Changes in the electronic
Immunisation Handbook – 6 June 2014
Since the print edition of the Immunisation Handbook was published in May 2014, changes have been
made to the electronic edition of the Handbook to reflect confirmed funding decisions.
Immunisation providers are encouraged to ensure that they are using the current recommendations as
available in the electronic edition of the Handbook, and to refer to the Pharmaceutical Schedule
(www.pharmac.health.nz) for the number of funded doses and any subsequent changes to the funding
decisions.
Summary of the changes
Schedule vaccines

In addition to DTaP-IPV vaccine, DTaP-IPV-HepB/Hib vaccine may be administered to children
aged under 10 years for catch-up immunisation.

All vaccines on the National Immunisation Schedule are funded for (re-)vaccination of individuals
following significant immunosuppression.

IPV vaccine may be used for primary immunisation of unvaccinated or partially-vaccinated
individuals.

Td vaccine may be used for primary vaccination of unvaccinated or partially-vaccinated
individuals, and may be used for boosting of tetanus-prone wounds.
Vaccines for special groups
Meningococcal, pneumococcal or varicella vaccines will be funded for the following individuals.
Meningococcal conjugate vaccines (MenCCV and MCV4-D)

individuals pre- or post-splenectomy or with functional asplenia

individuals with HIV, complement deficiency (acquired, including monoclonal therapy against C5,
or inherited) or pre- or post-solid organ transplant

close contacts of meningococcal cases

bone marrow transplant patients

individuals following immunosuppression.
Pneumococcal conjugate vaccine (PCV13)

high-risk children who have previously received four doses of PCV10

(re-)vaccination for children aged under 18 years: with HIV; who are post-haematopoietic stem
cell transplant (HSCT) or chemotherapy; who are pre- or post-splenectomy or with functional
asplenia; who are pre- or post-solid organ transplant, renal dialysis and other severely
immunosuppressive regimens.
Pneumococcal polysaccharide vaccine (23PPV)

individuals who are pre- or post-splenectomy or with functional asplenia

high risk children aged under 18 years.
Varicella vaccine

non-immune patients:
o
with chronic liver disease who may in future be candidates for transplantation
o
with deteriorating renal function prior to transplantation
o
prior to solid organ transplant
o
prior to any elective immunosuppression

patients at least two years after bone marrow transplantation, on advice of their specialist

patients at least six months after completion of chemotherapy, on advice of their specialist

HIV-positive individuals with mild or moderate immunosuppression who are non-immune to
varicella, on advice of their HIV specialist

individuals with inborn errors of metabolism at risk of major metabolic decompensation, with no
clinical history of varicella

household contacts of paediatric patients who are immune compromised, or undergoing a
procedure leading to immune compromise, where the household contact has no clinical history of
varicella

household contacts of adult patients who have no clinical history of varicella and who are severely
immune compromised or undergoing a procedure leading to immune compromise, where the
household contact has no clinical history of varicella.
Detailed description of the changes
The changes made in each section of the Handbook have been bolded in the text below for emphasis.
Introduction
National Immunisation Schedule 2014
Point 6 has been replaced with:
6.
DTaP-IPV-HepB/Hib (paediatric diphtheria, tetanus, acellular pertussis, polio,
hepatitis B and Hib vaccine, Infanrix-hexa) and DTaP-IPV may be administered to
children aged under 10 years for catch-up immunisation. This is a change from the previous
recommendation of age 7 years (see Appendix 2: ‘Planning immunisation catch-ups’ and the
relevant disease chapters).
Point 8 has been added:
8.
All vaccines on the National Immunisation Schedule are funded for (re-)
vaccination of individuals following significant immunosuppression. The timing
and number of doses should be discussed with the individual’s specialist.
2014 targeted programmes for special groups
Point 5 has been replaced with:
5.
Meningococcal conjugate vaccines, MenCCV and MCV4-D (see chapter 12), will be funded for:

individuals pre- or post-splenectomy or with functional asplenia

individuals with HIV, complement deficiency (acquired, including monoclonal
therapy against C5, or inherited) or pre- or post-solid organ transplant

close contacts of meningococcal cases

bone marrow transplant patients

individuals following immunosuppression.
Point 6 has been added:
6.
Pneumococcal conjugate vaccine, PCV13 (see chapter 15) will be funded for:

