An Indivual Who Has Had Chicken Pox Rarely Gets This Disease Again This Situation Is an Example of

Varicella (chickenpox)

Affliction Issues Vaccine Safety Vaccine Recommendations Varicella Zoster Immune Globulin Scheduling Vaccines Storage and Treatment Contraindications and Precautions

Disease Issues

How serious a illness is varicella (chickenpox)?

Prior to the availability of varicella vaccine there were approximately four million cases of varicella a twelvemonth in the U.S. Though usually a mild disease in healthy children, an estimated 150,000 to 200,000 people developed complications, about 11,000 people required hospitalization and 100 people died each year from varicella. Varicella tends to be more severe in adolescents and adults than in young children. The most mutual complications from varicella include bacterial superinfection of skin lesions, pneumonia, central nervous organisation involvement, and thrombocytopenia.

How is varicella transmitted and for how long is an infected person contagious?

The varicella zoster virus (VZV) spreads from person to person by direct contact or through the air by coughing or sneezing. It is highly contagious. Information technology tin can too be spread through direct contact with fluid from a blister of a person infected with varicella, or from direct contact with a skin lesion from a person with zoster (shingles). People with varicella are infectious 1 to 2 days before skin lesions appear until all lesions have crusted over, commonly 4 to seven days later on the advent of peel lesions.

What can be washed to protect a patient without evidence of amnesty who is exposed to varicella and is at high gamble for severe disease and complications?

These patients should receive varicella zoster immune globulin (VariZIG, Saol Therapeutics). VariZIG given up to 10 days afterward an exposure tin can modify or prevent clinical varicella disease. Run into the Varicella Zoster Immune Globulin department below, and www.cdc.gov/mmwr/pdf/wk/mm6228.pdf, pages 574–6). for more information on this topic.

What do you give to a kid younger than 1 year of age if they were exposed to the chickenpox or zoster virus?

The minimum age for varicella vaccine is 12 months. Vaccination is non recommended for infants younger than 12 months of age even as post-exposure prophylaxis. CDC recommends that a healthy infant should receive no specific treatment or vaccination later exposure to VZV. The child can be treated with an advisable antiviral medication if chickenpox occurs.

Run across the Varicella Zoster Allowed Globulin section below for details on the recommended use of VariZIG in immunocompromised children, infants exposed to varicella effectually the time of nativity and some hospitalized preterm infants.

Vaccine Recommendations Back to top

What varicella vaccines are available in the Usa?

Two vaccines containing varicella virus are licensed for use in the Usa. Both vaccines contain live, attenuated varicella zoster virus (VZV) derived from the Oka strain.

• Varivax (VAR, Merck) contains only varicella vaccine virus. • ProQuad (MMRV, Merck) is a combination measles, mumps, rubella, and varicella vaccine.

Both vaccines are administered by subcutaneous injection. VAR is canonical by the Food and Drug Administration (FDA) for people 12 months of age and older. MMRV is canonical for people 12 months through 12 years of age. MMRV should not be administered to people historic period 13 years or older.

Who is recommended to be vaccinated against varicella?

All children, beginning at age 12 months, too every bit adults without other prove of immunity (see adjacent question) should be vaccinated with 2 doses of varicella vaccine. Special consideration should exist given to vaccinating adults who (1) have close contact with people at loftier adventure for astringent disease (e.grand., healthcare workers and family contacts of immunocompromised people), or (2) are at high risk for exposure or transmission (e.chiliad., teachers of young children; child care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; non-pregnant women of childbearing age; and international travelers).

What are the criteria for bear witness of immunity to varicella?

The Advisory Committee on Immunization Practices (ACIP) considers evidence of immunity to varicella to be:

• Written documentation of 2 doses of varicella vaccine given no earlier than age 12 months with at least four weeks between doses. • U.Due south.-born earlier 1980* • A healthcare provider's diagnosis of varicella or verification of history of varicella affliction • History of herpes zoster, based on healthcare provider diagnosis • Laboratory evidence of amnesty or laboratory confirmation of disease *Annotation: year of nativity is non considered as prove of immunity for healthcare personnel, immunosuppressed people, and pregnant women.

Does ACIP recommend giving varicella vaccine to infants before age one year if they are traveling internationally?

No. ACIP recommends giving a dose of MMR to infants age 6 through 11 months before international travel, simply not varicella vaccine. Varicella vaccine is neither approved nor recommended for children younger than age 12 months in any state of affairs.

Tin varicella vaccine exist used every bit postexposure prophylaxis for a 9-calendar month-sometime who was exposed to herpes zoster?

