NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
US Public Health Service. Office of Disease Prevention and Health Promotion. Clinician's Handbook of Preventive Services. 2nd edition. Washington (DC): Department of Health and Human Services (US); 1999.
This publication is provided for historical reference only and the information may be out of date.
Approximately 3.9 million cases of primary varicella-zoster virus (VZV) disease (chickenpox) occur annually in the United States. Chickenpox is typically a mild disease but may be severe in newborn infants, immunocompromised persons, and susceptible adults. Approximately 90 fatal cases of chickenpox are reported annually. Infants born to women who contract varicella in the first or second trimester of pregnancy may be afflicted with congenital varicella syndrome, with abnormalities in the skin, limbs, eyes, and central nervous system. In approximately 15% of chickenpox cases, subsequent reactivation in the form of zoster (shingles) occurs; shingles is particularly prevalent and severe in persons who are elderly or immunocompromised.
A varicella vaccine was licensed for use in the United States in 1995. A similar vaccine has been widely used in Japan and Korea. The varicella vaccine has been shown to be highly efficacious in children (70% to 90% effective at preventing all clinical disease, 95% effective at preventing severe disease). Clinical disease that does occur in vaccinated children tends to be less severe than that experienced by nonimmunized children. Varicella vaccine has not been as well studied in adults. Because adults tend to have a poorer immune response to the vaccine, two doses are required to achieve optimal conversion rates. Chickenpox results in considerable costs to society in the form of hospitalizations, lost days of schooling, and lost days of work. Cost-benefit analysis has indicated that routine use of varicella vaccine in children at 1 year of age would result in savings of $384 million per year in the United States.
Recommendations of Major Authorities
Children/Adolescents
- Advisory Committee on Immunization Practices (ACIP), American Academy of Family Physicians, American Academy of Pediatrics (AAP), and US Preventive Services Task Force --
- Clinicians should routinely vaccinate children between the ages of 12 and 18 months. Children within this age range who have a prior history of chickenpox do not need to be immunized, although the ACIP has stated that it is acceptable to do so. Immunization is also recommended for children 19 months to 12 years of age who lack a prior history of immunization or clinical disease. Serologic testing of children before vaccination is not warranted, because most children aged 12 months to 12 years who do not have a history of chickenpox are susceptible, and the vaccine is well tolerated in seropositive persons. The AAP states that clinicians may decide to offer serologic testing to healthy adolescents who may be susceptible to VZV.
Adults
- Advisory Committee on Immunization Practices (ACIP) and US Preventive Services Task Force --
- Given the high prevalence of immunity in adults who have no history of chickenpox and the results of cost-effectiveness analysis, clinicians may wish to offer serologic testing for varicella susceptibility in lieu of routine immunization to history-negative adults who are likely to comply with return visits. ACIP and Centers for Disease Control and Prevention (CDC) recommend vaccination for susceptible persons aged 13 years and over who have close contact with persons at high risk for serious complications (eg, health-care workers and family contacts of immunocompromised persons). ACIP and CDC further state that vaccination should be considered for susceptible persons aged 13 years and over who: (1) live or work in environments in which transmission of VZV is likely (eg, teachers of young children, day-care workers, residents and staff in institutional settings); (2) live or work in environments in which transmission may occur (eg, college students, military personnel); (3) are women of childbearing age (if not pregnant and willing to avoid pregnancy for 1 month); and/or (4) travel internationally (especially if the traveler expects to have close personal contact with local populations).
Basics of Varicella Vaccination
1. Vaccine Types
The single vaccine available in the United States (Varivax®, Merck and Co, Inc) is a live, cell-free preparation. A multiple-antigen, measles-mumps-rubella-varicella (MMR) vaccine is currently being tested.
2. Schedule
Children should receive a single vaccination between 12 and 18 months of age. Older children, up to 12 years of age, should also receive a single vaccination at the earliest convenient date. Children and healthy adults who are immunized after age 13 years should receive two doses of varicella vaccine delivered 4 to 8 weeks apart. Do not administer varicella vaccine until at least 5 months after a patient has received any form of immune globulin or other blood product.
Varicella vaccine and other childhood vaccines may be given simultaneously but at different sites. If varicella vaccine and MMR are not given concurrently, these vaccines should be given at least 1 month apart.
Booster doses are currently not recommended. The duration of immunity provided by varicella vaccine has not been established, and research is needed to determine whether booster doses will be necessary to maintain protection throughout adulthood.
3. Dose and Administration
The recommended dose of varicella vaccine for children and adults is 0.5 mL. Administer the vaccine subcutaneously into the thigh of infants and the deltoid area of older children and adults using a 5/8" to 3/4", 23- to 25-gauge needle.
4. Contraindications/Precautions
There are few, true contraindications to administering vaccinations. See Appendix B, Table B.3 for a listing of valid contraindicaitons.
Varicella vaccine is specifically contraindicated in persons with a history of an anaphylactic reaction to neomycin. VZV should be used with caution in any immunocompromised individual, including individuals taking steroids and recent recipients of blood or blood products (including immunoglobulin). Varicella vaccine should not be given to any pregnant women or women who intend to become pregnant within 1 month of vaccination. Individuals suffering from a severe illness should not be vaccinated until full recovery.