high-risk children who have previously received four doses of PCV10

(re-)vaccination for children aged under 18 years: with HIV; who are posthaematopoietic stem cell transplant (HSCT) or chemotherapy; who are pre- or
post-splenectomy or with functional asplenia; who are pre- or post-solid organ
transplant, renal dialysis and other severely immunosuppressive regimens.
Point 7 has been added:
7.
Pneumococcal polysaccharide vaccine, 23PPV (see chapter 15), will be funded for:

individuals who are pre- or post-splenectomy or with functional asplenia

high risk children aged under 18 years.
Point 8 has been replaced with:
8.
Varicella vaccine (see chapter 21) will be funded for the following groups:

non-immune patients:
– with chronic liver disease who may in future be candidates for transplantation
– with deteriorating renal function prior to transplantation
– prior to solid organ transplant
– prior to any elective immunosuppression

patients at least two years after bone marrow transplantation, on advice of their specialist

patients at least six months after completion of chemotherapy, on advice of their specialist

HIV-positive individuals with mild or moderate immunosuppression who are non-immune
to varicella, on advice of their HIV specialist

individuals with inborn errors of metabolism at risk of major metabolic decompensation,
with no clinical history of varicella

household contacts of paediatric patients who are immune compromised, or undergoing a
procedure leading to immune compromise, where the household contact has no clinical
history of varicella
household contacts of adult patients who have no clinical history of varicella
and who are severely immune compromised or undergoing a procedure leading
to immune compromise, where the household contact has no clinical history of
varicella.
Note that ‘post-exposure prophylaxis for immune competent inpatients’ has been removed from the
‘non-immune patients’ section.

Table 2: Funded vaccines for special groups
The meningococcal, pneumococcal and varicella rows have been replaced with:
Meningococcal conjugate
vaccines (see chapter 12)
Meningococcal conjugate vaccines, MenCCV and MCV4-D, should be offered to:
 individuals pre- or post-splenectomy or with functional asplenia
 individuals with HIV, complement deficiency (acquired, including
monoclonal therapy against C5, or inherited) or pre- or post-solid organ
transplant
 close contacts of meningococcal cases
 bone marrow transplant patients
 individuals following immunosuppression.
PCV13 for:
Pneumococcal conjugate
(PCV13) and pneumococcal  high risk children who have previously received 4 doses of PCV10
polysaccharide (23PPV)
 (re-)vaccination for children aged under 18 years: with HIV; who are
vaccines (see chapter 15)
post-haematopoietic stem cell transplant (HSCT) or chemotherapy; who
are pre- or post-splenectomy or with functional asplenia; who are preor post-solid organ transplant, renal dialysis and other severely
immunosuppressive regimens.
23PPV for:
 individuals who are pre- or post-splenectomy or with functional
asplenia
 high-risk children aged under 18 years.
Varicella vaccine (see
chapter 21)
Recommended for:
 non-immune patients:
– with chronic liver disease who may in future be candidates for
transplantation
– with deteriorating renal function before transplantation
– prior to solid organ transplant
– prior to any elective immunosuppression*
 patients at least two years after bone marrow transplantation, on advice of
their specialist
 patients at least six months after completion of chemotherapy, on advice of
their specialist
 HIV-positive individuals with mild or moderate immunosuppression who are
non-immune to varicella, on advice of their HIV specialist
 individuals with inborn errors of metabolism at risk of major metabolic
decompensation, with no clinical history of varicella
 household contacts of paediatric patients who are immune compromised, or
undergoing a procedure leading to immune compromise, where the
household contact has no clinical history of varicella
 household contacts of adult patients who have no clinical history of
varicella and who are severely immunocompromised or undergoing a
procedure leading to immune compromise, where the household
contact has no clinical history of varicella.
Chapter 2 –Processes for safe immunization
2.2.4 Immunisation consent in primary care
The National Immunisation Register leaflet (HE1501) has been removed.
2.7 Adult vaccination
Table 2.11 Checklist for adult vaccination, excluding travel
The meningococcal, pneumococcal, IPV and varicella rows have been replaced with:
Meningococcal conjugate
(chapters 4 and 12)
For individuals:
 pre- or post-splenectomy or with functional asplenia
 with HIV, complement deficiency (acquired, including monoclonal
therapy against C5, or inherited) or pre- or post-solid organ
transplant
 who are close contacts of meningococcal cases
 bone marrow transplant patients
 following immunosuppressiona
Pneumococcal conjugate and 23PPV for individuals pre- or post-splenectomy or with functional
asplenia
polysaccharide (chapters 4
and 15)
IPV (chapter 16)
Any unvaccinated or partially-vaccinated individual
Varicella (chapter 21)
Non-immune individuals:
 with chronic liver disease
 with deteriorating renal function before transplantation
 prior to solid organ transplant
 prior to any elective immunosuppressiona
Patients at least 2 years after bone marrow transplant
Patients at least 6 months after completion of chemotherapy
HIV-positive patients who are non-immune to varicella, with mild or moderate
immunosuppression
Individuals with inborn errors of metabolism at risk of major metabolic
decompensation, with no clinical history of varicella
Household contacts of paediatric patients who are immune compromised or
undergoing a procedure leading to immune compromise, where the household
contact has no clinical history of varicella
Household contacts of adult patients who have no clinical history of
varicella and who are severely immune compromised, or undergoing a
procedure leading to immune compromise, where the household contact
has no clinical history of varicella
Chapter 3 – Vaccination questions and concerns
3.13 Allergies and illnesses
What if the child is due to have an operation (elective surgery)?
Varicella vaccine has been added to the third paragraph:
Pneumococcal, meningococcal, Hib, influenza and varicella vaccines are recommended for these
individuals pre- or post-splenectomy (see section 4.3.4 and the relevant disease chapters).
Chapter 4 – Immunisation of special groups
4.2.7 Infants with HIV
Meningococcal vaccine has been added:
Infants with HIV infection who do not have severe immunosuppression should follow the routine
Schedule and are also eligible to receive funded meningococcal, varicella and influenza vaccines.
4.2.8 Other conditions
Funded varicella vaccine has been added to the second bullet point.