Varicella vaccine is neither approved nor recommended for children younger than age 12 months. Assuming that the child is non immunocompromised, varicella zoster immune globulin (VariZIG) is also not recommended. If the kid had a condition which was considered to place the child at greater risk for complications than the general population, then VariZIG could exist considered (see the Varicella Zoster Immune Globulin department below and www.cdc.gov/mmwr/pdf/wk/mm6228.pdf, page 574–6).

ACIP does not take a recommendation for acyclovir for varicella postexposure prophylaxis. The American University of Pediatrics provide some guidance on this result in the current edition of the Red Book.

If a healthcare worker does non have a history of varicella vaccination or disease simply has had a clinically diagnosed case of shingles, does she or he yet demand varicella vaccination?

No. A healthcare provider's diagnosis or verification of a history of shingles is acceptable evidence of amnesty to varicella. According to ACIP, acceptable evidence of varicella immunity in healthcare personnel includes (1) documentation of 2 doses of varicella vaccine given at to the lowest degree 28 days apart, (2) history of varicella or canker zoster based on clinician diagnosis, (3) laboratory evidence of immunity, or (4) laboratory confirmation of disease.

I take a patient who is 62 years old and is immigrating to the U.S. She received a dose of live zoster vaccine at age 60. The immigration requirements state she should receive 2 doses of varicella vaccine. Does she need boosted varicella vaccine?

To meet the immigration requirements, the dose of live zoster vaccine counts every bit the first dose of the varicella vaccine serial. You should give a dose of varicella vaccine now since it has been more than 4 weeks since the dose of live zoster vaccine. The varicella vaccine dose may not be needed, merely it will not exist harmful and will allow your patient to run into the regulatory requirement. Note that if the vaccine she received was recombinant zoster vaccine (RZV, Shingrix, GlaxoSmithKline) it does Non count as the first of ii doses of varicella vaccine.

Concerning the recommendation for a 2d dose of varicella vaccine, does CDC recommend that a teen who received merely ane varicella vaccine when they were preschool age go a 2d dose now?

Yes. The electric current recommendation is for 2 doses regardless of historic period, for anyone schoolhouse age and older without evidence of immunity. For everyone whose varicella immunity is based on vaccination, ii doses of varicella vaccine are recommended.

Originally, ACIP only recommended one dose of varicella vaccine for children. Why did ACIP later revise its recommendations to add together a 2d dose of varicella vaccine for all children?

In the x years following vaccine licensure in 1995, in that location was a significant pass up in varicella affliction, as well as varicella-related hospitalizations and deaths. Although a 1-dose regimen was estimated to be lxxx% to 85% constructive, breakthrough affliction was still occurring in highly vaccinated populations. A two-dose regimen was adopted in 2006 to further reduce the take a chance of affliction among vaccinated people whose numbers would accumulate over fourth dimension, which could lead to varicella disease later on in life when it can be more severe.

Should a kid who has had chickenpox prior to the first birthday go the first dose of varicella vaccine at age one year?

If the child had confirmed varicella disease or laboratory prove of prior disease, it is non necessary to vaccinate regardless of historic period at infection. If in that location is any dubiety that the illness was actually varicella, the kid should be vaccinated.

How important is information technology to vaccinate older children and adults?

It is critical to vaccinate susceptible older children and adults whenever the opportunity arises. With younger children being routinely vaccinated, the chance of being exposed to cases of chickenpox is decreasing. Older children, adolescents, and adults who have non had chickenpox now accept a greater chance of remaining susceptible. These older individuals, when they contract chickenpox, are more likely to get seriously ill and have disease complications than younger children.

If an adult or child has not had documented chickenpox but has had shingles, is varicella vaccination recommended?

No. Shingles is acquired by varicella zoster virus, the same virus that causes chickenpox. A history of shingles based on a healthcare provider diagnosis is evidence of immunity to chickenpox. A person who has had shingles does not need to be vaccinated against varicella. He/she should nonetheless receive zoster vaccine, however, if it is non contraindicated and he/she is age 50 or older.

Can nosotros accept receipt of a unmarried documented dose of live zoster vaccine as proof of varicella amnesty in a healthcare employee who has no other testify of immunity?

No. Receipt of live zoster vaccine is not proof of prior varicella disease. According to CDC, adequate evidence of varicella immunity in healthcare personnel includes (i) documentation of 2 doses of varicella vaccine given at least 28 days apart, (2) history of varicella or herpes zoster based on clinician diagnosis, (3) laboratory evidence of immunity, or (4) laboratory confirmation of disease. If a healthcare employee has received a dose of live zoster vaccine in the by but has no other evidence of immunity to varicella, the live zoster dose tin can be considered the  first dose of the ii-dose varicella series. Note that recombinant zoster vaccine (RZV, Shingrix) cannot be counted as the showtime dose in a 2-dose varicella vaccination series.

Should a person who received 2 doses of varicella vaccine be vaccinated for herpes zoster when they plough 50?

