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varicella virus vaccine (Varivax)

Indications: 1) all healthy children between 12 months & 18 years a) children 12 months to 13 years who have not been immunized & have not had chickenpox should receive 1 vaccination b) children between 13 & 18 years of age require 2 vaccinations 4-8 weeks apart 2) added to childhood immunization schedule for infants 12-28 months of age (12-15 months) [2] 3) recommended to be given with measles, mumps, rubella vaccine (MMR) 4) a second vaccination at age 4-6 years, to be given with MMR as MMRV (ProQuad) now recommended [12] 5) susceptible adolescents & adults in one of the following groups a) health care workers b) household contacts of immunosuppressed patients c) workers in schools or day-care centers d) young adults in closed or semi-closed populations 1] college students 2] military e) non-pregnant women of child-bearing age f) international travelers who anticipate close contact with local populations Contraindications: 1) hypersensitivity to any component of the vaccine including gelatin 2) history of anaphylactoid reaction to neomycin 3) individuals with blood dyscrasias, leukemia, lymphoma, or other malignant neoplasm affecting the bone marrow or lymphatic systems 4) individuals on immunosuppressive therapy 5) primary & acquired immunodeficiency states 6) family history of congenital or hereditary immunnodeficiency 7) active, untreated tuberculosis 8) febrile illness 9) pregnancy Caution: 1) avoid pregnancy until 3 months after vaccination 2) avoid if breast feeding 3) immediate treatment for anaphylactoid reaction should be available 4) defer vaccination for 5 months following blood transfusions or immune globulin therapy 5) avoid immune globulin therapy for 2 months following vaccination 6) avoid salicylates for 5 weeks after vaccination (Reye syndrome) 7) vaccinated individuals should not have close contact with susceptible high-risk individuals following vaccination (newborns, pregnant women, immunocompromised individuals) pregnancy-category - safety in lactation ? Dosage: - children 12 months to 12 years: 0.5 mL SC - 2 dose vaccination schedule since 2006 [17] - children >12 years & adults: - 2 doses of 0.5 mL SC separated by 4-8 weeks Lyophilized powder for injection: - 0.5 mL single dose vials - store in freezer - can be stored refrigerated for 72 hours Pharmacokinetics: - elimination: liver - onset of action: 4-6 weeks after vaccination Adverse effects: 1) most common (1-10%) - pain, fever, irritability, nervousness, fatigue, disturbed sleep, headache, malaise, chills, redness, rash, pruritus, generalized varicella-like rash, diarrhea, loss of appetite, nausea/vomiting, abdominal pain, hematoma, induration & stiffness at the site of injection, myalgia, arthralgia, otitis, upper respiratory illness, allergic reaction 2) uncommon (< 1%) - febrile seizures (causality not established), pneumonitis 3) complications in immunodeficient children (contraindication) [15] Drug interactions: 1) immunosuppressive agents [7] a) decrease effectiveness of vaccine b) increase risk of varicella disease from vaccine 2) salicylates may increase the risk of Reye syndrome Notes: Effectiveness: 1) 48% of vaccinated children vs 86% of unvaccinated children developed chickenpox upon exposure in a daycare center [4,5] 2) 73% effective if given at 12 months of age 99% effective if given at 15 months of age difference only applies to 1st year after vaccination [8,9] 3) unknown if vaccine will prevent shingles [6] 4) universal childhood varicella vaccination diminishes mortality 5) vaccinated individuals can still develop chicken pox, but their clinical course is usually milder than in unvaccinated patients [16]

Related

Varicella [Herpes] zoster virus (VZV); human herpesvirus 3 (HHV3)

Specific

Herpes zoster (shingles) vaccine (Zostavax, Shingrix)

General

live virus vaccine

References

  1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
  3. Journal Watch 22(8):59, 2002 (vaccine effective in adults) Ampofo K et al Clin Infect Dis 34:774, 2002
  4. Journal Watch 23(3):26, 2003 Galil K et al, N Engl J Med 347:1909, 2002 Gershon AA, N Engl J Med 347:1962, 2002
  5. Prescriber's Letter 10(2):7 2003
  6. Prescriber's Letter 10(4):21 2003
  7. Prescriber's Letter 10(10):56 2003
  8. Prescriber's Letter 11(3):16 2004 Detail-Document#: 200308 (subscription needed) http://www.prescribersletter.com
  9. Journal Watch 24(6):45, 2004 Vazquez M et al JAMA 291:851, 2004 PMID: 14970064
  10. Journal Watch 25(6):46-47, 2005 Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med. 2005 Feb 3;352(5):450-8. PMID: 15689583
  11. Zhou F, Harpaz R, Jumaan AO, Winston CA, Shefer A. Impact of varicella vaccination on health care utilization. JAMA. 2005 Aug 17;294(7):797-802. PMID: 16106004
  12. Prescriber's Letter 13(8): 2006 CDC's Advisory Committee Recommends Changes in Varicella Vaccinations Detail-Document#: 220804 (subscription needed) http://www.prescribersletter.com
  13. Chaves SS et al, Loss of vaccine-induced immunity to varicella over time. N Engl J Med 2007, 356:1121-9
  14. Marin M, Guris D, Chaves SS, Schmid S, Seward JF; Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention (CDC). Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007 Jun 22;56(RR-4):1-40. PMID: 17585291 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5604a1.htm
  15. Maglione MA et al Safety of Vaccines Used for Routine Immunization of US Children: A Systematic Review. Pediatrics; published online July 1, 2014 PMID: 25086160 http://pediatrics.aappublications.org/content/early/2014/06/26/peds.2014-1079.full.pdf+html - Byington CL Vaccines: Can Transparency Increase Confidence and Reduce Hesitancy? Pediatrics; published online July 1, 2014 PMID: 25086161 http://pediatrics.aappublications.org/content/early/2014/06/26/peds.2014-1494.full.pdf+html
  16. Baxter R, Tran TN, Ray P et al Impact of vaccination on the epidemiology of varicella: 1995-2009. Pediatrics. 2014 Jul;134(1):24-30 PMID: 24913796
  17. Leung J, Harpaz R Impact of the Maturing Varicella Vaccination Program on Varicella and Related Outcomes in the United States: 1994-2012. J Ped Infect Dis (2015). August 12, 2015 http://jpids.oxfordjournals.org/content/early/2015/08/05/jpids.piv044.abstract

Component-of

measles virus vaccine live attenuated/mumps virus vaccine/rubella virus vaccine live/varicella virus vaccine