Varicella vaccine is funded for infants with inborn errors of metabolism at risk of
major metabolic decompensation (see section 21.5); and is recommended for a variety of
endocrine disorders – discuss with the specialist.
4.3.1 Introduction
Household contacts
‘Paediatric’ has been removed from the last sentence of the second paragraph about household
contacts:
Varicella vaccine is funded for household contacts of patients who are immunocompromised or
undergoing a procedure leading to immunocompromise.
4.3.2 Primary immune deficiencies
A new second paragraph has been added:
Hib, PCV13 and Td vaccines may be used in testing for primary immune deficiencies,
on the recommendation of an internal medicine physician or paediatrician.
4.3.3 Secondary (acquired) immune deficiencies
Solid organ transplants
Funded pneumococcal vaccine has been added to the first sentence of the final paragraph:
In patients undergoing organ transplantation, pneumococcal vaccine (funded for children
aged under 18 years) should be given at least two weeks before the transplant.
HIV infection – Table 4.4 Additional vaccine recommendations (funded and unfunded)
for HIV-positive individuals
The meningococcal conjugate vaccine rows have been shaded, to reflect funding of these vaccines for
HIV-positive individuals (vaccinators are reminded to refer to the Pharmaceutical Schedule for the
number of funded doses). MCV4-D has been added to the list of funded vaccines for adults aged 18
years and older.
PCV13 is now funded for HIV-positive children aged 5 to under 18 years, so this row has been shaded
in the table.
4.3.4 Asplenia
Table 4.5 Additional vaccine recommendations (funded and unfunded) and schedules
for individuals with functional or anatomical asplenia
Functional asplenia has been added to the ‘Adults ≥18 years’ row. A new footnote ‘h’ has been added
to the Hib row, as Hib vaccine is not funded for adults with functional asplenia.
4.3.6 (Re-)vaccination following immunosuppression
A reminder about the period of immunosuppression has been added:
(Note that the period of immunosuppression due to steroid or other
immunosuppressive therapy must be longer than 28 days.)
Chapter 9 – Human papillomavirus (HPV)
References
The URL to reference 7 has been replaced with:
https://cdn.auckland.ac.nz/assets/fmhs/faculty/ahrg/docs/2012-overview.pdf
Chapter 12 – Meningococcal disease
Key information
The funded vaccine indications have been replaced with:
Funded vaccine indications
MCV4-D or MenCCV for individuals:
 pre- or post-splenectomy or with functional asplenia
 with HIV, complement deficiency (acquired, including monoclonal
therapy against C5, or inherited) or pre- or post-solid organ transplant
 who are close contacts of meningococcal cases
 who are bone marrow transplant patients
 following immunosuppression.
12.5.1 At-risk individuals
Table 12.5 Meningococcal group C conjugate (MenCCV) and quadrivalent meningococcal vaccine
(MCV4-D) recommendations
The table has been updated to reflect the new funding.
Recommended and funded
MenCCV and MCV4-D are recommended and funded for individuals:
 who are pre- or post-splenectomy or with functional aspleniaa,b
 with HIV, complement deficiency (acquired, including monoclonal therapy against C5, or inherited)
or who are pre- or post-solid organ transplantb
 who are close contacts of meningococcal cases
 who are bone marrow transplant patientsb
 following immunosuppression.b,c
Recommended but not funded
MenCCV and MCV4-D are recommended,d but not funded, for individuals:
 who are laboratory workers regularly handling meningococcal cultures
 who are travelling to high-risk countries (see the WHO website), or before the Hajj
 who are adolescents and young adults living in communal accommodation (eg, in a hostel or at boarding
school, in military accommodation, in correctional facilities or in other long-term institutions).
a
Pneumococcal, Hib, influenza and varicella vaccines are also recommended for individuals pre- or post-splenectomy or
with functional asplenia. See section 4.3.4.
b
See sections 4.2 and 4.3 for more information.
c
The period of immunosuppression due to steroid or other immunosuppressive therapy must be longer than 28 days.
d
Quadrivalent meningococcal polysaccharide vaccines are another option for individuals aged 2 years and older.
Chapter 14 – Pertussis
14.5.1 Children
Catch-up immunisation
The bullets have been updated to reflect the DTaP-IPV-HepB/Hib funding for children aged under 10
years:
DTaP-IPV-HepB/Hib or DTaP-IPV may be used for primary immunisation of
children aged under 10 years.