In its 2018 recommendations for the prevention of canker zoster, ACIP states that Shingrix may be used in adults age 50 years or older irrespective of prior receipt of varicella vaccine or live zoster vaccine (Zostavax, Merck). For details, run across www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6703a5-H.pdf.

If a child has a very balmy example of chickenpox (for instance, only 5 to 10 pox), is s/he immune or should south/he be vaccinated?

A balmy instance of chickenpox produces immunity to varicella as does a moderate or severe instance. A child with a reliable history of chickenpox does not need to receive varicella vaccine. Still, if there is whatsoever doubt that the balmy illness really was chickenpox, it is all-time to vaccinate the child. There is no harm in vaccinating a child who is already immune.

I empathise that varicella vaccine can be used in postexposure settings. How before long afterward exposure does the vaccine demand to be administered?

Varicella vaccine is constructive in preventing chickenpox or reducing the severity of the disease if used inside 72 hours (3 days), and possibly up to 5 days after exposure. However, not every exposure to varicella leads to infection, so for hereafter amnesty, varicella vaccine should be given, even if more 5 days have passed since an exposure.

A healthcare worker with no history of chickenpox, and unknown serologic immunity, was exposed to a patient with zoster. She received varicella vaccine two days afterwards. She developed a pruritic maculopapular rash 11 days after vaccination. Is the rash from the vaccine or from her zoster exposure?

The only style to determine whether the rash is acquired past wild-blazon varicella or vaccine virus is to attempt to isolate virus from the rash and send information technology to a laboratory that is capable of differentiating wild and vaccine-type virus. This is more often than not not practical. Given the history, the conservative approach is to assume she has an active case of chickenpox and act according to your infection control guidelines.

Does varicella vaccine affect tuberculosis skin exam readings in the same way that MMR does?

There is currently no information on the effect of varicella vaccine on reactivity to a tuberculin skin test (TST). Until information is bachelor, it is prudent to apply the aforementioned rules to varicella vaccine as are applied to MMR: a TST (i.e., PPD) may exist applied before (preferably) or simultaneously with varicella vaccine. If vaccine has been given, delay the TST for at least iv weeks.

How has widespread use of varicella vaccine in children impacted disease?

Substantial reductions in varicella morbidity and mortality have occurred following the licensure of vaccine. Reported cases of varicella accept fallen more than 95%. For more information on the touch on of varicella vaccination see the CDC varicella webpage at world wide web.cdc.gov/chickenpox/surveillance/monitoring-varicella.html.

What are the recommendations for varicella vaccination before and afterwards pregnancy?

Live varicella vaccine should not be given to a adult female who is known to be pregnant or who plans to become pregnant inside ane month. If a woman who is planning to go significant in the future comes in for a visit or an annual exam, her varicella history should exist obtained and if indicated, 2 doses of vaccine should be given, spaced iv to 8 weeks autonomously. Pregnant women should be assessed for evidence of varicella amnesty and if non-immune, should receive the starting time dose of varicella vaccine following completion of the pregnancy and prior to hospital discharge. A second dose should be given iv to 8 weeks later on.

Can a meaning healthcare worker with a history of varicella infection care for a patient with varicella? Is it possible for her to take a failing titer, thus making her susceptible to the virus again?

People with a reliable history of varicella tin can be considered to be immune. A reliable history for healthcare personnel consists of (1) a healthcare provider's diagnosis of varicella or verification of history of varicella disease; (2) a history of herpes zoster, based on healthcare provider diagnosis; or (3) laboratory bear witness of immunity or laboratory confirmation of illness. Immunity post-obit affliction or vaccination is probably life-long. More than i primary infection with varicella is unusual.

Should all significant women have serology screening for varicella?

No. Serologic testing for varicella should be considered only for women who practise non accept evidence of immunity (reliable history of chickenpox or documented vaccination). One time a person has been found to be seropositive, information technology is not necessary to test again in the hereafter.

If a woman receives varicella vaccine, how long should she wait before condign pregnant?

Contrary to the information provided in the vaccine package insert, which states that pregnancy should be avoided for iii months, the ACIP recommends that a wait of i calendar month is sufficient.

If a woman receives varicella vaccine and subsequently finds out that she is significant, what should she be told near the risk to the fetus?

To date, no adverse outcomes of pregnancy or in a fetus take been reported among women who inadvertently received varicella vaccine before long before or during pregnancy. The chance of congenital varicella syndrome post-obit varicella affliction is small, then the risk of built anomalies following vaccination with alive attenuated varicella zoster virus (VZV)-containing vaccine is probably very small.

