Vaccines and Preventable Diseases:
Varicella - Submitted Questions & Answers
Questions submitted during immunization satellite broadcasts or through NIPINFO
For Health Professionals:
General Questions
A mother reports that she and her 6-month-old child had an extended exposure to chickenpox 2 days ago. The mother says she has never had chickenpox, so her child would have no antibodies. Who should be vaccinated? The mother, the infant, or both?
Testing the mother for specific varicella IgG antibody is preferable (most adults with negative histories are seropositive). If testing is not possible within 72 hours of exposure, the mother should be vaccinated within 72 hours or even up to 5 days after the exposure (do not delay vaccination because of testing). The child is too young for vaccination. The vaccine is not licensed or recommended by ACIP or AAP for use in infants under 12 months of age.
A patient has a negative varicella titer. He had leukemia as a child. Can he be vaccinated with varicella vaccine?
Vaccination would only be a problem if the patient were in remission for his leukemia and not really cured. If his childhood leukemia was cured, he is not on chemotherapy or some other immunosuppressant medication, and his physician does not consider him to be immunodeficient, then he can be vaccinated.
New ACIP Recommendations coming soon
If a child had chickenpox before 1 year of age, is the child immune or should the child still receive the vaccine?
Children who have had chickenpox diagnosed at any age by a healthcare provider or whose histories of varicella infection are verified by a healthcare provider are considered immune and do not need vaccination, according to current ACIP recommendations.
Healthcare providers should keep a high threshold of suspicion about whether the disease was really chickenpox. Other rash illnesses can look like chickenpox; so, if there is any doubt that the disease was chickenpox, then the child should be vaccinated.
If a patient developed arthritic pains or aches following MMR vaccination, are they likely to have the same type of reaction after varicella vaccine?
No. Varicella vaccine has not been associated with joint symptoms.
What are the views on immunizing a breastfeeding mother with varicella vaccine?
Neither inactivated nor most live vaccines (including varicella vaccine) administered to a lactating woman affect the safety of breastfeeding for mothers or infants. Breastfeeding does not adversely affect immunization and is not a contraindication for vaccines. NOTE: Vaccinia (smallpox) vaccine is the exception to this rule; vaccinia vaccine is contraindicated for breastfeeding mothers.
For varicella, a study involving 12 women who received single-antigen varicella vaccine while breastfeeding indicated no evidence of VZV DNA either in several hundred breast milk samples collected or in the infants tested after both vaccine doses. Another study did not detect varicella gene sequences in the postvaccination breast milk samples.
For more information see ACIP General Recommendations on Immunization, www.cdc.gov/mmwr/preview/mmwrhtml/rr5515a1.htm
Why is it necessary to delay varicella vaccination following receipt of blood products?
Blood (e.g., whole, blood, packed red blood cells, and plasma) and other antibody-containing blood products may interfere with the replication of live vaccine viruses and therefore with the immune response. Recent receipt of blood products is a precaution to MMR and varicella vaccines. Varicella and MMR vaccines should be given 14 days prior to the blood products or delayed until the antibody has degraded.
For more information see ACIP General Recommendations on Immunization, www.cdc.gov/mmwr/preview/mmwrhtml/rr5515a1.htm
If a child develops a rash following MMR, varicella, or MMRV vaccination but is otherwise well, can the child attend day care/school?
For MMR, this is not a problem because there is no risk of transmission of these viruses after MMR vaccination. If a child develops a rash following varicella or MMRV vaccination, clinical assessment is needed. Vaccine-associated varicella rashes tend to be mild, maculopapular lesions associated with an extremely low risk of transmission. If the rash looks extensive or is vesicular, the child might in fact have varicella disease and could be infectious. It is possible to become infected with wild virus varicella after vaccination before the immune system has had a chance to mount an immune response to the vaccine. The bottom line is that if it looks like chickenpox, it should be treated like chickenpox.
Of note, parents should also check with their child’s school/daycare to determine if there are existing policies for attendance in such situations.
Can Varivax, MMRV, and FluMist be stored in the same freezer?
Yes, the storage temperature is the same for Varivax, MMRV, and FluMist -- 5°F (-15°C) or colder.
How often does zoster (shingles) occur following varicella vaccination?
Varicella vaccine is a live virus vaccine, and may result in a latent infection, similar to that caused by wild varicella virus. Consequently, zoster in vaccinated persons has been reported. Not all of these cases have been confirmed as having been caused by vaccine virus. The risk of zoster following vaccination appears to be less than that following infection with wild-type virus. However, longer follow-up is needed to assess this risk over time.
If an adult has not had documented chickenpox but has had shingles, is vaccination recommended?
Primary infection with varicella is chickenpox. A history of shingles based on a healthcare provider diagnosis is de facto evidence of immunity to chickenpox, and such a person does not need to be vaccinated.
Additional Information
Varicella Immunity
Just because a person doesn’t remember having chickenpox doesn't mean that he/she is not immune. There are some adults who actually have not had chickenpox, but many people who think they have never had chickenpox turn out to be immune if tested.
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Content last reviewed on May 15, 2007
Content Source: National Center for Immunization and Respiratory Diseases