Tdap may be used for primary immunisation of children aged 7 to under 18
years.

Chapter 15 – Pneumococcal disease
Key information
The ‘Funded vaccines’ and ‘Funded immunisation’ schedule rows have been replaced with:
Funded vaccines
13-valent protein conjugate vaccine, PCV13 (Prevenar 13): for all children
aged under 5 years.
PCV13: for high-risk children who have previously received 4 doses
of PCV10; for (re-)vaccination of children aged under 18 years with
HIV, who are post-haematopoietic stem cell transplant (HSCT) or
chemotherapy, who are pre- or post-splenectomy or with functional
asplenia, who are pre- or post-solid organ transplant, renal dialysis
and other severely immunosuppressive regimens.
23-valent polysaccharide vaccine, 23PPV (Pneumovax 23): for
individuals who are pre-or post-splenectomy or with functional
asplenia; for high-risk children aged under 18 years.
Funded immunisation schedule
Children who have started with PCV10 can continue with PCV13.
Healthy children aged under 5 years: PCV13 at ages 6 weeks, 3, 5 and 15
months.
High-risk children aged under 5 years: standard PCV13 schedule, plus 1
dose of 23PPV at age 2 years or older (with at least 8 weeks between the
last PCV13 and the 23PPV). If risk persists, revaccinate once with 23PPV,
5 years after the first 23PPV.
Eligible children aged 5 to under 18 years: 1 dose of PCV13 followed 8
weeks later with 1 dose of 23PPV. Revaccinate once with 23PPV, 5 years
after the first 23PPV.
Eligible adults: a maximum of 3 doses of 23PPV in their lifetime, a
minimum of 5 years apart.
15.4.1 Available vaccines
Funded vaccines
The following has been added to the end of the first bullet point:

