About the Varicella Vaccines

Two vaccines containing varicella virus are licensed for use in the United States.

• Varivax® is the single-antigen varicella vaccine.
• ProQuad® is a combination measles, mumps, rubella, and varicella (MMRV) vaccine.

Both vaccines contain live, attenuated varicella-zoster virus derived from the Oka strain.

Dosage and Administration

Children 12 months through 12 years old

• 2 doses (0.5 ml each) of varicella vaccine should be given subcutaneously, separated by at least 3 months.
• MMRV vaccine is approved for healthy children in this age group.

Single-antigen vaccine and MMRV vaccine can be used for the routine 2-dose varicella vaccination.

• First dose: age 12 through 15 months
• Second dose: age 4 through 6 years

For the first dose, CDC recommends that MMR and varicella vaccines be given separately in children 12 through 47 months old unless the parent or caregiver expresses a preference for MMRV vaccine.  For the second dose of measles, mumps, rubella, and varicella vaccines at any age (15 months–12 years) and for the first dose at age ≥48 months, use of MMRV vaccine generally is preferred over separate injections of MMR and varicella vaccines.

Both vaccines may be given at the same time as other vaccines for children age 12 through 15 months and age 4 through 6 years.

People 13 years or older

• 2 doses (0.5 ml each) of the single-antigen varicella vaccine subcutaneously 4 to 8 weeks apart
• MMRV vaccine is not approved for people in this age group.

For more information on the two vaccines for varicella, see MMR & Varicella Vaccines or MMRV Vaccine: Discussing Options with Parents.

For package inserts, see Varivax^® and ProQuad^®.

Varicella Vaccine Effectiveness and Duration of Protection

Vaccine Effectiveness

One dose

• 1 dose of single-antigen varicella vaccine is:
  • 82% effective at preventing any form of varicella
  • Almost 100% effective against severe varicella

Two doses

• In a pre-licensure clinical trial, 2 doses of vaccine were:
  • 98% effective at preventing any form of varicella
  • 100% effective against severe varicella
• In post-licensure studies, two doses of vaccine were:
  • 92% (range 88% to 98%) effective at preventing all varicella

In Children with HIV-infection

• 1 dose of single-antigen varicella vaccine is:
  • 82% effective at preventing any form of varicella

Duration of Protection

It is not known how long a vaccinated person is protected against varicella. But, live vaccines in general provide long-lasting immunity.

• Several studies have shown that people vaccinated against varicella had antibodies for at least 10 to 20 years after vaccination. But, these studies were done before the vaccine was widely used and when infection with wild-type varicella was still very common.
• A case-control study conducted from 1997 to 2003 showed that 1 dose of varicella vaccine was 97% effective in the first year after vaccination and 86% effective in the second year. From the second to eighth year after vaccination, the vaccine effectiveness remained stable at 81 to 86%. Most vaccinated children who developed varicella during the 8 years after vaccination had mild disease.¹
• A clinical trial showed that children with 2 doses of varicella vaccine were protected 10 years after being vaccinated. Fewer people had breakthrough varicella after 2 doses compared with 1 dose. The risk of breakthrough varicella did not increase over time.²
• A meta-analysis that included 1-dose vaccine effectiveness reported through 2015 found a pooled estimate of 82% within the first decade. Considering the age of participants in the studies and vaccine recommendations in each country, the median time since vaccination is likely lower than 10 years. Four studies reported decline in VE with time since vaccination; however, the differences did not reach statistical significance.³
• Two doses of varicella vaccine add improved protection, with a pooled estimate of 92% (assessed ~5 years after vaccination).

¹Vázquez M, LaRussa PS, Gershon AA, Niccolai LM, Muehlenbein CE, Steinberg SP, Shapiro ED. Effectiveness over time of varicella vaccine. JAMA. 2004 Feb 18;291(7):851-5

²Kuter B, Matthews H, Shinefield H, Black S, Dennehy P, Watson B, et al. Ten year follow-up of healthy children who received one or two injections of varicella vaccine. Pediatr Infect Dis J. 2004;23:132–7

³Marin M, Marti M, Kambhampati A, Jeram S, Seward JF. Varicella vaccine effectiveness worldwide: a systematic review and meta-analysis. Pediatrics. 2016;137:1-10.

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