Varicella Virus Vaccine

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Contents 1 More Specific Terms 2 Indications 3 Contraindications 4 Dosage 5 Pharmacokinetics 6 Drug-interactions 7 More General Terms 8 Additional Terms 9 References

More Specific Terms

• Herpes zoster (shingles) vaccine (Zostavax)

Indications

• all healthy children between 12 months & 18 years

• children 12 months to 13 years who have not been immunized & have not had chickenpox should receive 1 vaccination
• children between 13 & 18 years of age require 2 vaccinations 4-8 weeks apart

• added to childhood immunization schedule for infants 12-28 months of age
• recommended to to given with measles, mumps, rubella vaccine (MMR)
• a second vaccination at age 4-6 years, to be given with MMR as MMRV ( ProQuad) now recommended [12]
• susceptible adolescents & adults in one of the following groups

• health care workers
• household contacts of immunosuppressed patients
• workers in schools or day-care centers
• young adults in closed or semi-closed populations

• college students
• military

• non- pregnant women of child-bearing age
• international travelers who anticipate close contact with local populations

Contraindications

• hypersensitivity to any component of the vaccine including gelatin
• history of anaphylactoid reaction to neomycin
• individuals with blood dyscrasias, leukemia, lymphoma, or other malignant neoplasm affecting the bone marrow or lymphatic systems
• individuals on immunosuppressive therapy
• primary & acquired immunodeficiency states
• family history of congenital or hereditary immunnodeficiency
• active, untreated tuberculosis
• febrile illness
• pregnancy

• Caution:

• avoid pregnancy until 3 months after vaccination
• avoid if breast feeding
• immediate treatment for anaphylactoid reaction should be available
• defer vaccination for 5 months following blood transfusions or immune globulin therapy
• avoid immune globulin therapy for 2 months following vaccination
• avoid salicylates for 5 weeks after vaccination ( Reye syndrome)
• 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
• 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 reactions:

• most common (1-10%)

• pain, fever, irritability, nervousness, fatigue, disturbed sleep, headache, malaise, chills, redness, rash, pruritis, 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

• uncommon (< 1%)

• febrile seizures (causality not established), pneumonitis

Drug-interactions

• immunosuppressive agents [7]

• decrease effectiveness of vaccine
• increase risk of varicella disease from vaccine

• salicylates may increase the risk of Reye syndrome Effectiveness:
• 48% of vaccinated children vs 86% of unvaccinated children developed chickenpox upon exposure in a daycare center [4,5]
• 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]
• unknown if vaccine will prevent shingles [6]
• universal childhood varicella vaccination diminishes mortality

More General Terms

• live virus vaccine

Additional Terms

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

References

1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
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#: [1] (subscription needed) [2]
9. Journal Watch 24(6):45, 2004 Vazquez M et al JAMA 291:851, 2004 PMID: [3]
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: [4]
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: [5]
12. Prescriber's Letter 13(8): 2006 CDC's Advisory Committee Recommends Changes in Varicella Vaccinations Detail-Document#: [6] (subscription needed) [7]
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. <PubMed> PMID: [8] <Internet> [9]
15. National Guideline Clearinghouse
    - Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention ngc-guideline: [10]
    - Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule. American Academy of Pediatrics ngc-guideline: [11]

varicella virus vaccine (Varivax)