36°F and 46°F). |
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| Transport of varicella-containing vaccine at temperatures other than the recommended range between -50°C and -15°C (-58°F and +v°F) is considered a temperature circuit, and then contact Merck at (800) 982-7482 for farther guidance. Do not discard vaccines without contacting the manufacturer and/or your immunization program for guidance. |
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| For additional guidance, meet the CDC Vaccine Storage and Handling Toolkit at www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf. |
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| I was told by a coworker that varicella vaccine tin be stored at refrigerator temperature for up to three days and still be used. Is this true? |
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| Yes. According to the manufacturer, unreconstituted varicella vaccine may be stored at refrigerator temperature (ii°C to 8°C, 36°F to 46°F) for up to 72 continuous hours prior to reconstitution. Vaccine stored at 2°C to 8°C that is not used within 72 hours of removal from-15°C (+5°F) storage should be discarded. See www.merck.com/product/usa/pi_circulars/5/varivax/varivax_pi.pdf. |
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