II. Indications

  1. Every child over age 1 without prior infection
  2. Postexposure Vaccination within 3-5 days
  3. Varicella outbreak control
  4. Women of childbearing age who are not immune
    1. Contraindicated in pregnancy
    2. May be safe in Lactation (see below)
  5. Safe in mildly immunocompromised children
    1. Children with Leukemia
    2. Marrow transplant recipient once recovered immunity
    3. Children with Human Immunodeficiency Virus

III. Contraindications

  1. Absolute
    1. Pregnancy
    2. Serious illness
    3. Severe Immunodeficiency
    4. First degree relative with Immunodeficiency
      1. Transmission is rare (transmitted to 3 household contacts 1995-2005)
    5. Active Tuberculosis
  2. Relative
    1. Tuberculosis
    2. Lactation
      1. Study suggests no virus transmission in Lactation
      2. Consider for postpartum Vaccination
      3. Bohlke (2003) Obstet Gynecol 102:970-7 [PubMed]
    3. Anaphylactic reaction previously to neomycin
  3. Conditions not contraindicating Vaccine
    1. Pregnant family member
    2. Low grade fever
    3. Diarrhea
    4. Otitis Media or Upper Respiratory Infection

IV. Pharmacokinetics

  1. Live virus Vaccine
  2. Must keep Vaccine frozen

V. Efficacy

  1. Underused Vaccine
    1. Universal Vaccination is key
    2. Spotty Vaccination will result in epidemic
  2. Protection against infection: 85-90% (prevents 3.5 million Varicella cases per year in U.S.)
  3. Protection against serious infection: 95%
  4. Breakthrough cases are more mild after Vaccine
  5. Decreased mortality in reactivated high risk patients

VI. Adverse Effects (low Incidence)

  1. Local injection site reaction (erythema, pain, swelling, Pruritus at Vaccination site)
    1. Occurs in 17% of children (24% of teens and adults)
  2. Fever (11.4 per 100,000 doses)
  3. Varicella-like rash
    1. Localized Varicella-Like Rash (at injection site): 3% of children
    2. Generalized Varicella-Like Rash: 37 case reports (1995 to 2005 in U.S.)
  4. Herpes Zoster Infection (48 cases per 100,000 in 2008, U.S.)
  5. Anaphylaxis (rare, 76 total case reports)
  6. Serious illness in severe Immunodeficiency
    1. Pneumonia (5 total case reports)
    2. Encephalitis (12 total case reports 1995 to 2005, U.S.)
    3. Hepatitis
    4. Mortality (2 case reports in history of Varicella Vaccine)

VII. Dosage Protocol

  1. Two dose protocol regardless of age at first dose
  2. Primary Series
    1. Dose 1: 12 months old
    2. Dose 2: Age 5 years
  3. Catch-up
    1. Administer 2 doses 1 month apart
    2. Consider checking Immune status prior to administer
  4. References
    1. Kuter (2004) Pediatr Infect Dis 23:132-7 [PubMed]
    2. Vasquez (2004) JAMA 291:851-5 [PubMed]

VIII. Resources

  1. Inadvertent Varivax use: Pregnancy registry
    1. Phone: 800-986-8999

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Ontology: Varivax (C0947706)

Concepts Pharmacologic Substance (T121) , Immunologic Factor (T129)
MSH D019433
French Varivax
English varivax, Varivax