Vaccines and Preventable Diseases:

Varicella Vaccine - Q&A about Eligibility
Clinical Questions and Answers

 

Does the Advisory Committee on Immunization Practices (ACIP) recommend routine varicella vaccination for children?

Yes, ACIP recommends routine 2-dose varicella vaccination for all children, with the first dose given at 12-15 months of age and the second dose given at 4-6 years. A second dose catch-up vaccination is recommended for children who previously received one dose. The second dose should be given 3 months after the first dose; however, if the second dose is administered at least 28 days after the first dose, the second dose is considered valid and does not need to be repeated.

For further information on the ACIP recommendations visit the following sites:

• New ACIP Recommendations coming soon
• Provisional ACIP recommendations 2006:
  www.cdc.gov/vaccines/vpd-vac/varicella/downloads/varicella-acip-recs-prov-june-2006.pdf

• Updated ACIP recommendations 1999:
  www.cdc.gov/mmwR/PDF/rr/rr4806.pdf
• ACIP recommendations 1996:
  ftp://ftp.cdc.gov/pub/Publications/mmwr/RR/RR4511.pdf

What age children are eligible to receive varicella vaccine through the Vaccines for Children (VFC) program?

Children qualifying for VFC who are 12 months through 18 years of age can receive varicella vaccine through the VFC program.

Is varicella vaccine recommended for adolescents and adults?

Yes, healthy adolescents and adults with no evidence of immunity should receive 2 doses of varicella vaccine 4-8 weeks apart. Varicella is a more severe disease in adults. Despite the fact that adults account for only 5-6% of varicella cases per year, they account for a disproportionate number of deaths (60%) and hospitalizations (40%) compared to children.

Are there some groups of adults for whom varicella vaccination is especially important?

Yes, varicella vaccination is especially important for the following groups of susceptible adults:

• persons who have close contact with persons at high risk for serious complications from VZV infection; for example, healthcare workers and family members/close contacts of people with impaired immune systems
• persons who live or work in environments in which VZV transmission is likely: for example, teachers of young children, childcare employees, and residents/staff in institutional settings
• persons who live or work in places where VZV transmission can readily occur; for example, college students, inmates and staff of correctional institutions, and military personnel
• nonpregnant women of childbearing age (women should avoid pregnancy for 1 month following each vaccine dose)
• adolescents and adults living in households with children
• international travelers.

However, all healthy susceptible adults should be vaccinated.

Can children with leukemia receive the vaccine?

Patients with leukemia whose diseases are in remission and whose chemotherapy has been terminated for at least 3 months can be vaccinated.

Should varicella vaccine be administered to a healthy child who has an immunocompromised household contact, such as a sibling with leukemia?

ACIP and AAP recommend that healthy household contacts of immunocompromised persons be vaccinated. This is the most effective way to protect the immunocompromised person from exposure to wild-type varicella. However, because of the small risk of household transmission of vaccine virus, vaccinees who develop a vaccine-related rash should avoid contact with immunocompromised persons while the rash is present. To date, there have been no documented cases of transmission of varicella vaccine virus to immunocompromised persons. If a susceptible immunocompromised person is inadvertently exposed to a person with a vaccine-related rash, post-exposure treatment with varicella zoster immune globulin (VZIG) is not needed because the disease associated with this type of transmission would be expected to be mild. On the basis of available data, the benefit of vaccinating susceptible household contacts of immunocompromised persons outweighs the low potential risk of transmission of vaccine virus to immunocompromised persons.

Can persons with HIV/AIDS receive the vaccine?

On the basis of safety and immunogenicity data, the ACIP recommends that physicians consider vaccinating HIV-infected children greater than or equal to 12 months who are in CDC clinical class N, A, or B and have CD4+ T-lymphocyte percentage greater than or equal to 15% and no evidence of varicella immunity. HIV-infected children in this group should receive 2 doses of the single-antigen vaccine (Varivax ®), separated by 3 months. They are encouraged to return to their healthcare provider if they experience a post-vaccination, varicella-like rash. Previously, this vaccine was recommended for children in CDC classes N1 and A1 who have age-specific CD4 percentages greater than 25 percent
(www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr4806a1.htm).

Data on the use of varicella vaccine in HIV-infected adolescents and adults are lacking, and the immunogenicity may be lower in this group of HIV-infected individuals. However, based on expert opinion in examining the risk of severe disease from wild varicella infection compared to the benefit of vaccination, vaccination (2 doses administered 3 months apart) of HIV-infected persons >8 years of age who are in CDC clinical class A or B and have CD4+ T-lymphocyte counts greater than or equal to 200 cells/µL may be considered. If inadvertent vaccination of HIV-infected person results in clinical disease, acyclovir may be used to modify the disease.

The quadrivalent vaccine for measles, mumps, rubella, and varicella (Proquad ®) should not be administered to HIV-infected children, adolescents, or adults because there are insufficient data on the safety, immunogenicity, or efficacy of this vaccine in these individuals.

Can persons with conditions requiring steroid therapy receive the vaccine?

Data are lacking on whether persons receiving inhaled, nasal, or topical steroids without evidence of immunity can be vaccinated safely. However, most experts agree that vaccination of these persons is generally well tolerated. Persons without evidence of immunity who are receiving systemic steroids for certain conditions (e.g., asthma) and who are not otherwise immunocompromised can be vaccinated if they are receiving less than 2 mg/kg of body weight or total of less than 20 mg/day of prednisone or its equivalent. Some experts suggest withholding steroids for 2-3 weeks after vaccination if that can be done safely. Persons who are receiving high doses of systemic steroids (i.e., greater than or equal to 2 mg/kg prednisone) for greater than or equal to 2 weeks may be vaccinated once steroid therapy has been discontinued for at least 1 month.

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