Advise parents to avoid administering salicylates to their children for 6 weeks following vaccination, because of the theoretical risk of developing Reye's syndrome.
5. Adverse Reactions
The vaccine is well tolerated. Transient pain and redness at the injection site are reported by approximately 25% of vaccinees. Fewer than 10% of vaccinees report a mild maculopapular or varicelliform rash, either local or generalized. Because of the small potential for transmission of the vaccine virus, vaccinees in whom a rash develops should avoid contact with immunocompromised susceptible persons. Inadvertent administration of varicella vaccine to individuals who are immune to varicella has not resulted in an increased number of adverse reactions.
Any adverse side effects should be reported to the Vaccine Adverse Event Reporting System (VAERS). Refer to Table B.4 for a detailed listing of adverse events. VAERS forms and instructions are available in the FDA Drug Bulletin (Food and Drug Administration) and the Physician's Desk Reference or by calling the 24-hour VAERS information recording at (800)822-7967. Refer to Appendix B for details.
6. Patient Education
The US Department of Public Health has developed vaccine information statements about varicella vaccination ( see Patient Resources). Copies of these statements must be available to patients in facilities where federally purchased vaccines are used, and their availability in other settings is encouraged.
7. Vaccine Storage and Handling
The lyophilized vaccine must be stored frozen at an average temperature of -15°C (8°F) or colder. Store the diluent separately at room temperature or in the refrigerator. Use the vaccine within 30 minutes of reconstitution with the supplied diluent. Discard any reconstituted vaccine that is not used within 30 minutes. Handle all vaccine preparations according to manufacturers' instructions.
Patient Resources
- Childhood Vaccines: What They Are and Why Your Child Needs Them. American Academy of Family Physicians, 8880 Ward Pkwy, Kansas City, MO 64114-2797; (800)944-0000. Internet address: http://www.aafp.org
- Vaccine Information Statement -- Chickenpox Vaccine: What you need to know before you or your child gets the vaccine, #I1894. US Department of Health and Human Services. This information is available from the National Immunization Program, Information/Distribution Center, M/S E-34, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, (404)639-8225, Fax (404)639-8828; or the American Academy of Pediatrics, PO Box 927, Elk Grove Village, IL 60009-0927; (800)433-9016. Internet address: http://www.aap.org
- Immunization Protects Children. American Academy of Pediatrics, PO Box 927, Elk Grove Village, IL 60009-0927; (800)433-9016. Internet address: http://www.aap.org
- Parents Guide to Childhood Immunizations, #00-590; Immunization of Adults: A Call to Action, #00-6040. US Department of Health and Human Services. This material is available from the National Immunization Program, Information/Distribution Center, M/S E-34, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333; (404)639-8225; fax (404)639-8828.
Provider Resources
- Rules of Childhood Immunization. Immunization Action Coalition, 1573 Selby Ave, Suite 229, St. Paul, MN 55104; (612)647-9009. Internet address: http://www.immunize.org
- Recommended Childhood Immunization Schedule, #I1743; Six Common Misconceptions About Vaccination and How to Respond to Them, #00-6561; Guide to Contraindications in Childhood Vaccines, #00-6562. These and other documents are available from the National Immunization Program, M/S E-34, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333; (404)639-8225; fax (404)639-8828.
Selected References
- American Academy of Family Physicians. Summary of Policy Recommendations for Periodic Health Examination. Kansas City, Mo: American Academy of Family Physicians; 1997.
- American Academy of Pediatrics, Committee on Infectious Diseases. Recommendation[s] for use of live attenuated varicella vaccine. Pediatrics. . 1995; 95:791–796. [PubMed: 7724330]
- Centers for Disease Control and Prevention. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. . 1996; 45:(No. RR–11)1-36. [PubMed: 8668119]
- Centers for Disease Control and Prevention. Recommended childhood immunization schedule-United States. 1997. MMWR. . 1997; 46:35–40. [PubMed: 9011782]
- Lieu T, Cochi SL, Black SB, et al. Cost-effectiveness of a routine varicella vaccination program for US children. JAMA. . 1994; 271:375–381. [PubMed: 8283587]
- Patel R, Kinsinger L. Childhood immunizations: American College of Preventive Medicine Practice Policy Statement. Am J Prev Med. . 1997; 13(2):74–77. [PubMed: 9088441]
- US Preventive Services Task Force. Adult immunizations.In: Guide to Clinical Preventive Services. 2nd ed. Washington, DC: US Department of Health and Human Services; 1996: chap 66.
- US Preventive Services Task Force. Childhood immunizations.In: Guide to Clinical Preventive Services. 2nd ed. Washington, DC: US Department of Health and Human Services; 1996: chap 65.
- Varicella (Including Adult Immunization) - Clinician's Handbook of Preventive Se...Varicella (Including Adult Immunization) - Clinician's Handbook of Preventive Services
Your browsing activity is empty.
Activity recording is turned off.
See more...