infectious diseases
Chickenpox
Prevention of Chickenpox
Infection provides lifelong protection. Potentially susceptible people should take strict precautions to avoid people capable of transmitting the infection. A live-attenuated Varicella Vaccine is available in 2 formulations in the United States: Standard two-dose varicella vaccine Combination measles-mumps-rubella-varicella (MMRV) vaccine ) ( Prevention reference ). Vaccination is particularly important for women of child-bearing age, those at high risk for exposure, and those who have contact with individuals at higher risk for severe disease. These include healthcare professionals, teachers, child care workers, and residents and staff of nursing homes or other institutional settings (eg, correctional institutions). Serologic testing to determine immune status before vaccination in adults is usually not required. Rarely the vaccine may cause chickenpox lesions in patients who are immunocompetent, but disease is usually mild ( Vaccination of health care workers who do not have evidence of varicella immunity is recommended. Susceptible health care workers who have been exposed to varicella should be vaccinated as soon as possible and kept off duty for 21 days. Vaccination is contraindicatedin Patients who had a severe allergic reaction (eg, anaphylaxis) after a previous dose of the vaccine or to a vaccine component Patients with moderate to severe acute concurrent illness (vaccination is postponed until illness resolves) Patients who are immunocompromised Pregnant women and those who intend to become pregnant within 1 month of vaccination (based on CDC recommendations) or within 3 months of vaccination (based on vaccine labeling) Patients taking high doses of systemic corticosteroids Children using salicylates After exposure, chickenpox can be prevented or attenuated by intramuscular (IM) administration ofvaricella-zoster immune globulin(VariZIG). Candidates for postexposure prophylaxis include People with leukemia, immunodeficiencies, or other severe debilitating illness without evidence of immunity Pregnant women without evidence of immunity Neonates whose mother developed chickenpox within 5 days before or 2 days after delivery Neonates born at < 28 weeks and exposed to a non-maternal source even if their mother has evidence of immunity (exposed neonates born at ≥ 28 weeks should receive immune globulin if their mother has no evidence of immunity) The VariZIG immune globulin should be given as soon as possible (and within 10 days of exposure) and may modify or prevent varicella. Vaccination should be given as soon as possible to exposed, susceptible healthy patients eligible for vaccination (eg, age ≥ 1 year and no contraindications). Vaccination can be effective in preventing or ameliorating disease within 3 days and possibly up to 5 days after exposure. To prevent nosocomial transmission, the CDC recommends postexposure prophylaxis with vaccination or varicella-zoster immunoglobulin, depending on immune status, for exposed health care workers and patients without evidence of immunity (available atImmunization of Health-Care Personnel). 1.Marin M, Güris 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 Rep56(RR-4):1-40, 2007. 