Chickenpox primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Primary Prevention

Vaccination

Main article: Varicella vaccine

A varicella vaccine has been available since 1995 to inoculate against the disease. Some countries require the varicella vaccination or an exemption before entering elementary school. Protection is not lifelong and further vaccination is necessary five years after the initial immunization.

In the UK, varicella antibodies are measured as part of the routine of prenatal care, and by 2005 all NHS healthcare personnel had determined their immunity and been immunised if they were non-immune and have direct patient contact. Population-based immunization against varicella is not otherwise practiced in the UK, because of lack of evidence of lasting efficacy or public health benefit.

Varicella containing vaccines	Indications	Efficacy and immunogenicity	Recommended dose	Contraindications
Varicella vaccine (Varivax)	Children Routine vaccination at 12-15 months of age Routine second dose at 4-6 years of age Adolescents and Adults All persons 13 years of age and older without evidence of varicella immunity	Detectable antibody 97% of children 12 months through 12 years following 1 dose 99% of persons 13 years and older after 2 doses 70% to 90% effective against any varicella disease 90%-100% effective against severe varicella disease	Children Minimum interval between doses of varicella vaccine is 3 months for children younger than 13 years of age Adolescents and Adults 2 doses separated by at least 4 weeks Do not repeat first dose because of extended interval between doses	Severe allergic reaction to vaccine component or following a prior dose Immunosuppression Pregnancy Moderate or severe acute illness Recent blood product
Measles-mumps-rubella-varicella vaccine (ProQuad)	Approved for children 12 months through 12 years Do not use for persons 13 years and older	Efficacy of MMRV vaccine was inferred from that of MMR vaccine and varicella vaccine on the basis of noninferior immunogenicity Formal studies to evaluate the clinical efficacy of MMRV vaccine have not been performed	May be used for both first and second doses of MMR and varicella vaccines Minimum interval between doses is 3 months	Severe allergic reaction to vaccine component or following a prior dose Immunosuppression Pregnancy Moderate or severe acute illness Recent blood product Personal or family (i.e., sibling or parent) history of seizures of any etiology

Normal Reactions to Vaccine

• Fever of 101.9 (38.9 C) up to 42 days after Injection
• Soreness, inching at the site of injection within 2 days
• Rash occurring at site of injection anywhere form 8 to 19 days after injection. If this happens you are considered contagious.
• Rash on other parts of body anywhere from 5 to 26 days after injection. If this happens you are considered contagious.

What to do Should Reaction Occur?

Control fever and lessen discomfort, take medication containing acetaminophen, (AKA paracetamol) such as

• Panadol,
• Tempra,
• Tylenol.

Vaccine Storage

All varicella-containing vaccines should be stored in a continuously frozen state at the manufacturer recommended freezer temperature until administration. Varicella and zoster vaccines should be stored at +5°F (-15°C) or colder. The combination vaccine measles, mumps, rubella, and varicella (MMRV) should also be stored frozen between -58°F and +5°F (-50°C to -15°C). If varicella and zoster vaccines are stored in the freezer with MMRV, keep the temperature between -58°F and +5°F (-50°C to -15°C). Measles, mumps, rubella vaccine (MMR) can be stored either in the freezer or the refrigerator. When stored in the freezer, the temperature should be the same as that required for MMRV, between -58°F and +5°F (-50°C to -15°C). Storing MMR in the freezer with MMRV may help prevent inadvertent storage of MMRV in the refrigerator.

CDC strongly discourages transport of varicella-containing vaccines to off-site clinics. All varicella-containing vaccines are fragile. If these vaccines must be transported to an off-site clinic, the vaccine manufacturer recommends they be trans322 Varicella 21 ported and stored at refrigerator temperatures, between 35°F and 46°F (2°C to 8°C), for no more than 72 continuous hours prior to reconstitution. Vaccine stored between 35°F and 46°F (2°C to 8°C) that is not used within 72 hours of removal from the freezer should be discarded. Varicella-containing vaccines cannot be refrozen. Providers should contact their immunization program for advice and details.

Having a patient pick up a dose of vaccine (e.g., zoster vaccine) at a pharmacy and transporting it in a bag to a clinic for administration is not an acceptable transport method for zoster vaccine or any other vaccine. The vaccine diluent should be stored separately at room temperature or in the refrigerator. The vaccine should be reconstituted according to the directions in the package insert and only with the diluent supplied (or with the diluent supplied for MMR vaccine), which does not contain preservative or other antiviral substances that might inactivate the vaccine virus. Once reconstituted, all varicella containing vaccines must be used immediately to minimize loss of potency. The vaccine must be discarded if not used within 30 minutes of reconstitution. Mishandled varicella vaccine should be clearly marked and replaced in the freezer separate from properly handled vaccine. The manufacturer must be contacted for recommendations before any mishandled vaccine is used.

References

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