Merck and the Centers for Disease Control and Prevention (CDC) jointly operated a pregnancy registry for women exposed to VZV-containing vaccines for seventeen years afterward the licensure of varicella vaccine. The registry was discontinued in 2013, having found no signals to indicate a risk of Built Varicella Syndrome or design of birth defects related to vaccination with VZV-containing vaccines. Healthcare providers may go on to study exposure to VZV-containing vaccines inside 3 months of formulation or during pregnancy past contacting Merck'southward call center at i-877-888-4231.

How has widespread utilise of varicella vaccine in children impacted affliction?

Substantial reductions in varicella morbidity and mortality have occurred post-obit the licensure of vaccine. Reported cases of varicella accept fallen more than 95%. For more information on the impact of varicella vaccination see the CDC varicella webpage at www.cdc.gov/chickenpox/surveillance/monitoring-varicella.html.

Scheduling Vaccines Back to top

What is the recommended schedule for vaccinating a kid? What almost adults?

For children, the first dose should be given at age 12 months with a second dose given at age 4 through 6 years. The second dose could be given earlier, if necessary, every bit long equally there is a three-month interval between doses. All children age 13 years and older likewise every bit adults without evidence of immunity should also have documentation of 2 doses of varicella vaccine, separated by a minimum interval of 4 weeks.

Some children in my practice accept had only i dose of varicella vaccine. Is there a problem waiting until the 11- to 12-year-old visit to give them the second dose?

Don't filibuster giving the 2nd dose of varicella vaccine. Give the 2nd dose the next fourth dimension the kid is in your office. The recommendation to routinely give a 2d dose at age 4 through 6 years is intended to provide improved protection in the 15% to 20% of children who exercise not adequately respond to the outset dose.

In what circumstances should I obtain a varicella titer subsequently vaccination?

Postvaccination serologic testing is not recommended in any group, including healthcare personnel.

A child received merely one dose of varicella vaccine and later on tests positive for varicella IgG antibody. Does the child still demand a second dose of varicella vaccine?

If a person tests positive for varicella antibody 28 days or more after vaccination, the Informational Committee on Immunization Practices (ACIP) considers the person to be allowed. CDC prefers that the child receive a 2nd dose to assure long-term immunity, but doing so is not absolutely necessary. You tin access the ACIP varicella vaccine recommendations, which include evidence of immunity (page 16) at world wide web.cdc.gov/mmwr/pdf/rr/rr5604.pdf.

Should I test women for varicella immunity at their get-go prenatal visit?

Test pregnant women who lack either (i) documentation of receipt of two doses of varicella vaccine or (ii) healthcare provider diagnosis or verification of varicella or herpes zoster disease. Women who are not immune should brainstorm the 2-dose vaccination serial immediately postpartum.

What is the advisable lab test to apply to determine whether there has been previous chickenpox disease?

Commercially available laboratory tests for varicella antibody are commonly based on a technique chosen EIA (enzyme immunoassay). Though these tests are sufficiently sensitive to find antibody resulting from varicella zoster virus infection, they are generally not sensitive plenty to detect vaccine-induced antibody. The more than sensitive assays needed to detect vaccine-induced antibody are not widely available. This is why CDC does non recommend antibody testing after varicella vaccination.

I work in employee health. Several hospital employees take told me they have had chickenpox, but their titers show no antibodies. Should I offering varicella vaccination to them even though they insist they've had the illness?

If you cannot verify a healthcare employee'south history of chickenpox, the employee should receive 2 doses of varicella vaccine at least 4 weeks apart. For details, refer to pages 16 and 26 of the CDC recommendations Prevention of Varicella at www.cdc.gov/mmwr/pdf/rr/rr5604.pdf.

A nursing student received 2 valid, documented doses of varicella vaccine. For whatever reason, she subsequently had a titer drawn. The titer was negative. Practice you recommend revaccination with 2 doses of varicella vaccine?

No. Documented receipt of 2 doses of varicella vaccine supersedes results of subsequent serologic testing. Virtually commercially available tests for varicella antibody are not sensitive plenty to detect vaccine-induced antibody, which is why CDC does not recommend mail service-vaccination testing. For more information, see page 24 of ACIP's Immunization of Health-Intendance Personnel, available at www.cdc.gov/mmwr/pdf/rr/rr6007.pdf.

A child in our practice received her first dose of varicella vaccine when she was 12 months onetime and her 2nd dose when she was 14 months sometime. The second dose was only ii months subsequently the first. Is the second dose valid or does it need to exist repeated?

The recommended minimum interval between two doses of varicella vaccine for children 12 months through 12 years of historic period is 12 weeks. Still, the second dose of varicella vaccine does not need to be repeated if information technology was separated from the get-go dose by at least iv weeks. See www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html, Table 3-1.

Contraindications and Precautions Back to top

What are the precautions and contraindications to varicella vaccine?

