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Varicella (Chickenpox/Varivax)
KEY POINTS
- Course: Usually mild, but can be severe in infants and adults (complications 5-10x more than in kids).
- Complications: Encephalitis (brain inflammation), hepatitis, bacterial skin infection and pneumonia, death; in later years, shingles.
- Wait at least one month after stopping high-dose steroids in otherwise non-immune compromised persons before receiving Varivax.
- Individuals who reside with non-immune pregnant women can be vaccinated, but the pregnant woman should avoid direct contact with them for a few weeks.
- Avoid pregnancy at least 1 month post-vaccination (manufacturer recommends 3 months).
- All travelers should be immune to chickenpox.
Disease: An highly contagious viral (Varicella zoster) infection, mainly of the respiratory tract and skin, but occasionally involving the liver and brain.
Signs/Symptoms:
- Fever
- Cough (dry)
- Headache
- Rash (blisters and pustules) x 4-5 days
Incubation: 10-21 days
Course: Usually mild, but can be severe in infants and adults (complications 5-10x more than in kids)
Complications: Encephalitis (brain inflammation), hepatitis, bacterial skin infection, pneumonia, death; in later years, shingles.
Prevalence: Worldwide
Transmission:
- Sneezing
- Coughing
- Skin blister fluid contact
- The most contagious period is 2 days before to just after rash appears; but the virus can be transmitted until the rash dries (crusts).
Treatment: Anti-viral medications
Prevention:
- Respiratory masks (N-95)
- Handwashing
- Varicella-Zoster Immune Globulin (VZIG) Injection
- Vaccine (live / Varivax)
- Primary Series: Two doses, 0.5cc subcutaneously,
- Children (12mo – 6yrs): at 12-15 mo’s old and at 4-6yrs-old
- Ages 7yrs-old-Adults: 2 doses at least 4wks apart
- No booster recommended
- Vaccine may prevent or diminish severity of chickenpox if given within 3-5 days of exposure.
- Side-Effects,
- Mild: Injection site pain/swelling (20 – 30%), fever (10%), rash (4%, up to a month after vaccination; these people may be infectious)
- Moderate: Jerking/staring seizure with fever
- Severe (rare): Pneumonia (rare), neurological reactions, low blood count
- Precautions/Contraindications
- Postpone vaccination if moderately ill, especially respiratory or feverish illness.
- Neomycin or gelatin allergies
- Do not take any salicylates, including aspirin, for 6 weeks after vaccination.
- Defer vaccination at least 5 months after receiving blood/plasma transfusion, or after receiving immune globulin or Varicella zoster immune globulin.
- After Varivax, no immune globulin, including VZIG, should be given for at least 2 mo’s, unless its use outweighs the benefit of vaccine.
- Pregnancy
- Untreated tuberculosis
- Immune compromised (there are exceptions; discuss with physician)
- Vaccinees to avoid contact with persons high-risk for chickenpox infection for 6 weeks post-vaccine. This risk is higher for vaccinees who develop rash from vaccine.
- Wait at least 3mo’s post malignancy chemotherapy before receiving Varivax.
- Wait at least one month after stopping high-dose steroids in otherwise non-immunocompromised persons before receiving Varivax.
- When indicated in immune compromised persons, 2 doses of Varivax are given 3 months apart.
- Pregnancy
- Individuals who reside with non-immune pregnant women can be vaccinated, but the pregnant woman should avoid direct contact with them for a few weeks.
- Avoid pregnancy at least 1 month post-vaccination (manufacturer recommends 3 months).
- If a woman becomes pregnant within 1 month of vaccination, she should be counseled on possible risks to the fetus.
- Breastfeeding (unknown risk)
- Targets*
- All travelers should be immune to chickenpox.
- All ≥ 12 mo’s-old
- Born 1980 or after; born prior to that are considered immune except,
- Healthcare workers
- Pregnant
- Immune compromised
- Post chickenpox exposure and for outbreak control
- Primary Series: Two doses, 0.5cc subcutaneously,
*Note: Proof of chickenpox vaccination is required for immigration into U.S.
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