VARICELLA VACCINATION
STANDING ORDER
INDICATIONS
Varicella virus vaccine (VARIVAX) is indicated for vaccination against varicella (chickenpox) in
individuals 12 months of age and older who have no history of or an uncertain history of
varicella infection.
CONTRAINDICATIONS
A.
People should not get chickenpox vaccine if they have ever had a life-threatening
allergic reaction to gelatin, the antibiotic neomycin, or (for those needing a second
dose) a previous dose of chickenpox vaccine. A history of contact dermatitis to
neomycin is not a contraindication.
B.
People who are moderately or severely ill at the time the shot is scheduled should
usually wait until they recover before getting chickenpox vaccine.
C.
Pregnant women should wait to get chickenpox vaccine until after they have given birth.
Women should not get pregnant for 1 month after getting chickenpox vaccine.
D.
Certain people should check with their doctor whether they should get the Varicella
vaccine. For individuals who have no doctor, call the Medical Director for this advice.
People requiring this guidance from a physician include anyone who:
 has HIV/AIDS, or another disease that affects the immune system
 is being treated with drugs that affect the immune system, such as steroids, for 2
weeks or longer.
 has any kind of cancer
 is taking cancer treatment with x-rays or drugs
 people who recently had a transfusion or were given other blood products
E.
Refer individuals with known or suspected contra-indications to their primary care
physician or a facility where they may obtain physician management.
INTERVAL BETWEEN LIVE-VIRUS VACCINES
Since 1983, ACIP has recommended that whenever possible, live-virus vaccines not
administered on the same day should be administered at least 30 days apart, because of
concern that the vaccine given first could interfere with response to the vaccine given
second. These concerns were based on two 1965 studies that indicated that recent measles
vaccination reduced the response to smallpox vaccine. A study recently published in
Morbidity and Mortality Weekly Report (MMWR 2001;50:1058-61) found that children who
received varicella vaccine less than 30 days after MMR vaccination had a 2.5-fold increased
risk of breakthrough varicella (i.e., varicella disease in a vaccinated person) compared with
those who received varicella vaccine before, simultaneous with, or more than 30 days after
MMR.
ACIP recommends that if two live parenteral vaccines are given less than 28 days apart, the
vaccine given second should not be counted as valid and should be repeated at least 4 weeks
Varicella Vaccination Standing Order, Page 1 of 3
later. One exception to this recommendation is that yellow fever vaccine may be given at any
time after measles vaccine.
This health department will follow the above ACIP recommendation. As a consequence, if
MMR vaccine has been given within the last 30 days, Varicella vaccine should be delayed until
at least 30 days after the MMR vaccination.
PRECAUTIONS
A.
Vaccination of individuals who have a severe illness should be postponed until recovery.
Do not delay vaccination for individuals with mild illnesses with or without low-grade
fever.
B.
Individuals with a family history of congenital or hereditary immunodeficiency must
demonstrate immune competence before vaccination.
C.
Varicella vaccine should not be given to pregnant women. All postpubertal females
should avoid pregnancy for one month following vaccination.
D.
Vaccination should be deferred for at least 5 months following blood or plasma
transfusions, or administration of immune globulin or varicella zoster immune globulin
(VZIG).
E.
Immune globulin including VZIG should not be given for 2 months following vaccination
unless its use outweighs the benefits of the vaccine.
F.
Vaccine recipients should avoid the use of salicylates (aspirin), for 6 weeks after
vaccination because of the theoretical risk of Reye's Syndrome.
G.
Vaccinated individuals may be capable of transmitting the vaccine virus to close
contacts. Therefore, vaccine recipients should avoid close contact with high risk
individuals (newborns, pregnant women, immunocompromised persons).
H.
Be prepared at all times for allergic reactions. All staff administering immunizations
should be familiar with standing orders pertaining to adverse reactions to immunizations.
DOSAGE AND ADMINISTRATION
A.
Children 12 months through 12 years of age;
A single dose of O.5 ml - subcutaneously
B.
Adolescents and adults 13 years of age and older;
O.5 ml - subcutaneously and a second O.5 ml dose
subcutaneously.4 to 8 weeks later
C.
Optimal timing of varicella vaccination;
Varicella Vaccination Standing Order, Page 2 of 3
All children should be routinely vaccinated at 12-18 mo. of age. Varicella virus vaccine
preferably should be given;
1.
At the same time as MMR vaccine, or
2.
When administered separately, give them at least 30 days apart.
Note: Varicella virus vaccine may be administered simultaneously with all vaccines
recommended for children 12-18 mo. of age.
OTHER
Always refer to and follow the additional information provided in the most current product
package insert.
REFERENCES
1.
Recommendations of the Advisory Committee on Immunization Practices (ACIP) ,
Prevention of Varicella, MMWR, Vol. 45, No. RR-11, July 12,1996. Centers for Disease
Control and Prevention (CDC).
2.
Product Package Insert, VARAVAX, 1995, Merck & Co. Inc., West Point, PA. 19486.
3.
General Recommendations on Immunization: Recommendations of the Advisory
Committee on Immunization Practices (ACIP); MMWR Vol. 5, RR-2, February 8, 2002
4.
Vaccine Information Statement for Chickenpox Vaccine, CDC, 12/16/98.
DISTRIBUTION
Immunization Manual
John R. Spriegel, M.D., M.P.H.
Date
Medical Director, Van Buren/Cass District Health Department
Deputy Medical Directory, Berrien County Health Department
Frederick A. Johansen, M.D., F.A.A.P.
Date
Medical Director, Berrien County Health Department
Deputy Medical Director, Van Buren/Cass District Health Department
Rev: 10/1/2002
StandingOrders/VaricellaVaccination-mhd.doc
Varicella Vaccination Standing Order, Page 3 of 3