This is the current release of the guideline.

This guideline updates a previous version: Marin M, Guris D, Chaves SS, Schmid S, Seward JF, Advisory Committee on Immunization Practices, Centers for Disease Control. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007 Jun 22;56(RR-4):1-40.

Varicella zoster viral infections: varicella (chickenpox) and herpes zoster (shingles)

Prevention

Family Practice
Internal Medicine
Obstetrics and Gynecology
Pediatrics

Advanced Practice Nurses
Physician Assistants
Physicians
Public Health Departments

2007 Guideline

• To advise physicians on the use of live, attenuated varicella virus vaccine and the use of varicella zoster immune globulin (VZIG) as prophylaxis against varicella
• To revise, update, and replace earlier ACIP (Advisory Committee on Immunization Practices) statements for prevention of varicella

2008 Addendum

To provide updated recommendations regarding the administration of the combination measles, mumps, rubella, and varicella (MMRV) vaccine

Children 12 months old or older; adolescents; and adults

1. Vaccination with live, attenuated varicella virus (VARIVAX^®, Merck and Company, Inc.)
2. Licensed combination mumps-measles-rubella-varicella vaccine (ProQuad^®, Merck and Company, Inc., not licensed for use among persons aged >13 years)
3. Varicella zoster immune globulin (VZIG) prophylaxis (VariZIG^™, Cangene Corporation, Winnipeg, Canada; available under an Investigational New Drug Application Expanded Access protocol in the United States)

• Incidence of infection by varicella zoster virus
• Efficacy and effectiveness of vaccination
• Adverse events associated with vaccination
• Annual varicella-related hospitalization rate
• Mortality from varicella infection
• Breakthrough rates for 1 and 2 does of single-antigen varicella vaccine

Searches of Electronic Databases
Searches of Unpublished Data

In response to increasing reports of varicella outbreaks among highly vaccinated populations, the Advisory Committee on Immunization Practices (ACIP)'s measles-mumps-rubella and varicella (MMRV) workgroup first met in February 2004 to review data related to varicella vaccine use in the United States since implementation of the vaccination program in 1995 and to consider recommendation options for improving control of varicella disease. The workgroup held monthly conference calls and met in person three times a year. The workgroup reviewed data on the impact of the 1-dose varicella vaccination program, including data on vaccination coverage, changes in varicella epidemiology, transmission from vaccinated persons with varicella, vaccine effectiveness, immune response to vaccination, evidence of immunity, and potential risk factors for vaccine failure. Published and unpublished data related to correlates of protection, safety, immunogenicity, and efficacy of the new quadrivalent MMRV vaccine and the immunogenicity and efficacy of a second dose of varicella vaccine also were reviewed.

Not stated

Expert Consensus

Not applicable

Review

Not stated

Expert Consensus

2007 Guideline

Presentations were made to the full Advisory Committee on Immunization Practices (ACIP) meetings in October 2004, February 2005, June 2005, and June 2006. Recommendation options were developed and discussed by the measles-mumps-rubella and varicella (MMRV) workgroup. When definitive research evidence was lacking, the recommendations incorporated expert opinion of the workgroup members. The workgroup sought input from partner organizations (i.e., the American Academy of Pediatrics [AAP], the American Academy of Family Physicians [AAFP], the American College of Obstetricians and Gynecologists, the Council of State and Territorial Epidemiologists, and the Association of Immunization Managers) and from state public health professionals and immunization program directors.

2008 Addendum

On February 27, 2008, new information was presented to ACIP regarding the risk for febrile seizures among children aged 12 to 23 months after administration of the combination measles, mumps, rubella, and varicella (MMRV) vaccine (ProQuad®, Merck & Co., Inc., Whitehouse Station, New Jersey). At this meeting, ACIP considered the preliminary results from the Vaccine Safety Datalink (VSD) and Merck studies, which suggested an increased risk for febrile seizures after the first dose of MMRV vaccine. Given the availability of alternative options for vaccination against measles, mumps, rubella, and varicella and the limited supply of MMRV vaccine, ACIP voted to change the preference language for MMRV vaccine to read as follows: "Combination MMRV vaccine is approved for use among healthy children aged 12 months to 12 years. MMRV vaccine is indicated for simultaneous vaccination against measles, mumps, rubella, and varicella. ACIP does not express a preference for use of MMRV vaccine over separate injections of equivalent component vaccines (i.e., MMR vaccine and varicella vaccine)."

