Recommendations for the Use of Live Attenuated Varicella Vaccine

Live attenuated varicella vaccine was licensed by the Food and Drug Administration on March 17, 1995, for use in individuals 12 months of age or older who have not had varicella. The American Academy of Pediatrics provides the following recommendations for varicella vaccine use in pediatric practice.

VARICELLA AND ZOSTER

Varicella-zoster virus (VZV) is the cause of two diseases, varicella (chickenpox), which is a primary infection, and zoster (shingles), a secondary infection caused by reactivation of latent VZV.¹ In the United States, vancella is typically an illness of children under the age of 10 years; 5% to 10% of adults remain susceptible. Varicella is a systemic infection that stimulates development of antibodies and cell-mediated immunity (CMI); second episodes in healthy persons are unusual. Varicella in otherwise healthy children is usually a self-limited disease characterized by fever, malaise, and a generalized vesicular pruritic rash of approximately 250 to 500 vesicles that usually lasts about 5 days.

Varicella is a characteristic disease that is easily recognized. A history of varicella infection is associated with positive serologic findings for VZV antibodies in >95% of individuals. Serologic tests include enzyme immunoassay (EIA), latex agglutination (LA), indirect fluorescent antibody, and fluorescent antibody membrane antigen assays. These tests are reliable in determining immune status in healthy persons but may not be as reliable in determining the immune status of immunocompromised persons in whom a positive but low titer may not correlate with protection.² The complement fixation test is not sensitive enough to be reliable in determining susceptibility in any child.

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The following policy statement is a revision:

Prevention of Varicella: Recommendations for Use of Varicella Vaccines in Children, Including a Recommendation for a Routine 2-Dose Varicella Immunization Schedule

Pediatrics 120: 221-231. [Full Text]

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