Varicella Vaccination and Pregnancy
Pregnant women should NOT receive the varicella vaccine, and women planning pregnancy should be vaccinated at least 1 month before conception. 1, 2
Clear Contraindication During Pregnancy
The varicella vaccine is absolutely contraindicated during pregnancy because it contains live attenuated virus. 2 The FDA drug label explicitly states: "Do not administer VARIVAX to individuals who are pregnant or planning on becoming pregnant in the next 3 months." 2 This is a firm contraindication, not a precaution.
Women who are vaccinated should avoid becoming pregnant for 1 month after each injection. 1
Reassurance for Inadvertent Vaccination
If a woman is inadvertently vaccinated during pregnancy or becomes pregnant within 1 month of vaccination:
- Do NOT terminate the pregnancy - this is not indicated 1, 3, 4
- Counsel the patient about theoretical risks, but reassure her with registry data
- The VARIVAX Pregnancy Registry (1995-2013) followed 1,601 women who received the vaccine inadvertently during or just before pregnancy 5
- Among 164 infants born to seronegative women vaccinated during pregnancy, zero cases of congenital varicella syndrome were documented (rate 0%, 95% CI: 0-2.2%) 5
- Major birth defects occurred at 4.3% - similar to the general population rate of 2-4% 5
- No pattern of defects consistent with congenital varicella syndrome was identified 1, 5
Optimal Timing Strategy
For Women Planning Pregnancy:
- Screen for varicella immunity before conception (history of infection, vaccination, or VZV IgG serology) 1
- Vaccinate non-immune women with 2 doses, 4-8 weeks apart 6
- Wait 1 month after the final dose before attempting conception 1
For Pregnant Women Without Immunity:
- Assess immunity prenatally - birth before 1980 is NOT considered evidence of immunity for pregnant women due to severe potential consequences 1
- Vaccinate immediately postpartum - give the first dose before hospital discharge 1
- Administer the second dose 4-8 weeks later at the postpartum visit 1
- Use standing orders in healthcare facilities to ensure vaccination occurs 1
Important Clinical Pearls
Having a pregnant household member is NOT a contraindication to vaccinating other family members - household contacts of pregnant women without immunity should be vaccinated to provide indirect protection. 1
During breastfeeding, vaccination is acceptable if there is expected benefit (e.g., varicella exposure, planned future pregnancy), though vaccine virus excretion in breast milk is unknown. 2, 7
The rationale for the contraindication is theoretical - wild-type varicella causes fetal harm and congenital varicella syndrome, so the live attenuated vaccine is avoided out of caution. However, the attenuated virus has lower virulence, and 19 years of registry data show the actual risk, if any, is extremely low. 1, 5