Not applicable

A cost-effectiveness analysis was performed before initiation of the varicella vaccination program in the United States. The results of the study indicated a savings of $5.40 for each dollar spent on routine vaccination of preschool-aged children when direct and indirect costs were considered. When only direct medical costs were considered, the benefit-cost ratio was 0.9:1.0. Benefit-cost ratios were only slightly lower when lower estimates of the short- and long-term effectiveness of the vaccine were used.

A recent analysis was performed that used current estimates of morbidity and mortality and current direct and indirect costs. The model considered that the second dose will reduce varicella disease residual after the first dose by 79%. From a societal perspective, both 1-dose and 2-dose vaccination programs are cost saving compared with no program. The vaccine program cost was estimated at $320 million for 1 dose and $538 million for 2 doses. The savings from varicella disease prevented were estimated at approximately $1.3 billion for the 1-dose program and approximately $1.4 billion for the 2-dose program. Compared with the 1-dose program, the incremental cost for the second dose was estimated to be $96,000 per quality-adjusted life year (QALY) saved. If benefits from preventing group A streptococcus infections and herpes zoster (HZ) among vaccinated persons are added, incremental costs per QALY saved are $91,000 and $17,000, respectively. Because of the uncertainty of the modeled predictions of an increase in HZ among persons with a history of varicella and the fact that no consistent trends demonstrate an increase in HZ attributable to the varicella vaccination program in the United States, HZ among persons with a history of varicella was not included in the model.

External Peer Review
Internal Peer Review

Proposed recommendations and a draft statement were presented to the full Advisory Committee on Immunization Practices (ACIP) in June 2005 and June 2006. After deliberations, final ACIP recommendations were approved in 2005 and 2006. Modifications to the draft statement were made following CDC and external review process to update and clarify wording in the document.

None provided

The type of evidence supporting the recommendations is not specifically stated.

• Prevention of varicella infection and complications
• Modification of varicella severity

Varicella Vaccine

Vaccinated persons might develop modified varicella disease with atypical presentation. Varicella disease that develops >42 days after vaccination (i.e., breakthrough varicella) typically is mild, with <50 skin lesions, low or no fever, and shorter (4-6 days) duration of illness. The rash is more likely to be predominantly maculopapular rather than vesicular. Nevertheless, breakthrough varicella is contagious.

Since 1999, when varicella deaths became nationally notifiable, two deaths from breakthrough varicella disease have been reported to the Centers for Disease Control and Prevention (CDC); one of a girl aged 9 years with a history of asthma who was receiving steroids when she had the breakthrough infection, and the other of a girl aged 7 years with a history of malignant ependymoma who also was under steroid therapy at the time of her death.

Other Adverse Events

• Pain, tenderness, soreness, erythema, and/or swelling at the injection site
• Localized and systemic rash, including varicelliform rash
• Fever

Not all adverse events that occur after vaccination are reported, and many reports describe events that might have been caused by confounding or unrelated factors (e.g., medications and other diseases). Because varicella disease continues to occur, wild-type virus might account for certain reported events. For serious adverse events for which background incidence data are known, Vaccine Adverse Event Reporting System (VAERS) reporting rates are lower than expected after natural varicella or than background rates of disease in the community. Inherent limitations of passive safety surveillance impede comparing adverse event rates after vaccination reported to VAERS with those from complications after natural disease. Nevertheless, the magnitude of these differences suggests that serious adverse events occur at a substantially lower rate after vaccination than after natural disease.

Rare Events - Laboratory Confirmed

• Pneumonia
• Hepatitis
• Severe disseminated varicella infection
• Secondary varicella transmission

Except for the secondary transmission cases, these cases all occurred in immunocompromised patients or in persons who had other serious medical conditions that were undiagnosed at the time of vaccination.

