CHICKENPOX and VARICELLA VACCINE
Chickenpox is an acute, generalized, viral disease of sudden onset with slight fever, mild constitutional symptoms and skin eruptions. Rarely fatal, a primary viral pneumonia is the commonest cause of death in adults; septic complications and encephalitis are the common cause of death in children. Neonates who develop varicella between day 5 and 10 or those whose mothers contact the disease prior to or within 5 days after delivery are at increased risk of developing severe generalized chickenpox with a 30% mortality rate. Herpes zoster is a local manifestation of recurrent, recrudescent or reactivation infection with the same virus.
Vaccination is now available for the varicella virus. Varivax is a live, attenuated vaccine approved by the FDA for vaccination against chickenpox. The vaccine safely and effectively reduces the incidence and severity of natural varicella. It has been useful following known exposure, and has some efficacy in adults.
An unanswered question is whether the vaccine virus becomes latent, resulting in later development of herpes zoster (shingles).
Candidates for vaccination:
Children 12 months or older who have not had chickenpox
Persons at risk for developing chickenpox due to recent exposure may benefit from vaccination to prevent or reduce symptoms of the disease
Persons at risk working in a school, pre-school or health care environment which may put susceptible children, pregnant women or immunocompromized patients at risk
Women anticipating future pregnancy
Precautions:
Hypersensitive to any of the components, including previous anaphylactic reactions to neomycin
Febrile illness
Pregnancy and those women planning to become pregnant within the next three months
Nursing women
Blood dyscrasias or other malignant neoplasms
Persons on immunosuppressive therapy
Persons with primary or acquired immunodeficiency
Reactions:
Pain at injection site
Redness and swelling at injection site
Chickenpox-like rash, generalized or localized near the injection
site, pruritis
Hematoma, induration or stiffness
Fever
Administration and Dosage:
The dosage for adults receiving the vaccine is 2 injections in the upper arm given 4 to 8 weeks apart.
Varicella and MMR have been successfully given at the same time at different injection sites or combined. Vaccination should be deferred for at least 5 months following blood or plasma transfusions, or administration of IG or VZIG. After vaccination any IG should not be given for 2 months unless its usefulness outweighs the benefits.
Duration of Immunity:
In healthy adolescents and adults antibody levels were present at least 1 year in 97.2% of individuals who received 2 injections 4 to 8 weeks apart. The duration of protection is unknown at present and the need for booster doses is not defined.
Post vaccination instructions:
Avoid pregnancy for at least 3 months
Avoid salicylates for 6 weeks after vaccination as Reye's syndrome has been reported following salicylate use during natural varicella infections.
Individuals vaccinated with varicella may potentially be capable of transmitting the vaccine to close contacts. Therefore, vaccine recipients should avoid close association with susceptible high risk individuals (newborns, pregnant women, immunocompromized persons).
Review possible reactions
Report any adverse effects to their health care provider.
Resources:
Control of Communicable Diseases in California
Drug Facts and Comparisons
Modern Medicine, Volume 63, May 1995
Kern County Health Department
CSUB STUDENT HEALTH SERVICES (661) 654-2394 Updated 2/06 ck