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mother says she and her 6 month old child had had an extended
exposure to chickenpox two days ago. The mother says she has
never had chickenpox so there would be no antibodies in her
child. Who should be vaccinated, the mother, or infant, or both?
The mother can be vaccinated within 72 hours, or even up to
5 days after the exposure, but the child is too young. The vaccine
is not licensed or recommended by ACIP or AAP for infants under
12 months of age. ACIP
Varicella Recommendations (2/13/03) More
patient has a negative varicella titer. He had leukemia as a
child. Can he be vaccinated with varicella vaccine?
This would only be a problem if he were in remission and not
really cured. But if his leukemia was cured, and if he is not
on chemotherapy or some other immunosuppressant medication,
and his physician does not consider him to be immunodeficient,
then he can be vaccinated. ACIP
Varicella Recommendations (See “Vaccination of HIV-Infected
Children and Other Persons With Altered Immunity”). (2/13/03)
a child had chickenpox before one year of age, is the child
immune or should the child still receive the vaccine?
Children who have a reliable history of varicella are considered
immune, according to the ACIP. There are no exceptions to this
recommendtion based on the child's age. However, some experts
disagree based on some research regarding immune system maturity
and the immune response, and believe a dose of vaccine should
be recommended for children who had the disease before one year
of age. To date, there has been no change in ACIP's recommendation.
On the other hand, keep a high threshold of suspicion about
whether the disease was really chickenpox. There are other illnesses
that can look like chickenpox; so if there is any doubt whatever
that the rash illness the person had was not chickenpox, then
Varicella Recommendations (2/27/03)
a patient developed arthritic pains or aches following MMR,
would you expect the same type of reaction after varicella vaccine?
No. Varicella vaccine has not been associated with joint symptoms.
are the views on immunizing a breastfeeding mother with varicella
Neither inactivated nor live vaccines (including varicella vaccine)
administered to a lactating woman affect the safety of breast-feeding
for mothers or infants. Breastfeeding does not adversely affect
immunization and is not a contraindication for vaccines. NOTE:
Vaccinia (smallpox) vaccine is the exception to this rule; vaccinia
vaccine is contraindicated for breastfeeding mothers. For more
information see ACIP General Recommendations on Immunization,
(see page 18).
is it necessary to wait to vaccinate with varicella following
receipt of blood products.
Blood (e.g., whole, blood, packed red blood cells, and plasma)
and other antibody-containing blood products may interfere with
the replication of live injected vaccine viruses. Recent receipt
of blood products is a precaution to MMR and varicella vaccines.
Varicella and MMR vaccines should be given 14 days prior to
the blood products or delayed until the antibody has degraded,
(see pages 6-7) (6/26/03)
does ACIP recommend for healthcare workers who are still seronegative
after two doses of varicella vaccine?
you encounter this situation, please contact NIPInfo@cdc.gov
for further information. (6/26/03)
a child develops a rash following MMR or varicella vaccination
but is otherwise well, can the child attend day care/school?
For MMR, it is not a problem because there is no risk of transmission
after vaccination. With varicella it is a little more complex.
You have to use clinical judgment about what you think the rash
looks like. Vaccine-associated varicella rashes tend to be mild,
maculopapular lesions that are essentially noncommunicable.
On the other hand, if the rash looks extensive, if it is vesicular,
or you think the person might in fact have breakthrough varicella
disease, the child could be infectious. It is possible to get
infected with wild virus varicella after vaccination before
the immune system has had a chance to mount an immune response
to the vaccine. The bottom line is that if it looks like chickenpox,
it should be treated like chickenpox. It would also depend on
the policy of the day care/school. (2/27/03)
Varivax and FluMist be stored in the same freezer?
Yes, the storage temperature is the same for Varivax and FluMist.
often does zoster (shingles) occur following varicella vaccination?
Varicella vaccine is a live virus vaccine, and may result in
a latent infection, similar to that caused by wild varicella
virus. Consequently, zoster caused by the vaccine virus has
been reported, mostly among vaccinated children. Not all these
cases have been confirmed as having been caused by vaccine virus.
The risk of zoster following vaccination appears to be less
than that following infection with wild-type virus. The majority
of cases of zoster following vaccine have been mild and have
not been associated with complications, including post-herpetic
neuralgia. For more information on development of zoster following
vaccination, refer to the 1999 ACIP recommendation for “Prevention
of Varicella”, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4806a1.htm.
an adult has not had documented chickenpox but has had shingles,
is vaccination recommended?
Primary infection with varicella is chickenpox. A reliable history
of shingles is de facto evidence of immunity to chickenpox.
However, if there is any doubt about whether the person actually
had shingles, you can either do serologic testing for immunity
or vaccinate with two doses of varicella vaccine 4-8 weeks apart.
because you don't remember having chickenpox doesn't mean you are
not immune. There are some adults who actually have not had chickenpox,
but many people who think they did not have chickenpox turn out
to be immune if tested. Back