Rare Events - Not Laboratory Confirmed

• Thrombocytopenia
• Acute cerebellar ataxia
• Acute hemiparesis consistent with varicella angiopathy (two cases)
• Recurrent papular urticaria
• Herpes zoster from latent viral infection
• Neuroblastoma with severe, chronic, drug-resistant zoster (one case)

Subgroups Most Likely to be Harmed

Persons with:

• Impaired cellular immunity or who have persons with impaired cellular immunity in their households
• Acute severe illness, including untreated, active tuberculosis
• Thrombocytopenia
• Recently administered blood, plasma, or immune globulin
• Requirement for salicylates within 6 weeks after receiving varicella vaccines

Refer to the original guideline document for additional information on adverse effects and precautions during use of varicella vaccines.

2008 Addendum

The administration of the combination measles, mumps, rubella, and varicella (MMRV) vaccine is associated with risk for febrile seizures.

General

Adequate treatment provisions for anaphylactic reactions, including epinephrine injection (1:1000), should be available for immediate use should an anaphylactic reaction occur. Before administering a vaccine, health-care providers should obtain the vaccine recipient's vaccination history and determine whether the individual had any previous reactions to any vaccine including Varivax, ProQuad or any measles, mumps, or rubella containing vaccines.

Allergy to Vaccine Components

The administration of live varicella-containing vaccines rarely results in hypersensitivity. The information in the package insert should be reviewed carefully before vaccine is administered. Vaccination is contraindicated for persons who have a history of anaphylactic reaction to any component of the vaccine, including gelatin. Single-antigen varicella vaccine does not contain preservatives or egg protein; these substances have caused hypersensitive reactions to other vaccines. For the combination measles-mumps-rubella-varicella (MMRV) vaccine, live measles and live mumps vaccines are produced in chick embryo culture. However, among persons who are allergic to eggs, the risk for serious allergic reactions after administration of measles- or mumps-containing vaccines is low. Because skin testing with vaccine is not predictive of allergic reaction to vaccination, skin testing is not required before administering combination MMRV vaccine to persons who are allergic to eggs. The majority of anaphylactic reactions to measles- and mumps-containing vaccines are associated not with hypersensitivity to egg antigens but with other vaccine components. Neither single-antigen varicella nor combination MMRV vaccines should be administered to persons who have a history of anaphylactic reaction to neomycin. However, neomycin allergy usually is manifested as a contact dermatitis, which is a delayed-type immune response rather than anaphylaxis. For persons who experience such a response, the adverse reaction, if any, would appear as an erythematous, pruritic nodule or papule present 48 to 96 hours after vaccination. A history of contact dermatitis to neomycin is not a contraindication to receiving varicella vaccines.

Altered Immunity

Single-antigen varicella and combination MMRV vaccines are not licensed for use in persons who have any malignant condition, including blood dyscrasias, leukemia, lymphomas of any type, or other malignant neoplasms affecting the bone marrow or lymphatic systems. Combination MMRV vaccine should not be administered to persons with primary or acquired immunodeficiency, including immunosuppression associated with acquired immunodeficiency syndrome (AIDS) or other clinical manifestations of human immunodeficiency virus (HIV) infections, cellular immunodeficiencies, hypogammaglobulinemia, and dysgammaglobulinemia. Combination MMRV vaccine should not be administered as a substitute for the component vaccines when vaccinating HIV-infected children.

Varicella vaccines should not be administered to persons who have a family history of congenital or hereditary immunodeficiency in first-degree relatives (e.g., parents and siblings) unless the immune competence of the potential vaccine recipient has been clinically substantiated or verified by a laboratory.

Varicella vaccines should not be administered to persons receiving high-dose systemic immunosuppressive therapy, including persons on oral steroids >2 mg/kg of body weight or a total of >20 mg/day of prednisone or equivalent for persons who weigh >10 kg, when administered for >2 weeks. Such persons are more susceptible to infections than healthy persons. Administration of varicella vaccines can result in a more extensive vaccine-associated rash or disseminated disease in persons receiving immunosuppressive doses of corticosteroids. This contraindication does not apply to persons who are receiving inhaled, nasal, or topical corticosteroids or low-dose corticosteroids as are used commonly for asthma prophylaxis or for corticosteroid-replacement therapy (see "Situations in Which Some Degree of Immunodeficiency Might Be Present" in the original guideline document).

Pregnancy

Because the effects of the varicella virus vaccine on the fetus are unknown, pregnant women should not be vaccinated. Nonpregnant women who are vaccinated should avoid becoming pregnant for 1 month after each injection. For persons without evidence of immunity, having a pregnant household member is not a contraindication to vaccination.

