Varicella Vaccination for Specific Groups

People with HIV infection

• HIV-infected children ≥12 months old with CD4+ T-lymphocyte percentages ≥15%
• HIV-infected people >8 years old with CD4+ T-lymphocyte counts ≥200 cells/µL
  • There is a lack of data on the use of varicella vaccine in HIV-infected adolescents and adults. The immunogenicity may be lower in these groups compared to children 1 to 8 years old. The benefits of varicella vaccination may outweigh the risk of severe disease from wild-type varicella infection. Therefore, vaccination may be considered in these groups.
  • If vaccination of HIV-infected person results in clinical disease, acyclovir may be used to help prevent severe disease.

HIV-infected people eligible for vaccination should get 2 doses of single-antigen varicella vaccine (Varivax®) separated by 3 months.

HIV-infected children, adolescents, or adults should not get the combination measles, mumps, rubella, and varicella vaccine (ProQuad®).

People with some degree of immunodeficiency

Varicella vaccine is recommended for people who may have some degree of immunodeficiency inclusing:

• People with impaired humoral immunity
• People receiving systemic steroids for certain conditions, such as asthma, and who are receiving steroids <2 mg/kg of body weight or total of <20 mg/day of prednisone or its equivalent and are not otherwise immunocompromised
  • There is a lack of data on whether people who use inhaled, nasal, or topical steroids can be vaccinated safely. However, based on clinical experience, these people can generally tolerate vaccination well.
  • Some experts suggest withholding steroids for 2 to 3 weeks after vaccination if that can be done safely.
• People receiving high doses of systemic steroids (≥2 mg/kg/day or ≥20 mg/day prednisone or its equivalent, for ≥2 weeks) if steroid therapy has been discontinued for ≥1 month
• People with leukemia, lymphoma, or other malignancies that are in remission and who have not received chemotherapy for ≥3 months
  • Children with leukemia that is in remission and who do not have evidence of immunity to varicella should only be vaccinated with expert guidance and access to antiviral therapy in case complications occur.

People who may have some degree of immunodeficiency should not get the combination measles, mumps, rubella, and varicella vaccine (ProQuad^®).

Household contacts of immunocompromised people

• Healthy people who get vaccinated against varicella can protect immunocompromised people from being exposed to the disease
• If the vaccinated person develops a vaccine-related rash, they should stay away from immunocompromised people who do not have evidence of immunity against varicella until all lesions resolve or no new lesions appear within a period of 24 hours

Postpartum & nursing mothers

A person who is or may be pregnant should not receive varicella vaccination.

Postpartum mothers should get 2 doses of varicella vaccine after their pregnancy:

• The 1st dose should be given after delivery and before they are discharged from the medical facility.
• A 2nd dose should be given at 4 to 8 weeks after the first dose. This dose can be given during the postpartum visit (6 to 8 weeks after delivery).

There is no need to delay postpartum vaccination because of breastfeeding. People who get varicella vaccine may continue to breastfeed.

Recommendations for healthcare personnel

The Advisory Committee on Immunization Practices (ACIP), with support from the Hospital Infection Control Practices Advisory Committee (HICPAC), recommends that healthcare institutions ensure all healthcare personnel have evidence of immunity against varicella. Those without evidence of immunity should receive:

• Two doses of varicella vaccine 4 to 8 weeks apart, or
• If previously received 1 dose, the 2nd dose at least 4 weeks after the 1st dose.

Additional information:

• Immunization of Healthcare Personnel
• Post-exposure Varicella Vaccination

Resources

Special Considerations for Vaccination | MMWR