Precautions:

• Contempo receipt (within the previous 11 months) of antibody-containing blood product (specific interval depends on product) • Moderate or severe acute illness with or without fever • Use of aspirin or aspirin-containing products • Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination)

Contraindications:

• history of a serious allergic reaction (e.g., anaphylaxis) afterwards a previous dose of varicella vaccine or to a varicella vaccine component. For information on vaccine components, refer to the manufacturer'due south parcel insert (www.immunize.org/fda) or become to www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-two.pdf. • pregnant now or may become pregnant within 1 month • known astringent immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy [east.g., two weeks or more of daily receipt of twenty mg or more than, or 2 mg/kg trunk weight or more than, of prednisone or equivalent] or patients with HIV infection who are severely immunocompromised [a child age one through five years with CD4+ T-lymphocyte percentage less than 15% or a person age 6 years or older with a CD4+ T-lymphocyte count less than 200 cells per microliter]) • family history of congenital or hereditary immunodeficiency in starting time-caste relatives (e.one thousand., parents, siblings) unless the allowed competence of the potential vaccine recipient has been clinically substantiated or verified by a laboratory • for combination MMRV merely (approved only for children one through 12 years of age), primary or acquired immunodeficiency, including immunosuppression associated with AIDS or other clinical manifestations of HIV infections, cellular immunodeficiency, hypogammaglobulinemia, and dysgammaglobulinemia.

For boosted data, see the ACIP General Best Practice Guidelines for Immunization section on contraindications and precautions, table 4–one and associated footnotes, at world wide web.cdc.gov/vaccines/hcp/acip-recs/full general-recs/contraindications.html or consult IAC's "Guide to Contraindications and Precautions to Commonly Used Vaccines" at world wide web.immunize.org/catg.d/p3072a.pdf.

What are the recommendations for the use of varicella vaccine in children with HIV or other immunodeficiencies?

The ACIP General Best Exercise Guidelines for Immunization section on altered immunocompetence recommends varicella vaccination of children with humoral (but non cellular) immunodeficiencies. In improver, single-antigen varicella vaccine should be considered for HIV-infected children age one through 5 years with CD4+ T-lymphocyte percentages greater than or equal to 15% for at least 6 months or for children age six years and older with CD4+ T-lymphocytes count greater than or equal to 200 cells per microliter for at to the lowest degree 6 months. Eligible children should receive 2 doses of varicella vaccine with a three-month interval between doses. Additional details of these recommendations can exist found in table 8-1 and associated footnotes at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/immunocompetence.html.

We have a xl lb six-twelvemonth-old patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can we give the child MMR and varicella vaccine based on this methotrexate dosage?

Based on the weight and dosage provided (40 lbs and xv mg/calendar week), the child is currently receiving more than 0.4 mg/kg/week of methotrexate. This meets the Infectious disease Society of America (IDSA) definition of high-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage tin can be reduced. The 2013 IDSA definition of depression-level immunosuppression for methotrexate is a dosage of less than 0.4 mg/kg/calendar week. For additional details, come across the 2013 IDSA Clinical Practise Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early/2013/eleven/26/cid.cit684.full.pdf.

I had an 18-twelvemonth-old in the clinic today for varicella vaccination. He reports having antiphospholipid syndrome being treated with rituximab (a drug that affects the function of lymphocytes). The side by side dose of rituximab will be in 2 weeks. He has also had 12 allowed globulin (IG) injections in the terminal yr. Should he get the varicella vaccine at all with this condition, and if so, what fourth dimension frame practice we demand to be concerned with in relation to the rituximab treatment and/or IG?

The IDSA guidelines betoken that persons receiving rituximab should be considered to take high-level immunosuppression. Both inactivated and alive vaccines should exist withheld at least 6 months following treatment with lymphocyte depleting medications such every bit rituximab. As for the IG, the interval to alive vaccination depends on the dose. For guidance, please refer to the Timing and Spacing of Immunobiologics section of the ACIP's General Best Practices Guidelines for Immunization, table iii–five: "Recommended intervals between administration of antibiotic-containing products and measles- or varicella-containing vaccine, by product and indication for vaccination" at world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html. This interval could be equally long as 11 months, depending on the dose he receives.

Recently we had a one-yr-one-time with built middle disease and who is on chronic aspirin therapy in for a well-child check and routine vaccination. Are there any recommendations regarding varicella vaccine being given to children who are on chronic aspirin therapy?

The ACIP's varicella vaccine recommendations state that no adverse events associated with the use of salicylates after varicella vaccination have been reported, even so, the vaccine manufacturer recommends that vaccine recipients avoid using salicylates for half dozen weeks later receiving varicella vaccines because of the association betwixt aspirin use and Reye syndrome later on varicella illness (chickenpox). Vaccination with subsequent close monitoring should be considered for children who take rheumatoid arthritis or other conditions requiring therapeutic aspirin. The chance for serious complications associated with aspirin is likely to exist greater in children in whom natural varicella develops than it is in children who receive the vaccine containing adulterate varicella zoster virus. In other words, the benefit of varicella vaccine likely outweighs the theoretical risk of Reye syndrome. See the ACIP varicella recommendations at www.cdc.gov/mmwr/PDF/rr/rr5604.pdf, page 29.