or who are eligible for (re-)vaccination.
15.5.2 High-risk children aged under 5 years
PCV13
The following has been added to the end of the paragraph:
High-risk children who have previously received four doses of PCV10 may receive
one dose of PCV13.
15.5.3 Older children and adults at higher risk of pneumococcal disease
The note has been deleted:
Note: Only children aged under 18 years with functional asplenia or who are pre- or
post-splenectomy are eligible for funded PCV13 and 23PPV vaccines. Adults aged 18
years and older who are pre- or post-splenectomy are eligible for funded 23PPV
vaccine. However, PCV13 is recommended (but not funded) for adults.
15.5.4 (Re-)vaccination
HIV has been added to the list of conditions.
15.5.5 Summary of pneumococcal vaccine schedules
Table 15.5 Summary of pneumococcal vaccine recommendations (funded and unfunded) and
schedules
The table has been updated as shown below. Note that ‘Children aged 5 to <18 years with other highrisk conditions’ has been moved from the ‘Recommended but not funded’ section to the ‘Funded and
unfunded’ section, to reflect the funded 23PPV vaccine.
High-risk children aged 5 to under 18 years (funded and unfunded)
Children aged 5 to <18
1 dose of PCV13.b,e
years with functional
Followed by 1 dose of 23PPV at least 8 weeks after the PCV13 dose.
asplenia or who are pre- or
Revaccinate once with 23PPV, 5 years after the 1st 23PPV.
post-splenectomy,a,d or
who meet the PCV (re-)
vaccination criteria
Children aged 5 to <18
years with other highrisk conditions
1 dose of PCV13.b,e
1 dose of 23PPV at least 8 weeks after the PCV13 dose.
Revaccinate once with 23PPV, 5 years after the 1st 23PPV.
High-risk adults aged 18 years (funded and unfunded)
Adults (≥18 years) who are 1 dose of PCV13.b,e
pre- or post-splenectomya,d
Give a maximum of 3 doses of 23PPV in a lifetime, a minimum of 5 years apart.
or with functional
The 1st 23PPV dose is given at least 8 weeks after PCV13; the 2nd a minimum of
asplenia
5 years later; the 3rd dose at age ≥65 years.
Chapter 16 – Poliomyelitis
16.5.3 Unimmunised adults and children
The first paragraph has been reworded to reflect funding for partially immunised individuals.
For partially immunised or previously unimmunised individuals, a primary immunisation
course consists of three doses of IPV-containing vaccine (funded).
Chapter 19 – Tetanus
19.5.2 Adults and children from age 10 years
The second paragraph has been reworded to reflect funding for partially immunised individuals.
For partially immunised or previously unimmunised individuals aged 10 years and older, a
primary immunisation course consists of three doses of a tetanus toxoid-containing vaccine at
intervals of not less than four weeks (see Appendix 2).
Table 19.2 Guide to tetanus prophylaxis in wound management
Footnote a has been updated to reflect funding up to age 10 years for DTaP-IPV and DTaP-IPVHepB/Hib vaccines:
a See Appendix 2 for catch-up schedules for previously unimmunised children. DTaPcontaining vaccine may be used in children aged under 10 years.
19.5.4 (Re-)vaccination
Has been replaced with:
Tetanus toxoid-containing vaccine is funded for (re-)vaccination following
immunosuppression. (See also sections 4.2 and 4.3.)
Chapter 21 – Varicella
21.5.1 Funded vaccine for high-risk groups
Table 21.1 High-risk groups eligible for funded varicella immunisation
The table has been updated to reflect the new funding. Note that ‘post-exposure prophylaxis for
immune competent inpatients’ has been removed from the ‘non-immune patients’ section.
High-risk groups funded for immunisation are:

non-immune patients:
– with chronic liver disease who may in future be candidates for transplantation
– with deteriorating renal function before transplantation
– prior to solid organ transplant
– prior to any elective immunosuppression*

patients at least 2 years after bone marrow transplantation, on the advice of their specialist

patients at least 6 months after completion of chemotherapy, on the advice of their specialist

HIV-positive patients who are non-immune to varicella, with mild or moderate immunosuppression, on the
advice of an HIV specialist

individuals with inborn errors of metabolism at risk of major metabolic decompensation, with no
clinical history of varicella

household contacts of paediatric patients who are immune compromised or undergoing a procedure leading
to immune compromise, where the household contact has no clinical history of varicella

