Varicella (Chickenpox/Varivax)

KEY POINTS

1. Course: Usually mild, but can be severe in infants and adults (complications 5-10x more than in kids).
2. Complications: Encephalitis (brain inflammation), hepatitis, bacterial skin infection and pneumonia, death; in later years, shingles.
3. Wait at least one month after stopping high-dose steroids in otherwise non-immune compromised persons before receiving Varivax.
4. 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.
5. Avoid pregnancy at least 1 month post-vaccination (manufacturer recommends 3 months).
6. 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:

1. Fever
2. Cough (dry)
3. Headache
4. 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:

1. Respiratory masks (N-95)
2. Handwashing
3. Varicella-Zoster Immune Globulin (VZIG) Injection
4. Vaccine (live / Varivax)
   1. Primary Series: Two doses, 0.5cc subcutaneously,
      1. Children (12mo – 6yrs): at 12-15 mo’s old and at 4-6yrs-old
      2. Ages 7yrs-old-Adults: 2 doses at least 4wks apart
   2. No booster recommended
   3. Vaccine may prevent or diminish severity of chickenpox if given within 3-5 days of exposure.
   4. Side-Effects,
      1. Mild: Injection site pain/swelling (20 – 30%), fever (10%), rash (4%, up to a month after vaccination; these people may be infectious)
      2. Moderate: Jerking/staring seizure with fever
      3. Severe (rare): Pneumonia (rare), neurological reactions, low blood count
   5. Precautions/Contraindications
      1. Postpone vaccination if moderately ill, especially respiratory or feverish illness.
      2. Neomycin or gelatin allergies
      3. Do not take any salicylates, including aspirin, for 6 weeks after vaccination.
      4. Defer vaccination at least 5 months after receiving blood/plasma transfusion, or after receiving immune globulin or Varicella zoster immune globulin.
      5. After Varivax, no immune globulin, including VZIG, should be given for at least 2 mo’s, unless its use outweighs the benefit of vaccine.
      6. Pregnancy
      7. Untreated tuberculosis
      8. Immune compromised (there are exceptions; discuss with physician)
      9. 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.
      10. Wait at least 3mo’s post malignancy chemotherapy before receiving Varivax.
      11. Wait at least one month after stopping high-dose steroids in otherwise non-immunocompromised persons before receiving Varivax.
      12. When indicated in immune compromised persons, 2 doses of Varivax are given 3 months apart.
      13. Pregnancy
          1. 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.
          2. Avoid pregnancy at least 1 month post-vaccination (manufacturer recommends 3 months).
          3. If a woman becomes pregnant within 1 month of vaccination, she should be counseled on possible risks to the fetus.
      14. Breastfeeding (unknown risk)
   6. Targets*
      1. All travelers should be immune to chickenpox.
      2. All ≥ 12 mo’s-old
      3. Born 1980 or after; born prior to that are considered immune except,
         1. Healthcare workers
         2. Pregnant
         3. Immune compromised
      4. Post chickenpox exposure and for outbreak control

*Note: Proof of chickenpox vaccination is required for immigration into U.S.

Access the VIS Sheet here

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