If a pregnant woman is vaccinated or becomes pregnant within 1 month of vaccination, she should be counseled about potential effects on the fetus. Wild-type varicella poses a low risk to the fetus (see "Prenatal and Perinatal Exposure" in the original guideline document). Because the virulence of the attenuated virus used in the vaccine is less than that of the wild-type virus, the risk to the fetus, if any, should be even lower. In 1995, Merck and Co., Inc., in collaboration with the Centers for Disease Control and Prevention (CDC), established the VARIVAX Pregnancy Registry to monitor the maternal-fetal outcomes of pregnant women who were inadvertently administered varicella vaccine 3 months before or at any time during pregnancy (to report, call: 1-800-986-8999). During the first 10 years of the pregnancy registry no cases of congenital varicella syndrome or birth defects compatible with congenital varicella syndrome have been documented. Among 131 live-born infants of prospectively reported seronegative women (82 of whom were born to mothers vaccinated during the highest risk period [i.e., the first or second trimester of pregnancy]), no birth defects consistent with congenital varicella syndrome have been documented (prevalence rate = 0; CI = 0 to 6.7%), and three major birth defects were reported (prevalence rate = 2.3%; CI = 0.5% to 6.7%). The rate of occurrence of major birth defects from prospective reports in the registry was similar to the rate reported in the general United States population (3.2%), and the defects indicated no specific pattern or target organ. Although the study results do not exclude the possibility of risk for women who received inadvertent varicella vaccination before or during pregnancy, the potential risk, if any, is low.

An implementation strategy was not provided.

Staying Healthy

Effectiveness
Safety

Not applicable: The guideline was not adapted from another source.

1999 May (revised 2007 Jun 22; addendum released 2008 14 Mar)

Centers for Disease Control and Prevention - Federal Government Agency [U.S.]

United States Government

Advisory Committee on Immunization Practices (ACIP)

Advisory Committee on Immunization Practices Varicella Working Group Members

Chairperson: Judith R. Campbell, MD, Houston, Texas; Ann M. Arvin, MD, Stanford, California; David W. Kimberlin, MD, Birmingham, Alabama; James L. Hadler, MD, Hartford, Connecticut; Barbara Watson, MB ChB, Philadelphia, Pennsylvania; Penina Haber, MPH, Atlanta, Georgia; William Atkinson, MD, Atlanta, Georgia; Anne A. Gershon, MD, New York, New York; Tracy Lieu, MD, Boston, Massachusetts; Teresa Thornton, Des Moines, Iowa; Myron J. Levin, Denver, Colorado; John F. Modlin, MD, Lebanon, New Hampshire; Dale L. Morse, MD, Albany, New York; Reginald Finger, MD, Colorado Springs, Colorado; Dalya Guris, MD, Atlanta, Georgia; Mona Marin, MD, Atlanta, Georgia; Sandra S. Chaves, MD, Atlanta, Georgia; Paul Gargiullo, PhD, Atlanta, Georgia; John W. Glasser, PhD, Atlanta, Georgia; Rafael Harpaz, MD, Atlanta, Georgia; Gregory Wallace, MD, Atlanta, Georgia; Jane F. Seward, MBBS, Atlanta, Georgia; Scott Schmid, PhD, Atlanta, Georgia; Philip LaRussa, MD, New York, New York; Angela Calugar, MD, Atlanta, Georgia; H. Cody Meissner, MD, Boston, Massachusetts; Philip R. Krause, MD, Bethesda, Maryland; Keith Powell, MD, Akron, Ohio; Gustavo H. Dayan, MD, Atlanta, Georgia

Advisory Committee on Immunization Practices Membership List, June 2006

Chairperson: Jon Abramson, MD, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Executive Secretary: Larry Pickering, MD, CDC, Atlanta, Georgia