Later on receiving varicella vaccine, should healthcare personnel avert contact with immunocompromised patients?

This is not necessary unless the person who was vaccinated develops a rash.

Is there any business concern when giving varicella vaccine to a kid who lives with a susceptible pregnant woman or an immunocompromised individual?

ACIP recommends varicella vaccine for good for you household contacts of significant women and immunosuppressed people. Although in that location may exist a small adventure of transmission of varicella vaccine virus to household contacts, the risk is much greater that the susceptible kid volition be infected with wild-blazon varicella, which could present a more serious threat to household contacts.

A pediatric surgeon's 12-month-one-time child received the varicella vaccine and 2 weeks later developed a varicella-like rash. The surgeon had chickenpox as a child and had a positive varicella titer several years ago. Is it okay for the surgeon to go on to see patients? Also, is the varicella virus in the rash that develops post-obit vaccination as virulent as the wild-type virus?

Considering the surgeon is immune, the kid's rash is non a problem and in that location is no need for the surgeon to restrict activity. In comparing a vaccine rash to wild-type chickenpox infection, transmission is less likely with a vaccine rash and, in full general, there are fewer skin lesions.

If a patient is breast-feeding her six-month-sometime baby, can she receive varicella vaccine without the risk of transmitting the vaccine virus to her baby?

There has been simply i published study of mother to kid transmission of varicella vaccine virus. If the susceptible woman were to be infected with wild varicella virus, the risk of manual to the babe would be much higher. Breastfeeding is not a contraindication or a precaution to varicella vaccination of the mother when vaccination is indicated.

A 10-twelvemonth-old girl came to our immunization clinic, and the nurse noted crusted lesions on her arms and legs. The parent said the child had had chickenpox a calendar week earlier. The girl was not ill, so we vaccinated her. But now I wonder if her recent example of chickenpox might interfere with her immune response to vaccines.

A previous history of chickenpox disease, even recent disease, is non known to interfere with the immune response to different vaccines. To review the true contraindications and precautions to vaccination, consult IAC's "Guide to Contraindications and Precautions to Commonly Used Vaccines" at www.immunize.org/catg.d/p3072a.pdf.

Some other helpful resource is ACIP's General All-time Practice Guidelines for Immunization. Information technology contains a useful tabular array titled "Conditions incorrectly perceived as contraindications or precautions to vaccination (i.e., vaccines may be given nether these weather)". The table is available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html, Table 4-2.

Nosotros have a patient who has selective IgA deficiency. We also have patients with selective IgM deficiency. Can MMR or varicella vaccine be administered to these patients?

There is no known run a risk associated with MMR or varicella vaccination in someone with selective IgA or IgM deficiency. It is possible that the immune response may be weaker, but the vaccines are likely effective.

Vaccine Prophylactic Back to superlative

How safe is varicella vaccine?

Varicella vaccine is very prophylactic. Almost 20% of vaccine recipients will take minor injection site complaints, such every bit pain, swelling, or redness. Fewer than 5% of recipients develop a localized or generalized varicella-similar rash 5 to 26 days afterwards vaccination. These rashes take an boilerplate of 2 to 5 lesions, and may be maculopapular rather than vesicular. Fever following varicella vaccine is uncommon.

If a child had ane varicella vaccination and developed a vesicular (chickenpox-similar) rash at the vaccination site 7 to 10 days after vaccination, does the patient withal demand the 2d dose? What if the rash covered the entire trunk?

If you believe the child had varicella disease (that is, breakthrough varicella) after the first dose, the kid does not need another dose. If yous are uncertain whether the child had varicella, the second dose should be administered on schedule. If in doubt, requite the 2d dose. If this was a case of breakthrough varicella, a 2d dose volition not be harmful.

If a child breaks out in 5 to 10 maculopapular spots 2 weeks post-obit varicella vaccination, tin can s/he go to school?

Manual of varicella vaccine virus is a rare outcome, and appears to occur just when the vaccinated person develops a vesicular rash. A maculopapular rash 2 weeks after varicella vaccine may not have been caused past the vaccine. If the rash were acquired by the vaccine, the adventure of transmission is very small; however, the child should avoid close contact with people who do not have evidence of varicella immunity and who are at loftier gamble of complications of varicella, such equally immunocompromised people, until the rash has resolved.

If a vaccinated kid gets v to 10 vesicular lesions 2 weeks subsequently vaccination, can southward/he nourish schoolhouse?