household contacts of adult patients who have no clinical history of varicella and who are severely
immune compromised or undergoing a procedure leading to immune compromise, where the
household contact has no clinical history of varicella.
*
Note that the period of immunosuppression due to steroid or other immunosuppressive therapy must be longer than 28
days.
21.5.4 Immunosuppressed individuals
The first sentence of the second paragraph has been updated to reflect funding for household contacts
of immunosuppressed individuals.
Where immunosuppressed individuals cannot be vaccinated, it is important to vaccinate the
household members and other close contacts (funded for household contacts) to provide ‘ring
fence’ protection (see sections 4.2, 4.3 and 21.7).
Appendix 2
A2.1.1 Principles of catch-up for children aged under 10 years
Point 6 has been replaced with:
6.
For infants and children aged under 10 years, use DTaP-IPV-HepB/Hib or DTaP-IPV for
primary immunisation. Tdap may be used for primary immunisation of children
aged 7 to under 18 years (note that Tdap is not registered for children aged under 10 years
or for primary immunisation, but there are not expected to be any safety concerns).
A2.1.3 National Immunisation Schedule catch-up guides for infants and
children aged up to 18 years
Table A2:7 Age at presentation: 5 years to under 10 years
The table has been updated to reflect funding of both DTaP-IPV and DTaP-IPV-HepB/Hib for catchup immunisation of children aged under 10 years.
Dose
Vaccines
First dose
DTaP-IPV-HepB/Hiba or DTaP-IPVb
Hep Bc
MMR
4 weeks later
DTaP-IPV-HepB/Hiba,d or DTaP-IPVb,d
Hep Bc
MMR
4 weeks later
DTaP-IPV-HepB/Hiba,d
6 months later
DTaP-IPVd
or
DTaP-IPVb,d
Hep
Bc
Once the child has received the appropriate vaccines for their age, continue on the Schedule as usual.
a
Parents/guardians should be informed that their child will receive extra doses of Hib but there are no safety
concerns with these extra doses.
b
If the parents/guardians prefer, vaccinators may administer the DTaP-IPV and Hep B vaccines as 2 separate
injections instead of the combination DTaP-IPV-HepB/Hib vaccine.
c
Hep B is not required if DTaP-IPV-HepB/Hib is given.
d
If a child turns 10 years before completing their catch-up programme, they should continue on the 10 to under 18 years
catch-up schedule (refer to Table A2.8).
A2.2 Immunisation catch-up for adults aged 18 years and older
Table A2.9: Primary immunisation requirements for adults aged 18 years and older
Footnotes a and b have been updated to reflect funding of Td and IPV vaccines for partially
immunised adults.
a
A primary course of 3 doses of adult Td vaccine is recommended and funded for unimmunised or partially-immunised
adults. Unfunded Tdap may be offered as an alternative to Td for pertussis protection. At ages 45 and 65 years, the Td
booster immunisation administration (the immunisation benefit) is not funded, although the vaccine is free.
b
A primary course of 3 doses of IPV is recommended and funded for unimmunised or partially-immunised adults. The
minimum recommended interval between IPV doses 1 and 2 is 4 weeks; the 3rd IPV dose should be given at least 6
months after dose 2. If necessary, the interval may be shortened to 4 weeks between doses, but this is not the preferred
schedule.
Appendix 9 – Websites
International websites
American Academy of Pediatrics
The name of the first article has been corrected:
‘Why immunize your child?’
Funded vaccines for special groups
Note: this summary page is only in the print and PDF versions of the Handbook (at the back of the
book, page 680). It is not in the e-book or html versions. A separate PDF of this table is available for
download, to replace page 680
(http://www.health.govt.nz/system/files/documents/publications/funded-vaccines-for-specialgroups-june14.pdf).
The meningococcal, pneumococcal and varicella rows have been updated to:
MenCCV and For individuals: pre- or post-splenectomy or with functional asplenia; with HIV, complement
MCV4-D
deficiency (acquired or inherited) or pre- or post-solid organ transplant; close contacts of
meningococcal cases; bone marrow transplant patients; following immunosuppression.
PCV13 and
23PPV
PCV13 for high-risk children who have previously received 4 doses of PCV10. PCV13 for
children aged 5 to <18 years who are eligible for (re-) vaccination. 23PPV for individuals pre- or
post-splenectomy or with functional asplenia; for high-risk children aged under 18 years.
Varicella
Non-immune patients: with chronic liver disease who may need a transplant in the future; with
deteriorating renal function before transplant; prior to solid organ transplant; prior to elective
immunosuppression. Patients at least 2 years after bone marrow transplant or at least 6 months after
completion of chemotherapy, on advice of their specialist. HIV-positive individuals with mild or moderate
immunosuppression who are non-immune to varicella, on advice of their specialist. Individuals with
inborn errors of metabolism at risk of major metabolic decompensation, with no clinical history of
varicella. Household contacts of paediatric patients who are immune compromised, or undergoing a
procedure leading to immune compromise, where the household contact has no clinical history of
varicella. Household contacts of adult patients who have no clinical history of varicella and who
are severely immune compromised or undergoing a procedure leading to immune compromise,
where the household contact has no clinical history of varicella.