Members: Ban Mishu Allos, MD, Vanderbilt University School of Medicine, Nashville, Tennessee; Judith Campbell, MD, Baylor College of Medicine, Houston, Texas; Robert Beck, JD, Consumer Representative, Palmyra, Virginia; Reginald Finger, MD, Focus on the Family, Colorado Springs, Colorado; Janet Gilsdorf, MD, University of Michigan, Ann Arbor, Michigan; Harry Hull, MD, Minnesota Department of Health, St. Paul, Minnesota; Tracy Lieu, MD, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts; Edgar Marcuse, MD, Children's Hospital and Regional Medical Center, Seattle, Washington; Dale Morse, MD, New York State Department of Health, Albany, New York; Julia Morita, MD, Chicago Department of Public Health, Chicago, Illinois; Gregory Poland, MD, Mayo Medical School, Rochester, Minnesota; Patricia Stinchfield, MSN, Children's Hospitals and Clinics of Minnesota, St. Paul, Minnesota; John J. Treanor, MD, University of Rochester, Rochester, New York; Robin Womeodu, MD, University Hospital, Memphis, Tennessee

Ex-Officio Members: James E. Cheek, MD, Indian Health Services, Albuquerque, New Mexico; Wayne Hachey, DO, Department of Defense, Falls Church, Virginia; Geoffrey S. Evans, MD, Health Resources and Services Administration, Rockville, Maryland; Bruce Gellin, MD, National Vaccine Program Office, Washington, DC; Linda Murphy, Centers for Medicare and Medicaid Services, Baltimore, Maryland; George T. Curlin, MD, National Institutes of Health, Bethesda, Maryland; Kristin Lee Nichol, MD, Department of Veterans Affairs, Minneapolis, Minnesota

Liaison Representatives: American Academy of Family Physicians, Jonathan Temte, MD, Madison, Wisconsin, and Doug Campos-Outcalt, MD, Phoenix, Arizona; American Academy of Pediatrics, Keith Powell, MD, Akron, Ohio, and Carol Baker, MD, Houston, Texas; America's Health Insurance Plans, Andrea Gelzer, MD, Hartford, Connecticut; American College Health Association, James C. Turner, MD, Charlottesville, Virginia; American College of Obstetricians and Gynecologists, Stanley Gall, MD, Louisville, Kentucky; American College of Physicians, Kathleen M. Neuzil, MD, Seattle, Washington; American Medical Association, Litjen Tan, PhD, Chicago, Illinois; American Pharmacists Association, Stephan L. Foster, PharmD, Memphis, Tennessee; Association of Teachers of Preventive Medicine, W. Paul McKinney, MD, Louisville, Kentucky; Biotechnology Industry Organization, Clement Lewin, PhD, Cambridge, Massachusetts; Canadian National Advisory Committee on Immunization, Monica Naus, MD, Vancouver, British Columbia; Healthcare Infection Control Practices Advisory Committee, Steve Gordon, MD, Cleveland, Ohio; Infectious Diseases Society of America, Samuel L. Katz, MD, Durham, North Carolina; London Department of Health, David Salisbury, MD, London, United Kingdom; National Association of County and City Health Officials, Nancy Bennett, MD, Rochester, New York, and Jeffrey S. Duchin, MD, Seattle, Washington; National Coalition for Adult Immunization, David A. Neumann, PhD, Alexandria, Virginia; National Foundation for Infectious Diseases, William Schaffner, MD, Nashville, Tennessee; National Immunization Council and Child Health Program, Romeo S. Rodriquez, Mexico City, Mexico; National Medical Association, Patricia Whitley-Williams, MD, New Brunswick, New Jersey; National Vaccine Advisory Committee, Gary Freed, MD, Swiftwater, Pennsylvania, and Peter Paradiso, PhD, Collegeville, Pennsylvania; Society for Adolescent Medicine, Amy B. Middleman, MD, Houston, Texas; Pharmaceutical Research and Manufacturers of America, Damian A. Araga, Swiftwater, Pennsylvania

Advisory Committee on Immunization Practices Membership List, June 2005

Chairman: Myron J. Levin, MD, University of Colorado Health Sciences Center, Denver, Colorado

Executive Secretary: Larry K. Pickering, MD, Senior Advisor to the Director, National Immunization Program, CDC, Atlanta, Georgia