You cannot distinguish a balmy case of varicella disease from a rash caused by the vaccine. The kid may have been infected with varicella at about the same fourth dimension s/he was vaccinated. The conservative arroyo would exist to treat the child equally if s/he had chickenpox and restrict her/his activities until all the lesions crust.

If a kid gets quantum varicella infection, nearly 50 lesions, tin can s/he become to school?

Breakthrough varicella represents replication of wild varicella virus in a vaccinated person. Although most quantum disease is very balmy, the kid is contagious and activities should be restricted to the same extent as an unvaccinated person with varicella disease.

Can a immature child, who was recently vaccinated for chickenpox, spread the vaccine virus to other household members?

Available data suggest that healthy children are unlikely to transmit vaccine virus. Transmission of vaccine virus to a household contact has rarely been documented. Information technology appears that manual of vaccine occurs generally, or mayhap even exclusively, when the vaccinated person develops a rash post-obit vaccination.

If a person develops a rash afterwards receiving varicella vaccination, does he demand to be isolated from susceptible people who are either significant or immunosuppressed?

Transmission of varicella vaccine virus is rare. However, if a pregnant or immunosuppressed household contact of a vaccinated person is known to be susceptible to varicella, and if the vaccinee develops a rash 7 to 21 days following vaccination, it is prudent that they avert prolonged close contact with the susceptible person until the rash resolves.

An 8-month-old was erroneously given varicella vaccine. What might the consequences be? What should we do now?

An 8-month-onetime is likely to take residual passive varicella antibody from his or her mother. The vaccine probably volition have no effect, and no activity is necessary. The dose should not be counted, and the child should be revaccinated on schedule at 12 through 15 months of historic period.

Varicella Zoster Immune Globulin Back to top

What is varicella zoster immune globulin?

Varicella zoster immune globulin (VariZIG, Saol Therapeutics) is a human blood product prepared from plasma obtained from healthy, volunteer blood donors identified past routine screening to have high antibody titers to varicella-zoster virus. The outset varicella zoster immune globulin, VZIG, became available in 1978. In a study of immunocompromised children who were administered VZIG inside 96 hours of exposure, approximately one in v exposed children developed clinical varicella, and one in 20 developed subclinical illness compared with 65%—85% assault rates amid historical controls. In 2006, VZIG was discontinued and a new production, VariZIG, became available.

In what circumstances should I consider giving VariZIG?

According to CDC the conclusion to administrate VariZIG depends on three factors: 1) whether the patient lacks show of amnesty to varicella, 2) whether the exposure is likely to result in infection, and 3) whether the patient is at greater take a chance for varicella complications than the general population. For high-run a risk patients who accept additional exposures to varicella-zoster virus 3 weeks or longer after initial VariZIG assistants, some other dose of VariZIG should be considered. The most recent recommendations for the use of VariZIG were published in 2013 and are bachelor at www.cdc.gov/mmwr/pdf/wk/mm6228.pdf, pages 574–6.

What groups of patients are eligible for VariZIG?

VariZIG is recommended for patients without evidence of immunity to varicella who are at high chance for severe varicella and complications, who have been exposed to varicella or herpes zoster, and for whom varicella vaccine is contraindicated. Patient groups recommended past CDC to receive VariZIG include the following:

• Immunocompromised patients without testify of immunity • Newborn infants whose mothers have signs and symptoms of varicella around the fourth dimension of delivery (i.e., 5 days before to 2 days after) • Hospitalized preterm infants born at 28 weeks or more than of gestation whose mothers do not have bear witness of immunity to varicella • Hospitalized preterm infants born at less than 28 weeks of gestation or who weigh one,000 grams or less at nascence, regardless of their mothers' prove of amnesty to varicella • Significant women without show of immunity

CDC recommends assistants of VariZIG every bit shortly equally possible after exposure to varicella-zoster virus, ideally within 96 hours, upwards to 10 days afterwards exposure.

What is the recommended dosage of VariZIG?

VariZIG is supplied in 125-IU vials and should be administered intramuscularly every bit directed by the manufacturer. The recommended dose is 125 IU/10 kg of body weight, up to a maximum of 625 IU (v vials). The minimum dose is 62.5 IU (0.five vial) for patients weighing 2.0 kg or less and 125 IU (one vial) for patients weighing two.ane–10.0 kg. VariZIG is bachelor from Saol Therapeutics. For ordering data encounter varizig.com/liquid-product_info.html.

A one-month-old babe was exposed for the last 6 days to chickenpox. What should be done to protect the exposed infant, who is too young to vaccinate?

There is no show that healthy full-term infants built-in to women in whom varicella occurs more than 48 hours afterwards delivery are at increased risk for serious complications such every bit pneumonia or death. Varicella zoster allowed globulin, VariZIG, can be given up to 10 days after exposure but is only recommended for newborn infants whose mothers have signs and symptoms of varicella around the time of delivery (5 days before to 2 days after), hospitalized premature infants built-in at 28 or more than weeks of gestation whose mothers exercise not have testify of immunity to varicella, or hospitalized premature infants born at less than 28 weeks of gestation or who weigh 1,000 grams or less at nativity regardless of their mothers' evidence of immunity to varicella. Assuming this is an infant at home, VariZIG would not be recommended. Varicella, if it develops, would be managed as for whatever child.

Storage and Handling Back to top

How should varicella vaccine be stored in my clinic?

Live varicella-containing vaccines (varicella, MMRV) must be stored in a freezer at a temperature between -50°C and -15°C (between -58°F and +5°F) until reconstitution and assistants. These vaccines can deteriorate rapidly after they are removed from the freezer. A separate stand-alone freezer should be used to shop frozen vaccines that crave storage temperatures between -50°C and -15°C (between -58°F and +five°F). A stand-lonely storage unit that is frost-complimentary or has an automatic defrost bike is preferred. Frozen vaccines should not be stored in the freezer compartment of a combination unit considering household freezers cannot maintain proper storage temperatures for frozen vaccines. This applies to both temporary and long-term storage of frozen vaccines. The diluents should be kept separately in the refrigerator or at room temperature. Live varicella-containing vaccines must be administered within 30 minutes of reconstitution.

What happens if you put varicella vaccine in the fridge instead of the freezer?

Vaccine will be damaged if not stored according to the manufacturer'southward instructions. However, it may withal be possible to utilize vaccine that has not been properly stored. Put the affected vaccine vials into the freezer subsequently you have marked them so they are not confused with the unaffected vials, and then call the manufacturer at 1-800-ix-VARIVAX (1-800-982-7482) for farther guidance about whether the vaccine is nevertheless usable. Unreconstituted varicella vaccine may be stored in the fridge for up to 72 hours before use. If refrigerated varicella vaccine is non used within 72 hours, it should be discarded.

If you have inadvertently left your vaccine at room temperature instead of in the freezer or have experienced a power failure, label the affected vaccine to keep it separated from unaffected vaccine and return information technology to recommended storage weather in a freezer promptly, then contact the manufacturer for farther guidance. Do not administrate the vaccine until you have consulted with Merck.

How can I transport varicella vaccine? What if I exercise not have admission to a portable freezer?

The vaccine manufacturer does not recommend transporting varicella-containing vaccines (varicella, MMRV). If these vaccines must be transported (for example during an emergency), CDC recommends use of a portable vaccine freezer unit or qualified container and packout that maintains temperatures between -l°C and -15°C (- 8°F and +v°F). Do not use dry ice, even for temporary storage. Dry ice might betrayal the vaccines to temperatures colder than -50°C (-58°F).

Follow these steps for transporting frozen vaccines:

• Identify a temperature monitoring device (preferably with a buffered probe) in the container equally close as possible to the vaccines. • Immediately upon arrival at the destination, unpack the vaccines and place them in a freezer at a temperature range between -50°C and -15°C (-58°F and +five°F) . Any stand up-lone freezer that maintains these temperatures is adequate. • Record the fourth dimension vaccines are removed from the storage unit and placed in the transport container, the temperature during send, and the fourth dimension at the end of transport when vaccines are placed in a stable storage unit.

If necessary, varicella-containing vaccines may exist transported or stored at fridge temperature between 2°C and 8°C (between 36°F and 46°F) for up to 72 continuous hours prior to reconstitution. To do so, follow the steps above using a portable vaccine fridge unit or a qualified container and packout designed to maintain vaccine storage temperatures between 2°C and 8°C (between 36°F and 46°F).

Transport of varicella-containing vaccine at temperatures other than the recommended range between -l°C and -15°C (-58°F and +five°F) is considered a temperature excursion, so contact Merck at (800) 982-7482 for further guidance. Practice non discard vaccines without contacting the manufacturer and/or your immunization program for guidance.

For additional guidance, encounter the CDC Vaccine Storage and Treatment Toolkit at www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf.

I was told past a coworker that varicella vaccine tin be stored at fridge temperature for up to 3 days and still be used. Is this truthful?

Yes. According to the manufacturer, unreconstituted varicella vaccine may be stored at refrigerator temperature (2°C to 8°C, 36°F to 46°F) for upward to 72 continuous hours prior to reconstitution. Vaccine stored at 2°C to eight°C that is not used inside 72 hours of removal from-fifteen°C (+5°F) storage should be discarded. See world wide web.merck.com/product/u.s.a./pi_circulars/v/varivax/varivax_pi.pdf.

Back to top

frasierpring1961.blogspot.com

Source: https://www.immunize.org/askexperts/experts_var.asp

Share this post