Members: Jon S. Abramson, MD, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Ban Mishu Allos, MD, Vanderbilt University School of Medicine, Nashville, Tennessee; Guthrie S. Birkhead, MD, New York State Department of Health, Albany, New York; Judith Campbell, MD, Baylor College of Medicine, Houston, Texas; Reginald Finger, MD, Focus on the Family, Colorado Springs, Colorado; Janet R. Gilsdorf, MD, University of Michigan, Ann Arbor, Michigan; Tracy Lieu, MD, Harvard Pilgrim Healthcare and Harvard Medical School, Boston, Massachusetts; Edgar K. Marcuse, MD, Children's Hospital and Regional Medical Center, Seattle, Washington; Julie Morita, MD, Chicago Department of Public Health, Chicago, Illinois; Gregory A. Poland, MD, Mayo Medical School, Rochester, Minnesota; John B. Salamone, National Italian American Foundation, Washington, D.C.; Patricia, Stinchfield, MS, Children's Hospitals and Clinics, St. Paul, Minnesota; John J. Treanor, MD, University of Rochester School of Medicine and Dentistry, Rochester, New York; and Robin J. Womeodu, MD, University of Tennessee Health Sciences Center, Memphis, Tennessee

Ex-Officio Members: James E. Cheek, MD, Indian Health Service, Albuquerque, New Mexico; Wayne Hachey, DO, Department of Defense, Falls Church, Virginia; Geoffrey S. Evans, MD, Health Resources and Services Administration, Rockville, Maryland; Bruce Gellin, MD, National Vaccine Program Office, Washington, DC; Linda Murphy, Centers for Medicare and Medicaid Services, Baltimore, Maryland; George T. Curlin, MD, National Institutes of Health, Bethesda, Maryland; Norman Baylor, PhD, Office of Vaccines Research Review, Rockville, Maryland; Kristin Lee Nichol, MD, Department of Veterans Affairs, Minneapolis, Minnesota

Liaison Representatives: Jonathan Temte, MD, Madison, Wisconsin, Richard D. Clover, MD, Louisville, Kentucky, American Academy of Family Physicians; Margaret Rennels, MD, Baltimore, Maryland, Carol Baker, MD, Houston, Texas, American Academy of Pediatrics; Andrea Gelzer, MD, Hartford, Connecticut, America's Health Insurance Plans; James C. Turner, MD, Charlottesville, Virginia, American College Health Association; Stanley Gall, MD, Louisville, Kentucky, American College of Obstetricians and Gynecologists; Kathleen M. Neuzil, MD, Seattle, Washington, American College of Physicians; Litjen Tan, PhD, Chicago, Illinois, American Medical Association; Stephan L. Foster, PharmD, Memphis, Tennessee, American Pharmacists Association; W. Paul McKinney, MD, Louisville, Kentucky, Association of Teachers of Preventive Medicine; Clement Lewin, PhD, Orange, Connecticut, Biotechnology Industry Organization; Monika Naus, MD, Vancouver, British Columbia, Canada, Canadian National Advisory Committee on Immunization; Steve Gordon, MD, Cleveland, Ohio, Healthcare Infection Control Practices Advisory Committee, Samuel L. Katz, MD, Durham, North Carolina, and William Schaffner, MD, Nashville, Tennessee, Infectious Diseases Society of America; David M. Salisbury, MD, London, United Kingdom, London Department of Health; Nancy Bennett, MD, Rochester, New York, National Association of County and City Health Officials; David A. Neumann, PhD, Alexandria, Virginia, National Coalition for Adult Immunization; Romeo Rodriguez, Mexico City, Mexico, National Immunization Council and Child Health Program; Dennis A. Brooks, MD, Baltimore, Maryland, National Medical Association; Charles Helms, MD, Iowa City, Iowa, National Vaccine Advisory Committee; Amy B. Middleman, MD, Houston, Texas, Society for Adolescent Medicine; Damian A. Braga, MBA, Swiftwater, Pennsylvania, Peter Paradiso, PhD, Collegeville, Pennsylvania, Pharmaceutical Research and Manufacturers of America

CDC, our planners, and our content experts wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers or commercial services, or commercial supporters. Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use.

This is the current release of the guideline.

This guideline updates a previous version: Marin M, Guris D, Chaves SS, Schmid S, Seward JF, Advisory Committee on Immunization Practices, Centers for Disease Control. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007 Jun 22;56(RR-4):1-40.

None available

This summary was completed by ECRI on June 30, 1998. The information was verified by the guideline developer on December 1, 1998. The summary was updated by ECRI on December 1, 1999. This updated information was verified by the guideline developer on May 1, 2000. This NGC summary was updated by ECRI Institute on July 31, 2007, and again on March 27, 2008.

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