When do children receive their first Verace vaccine?

Timing of First Verace Vaccine Administration

The first dose of Verace (varicella) vaccine should be administered at 12-15 months of age, with a second dose recommended at 4-6 years of age.

Recommended Schedule for Varicella Vaccination

The Advisory Committee on Immunization Practices (ACIP) provides clear guidance on when children should receive the varicella vaccine:

• First dose: 12-15 months of age 1
• Second dose: 4-6 years of age (before kindergarten or first grade) 1
• Minimum age for administration: 12 months 1
• Minimum interval between doses for children 12 months-12 years: 3 months 1
  • Note: If the second dose is inadvertently given between 28 days and 3 months after the first dose, it is considered valid and does not need to be repeated 1

Administration Details

Dosage and Route

• Each dose is 0.5 mL administered subcutaneously 1
• Only single-antigen varicella vaccine is approved for use in persons aged ≥13 years, while both single-antigen and combination MMRV (measles-mumps-rubella-varicella) vaccines are approved for children 12 months through 12 years 1

Special Considerations

When considering MMRV vaccine versus separate MMR and varicella vaccines:

• For first dose at age 12-47 months: Either MMR vaccine plus varicella vaccine or MMRV vaccine may be used, but MMR and varicella as separate injections are preferred due to slightly higher risk of fever and febrile seizures with MMRV 1
• For second dose at any age or first dose at age ≥48 months: MMRV vaccine is generally preferred 1

Importance of Varicella Vaccination

Before the varicella vaccine was introduced in 1995, approximately 4 million cases of varicella occurred annually in the United States, resulting in 10,000-13,500 hospitalizations and 100-150 deaths 1, 2. Since implementation of universal vaccination, there has been:

• 71-84% decrease in reported varicella cases
• 88% decrease in varicella-related hospitalizations
• 59% decrease in varicella-related ambulatory care visits
• 92% decrease in varicella-related deaths in 1-4 year-old children 1

Contraindications and Precautions

• Personal or family history of seizures (siblings or parents) is a precaution for MMRV vaccination 1
• Immunocompromised patients: Varicella vaccine should not be administered to severely immunocompromised patients 1
• HIV-infected children: Limited data support use in HIV-infected children with CD4+ T-lymphocyte percentages ≥15% 1

Common Pitfalls to Avoid

1. Delaying beyond recommended age: Starting the vaccine series later than 12 months may leave children vulnerable to varicella infection.

2. Starting too early: Administering the vaccine before 12 months of age is not recommended as maternal antibodies may interfere with the immune response.

3. Inadequate spacing between doses: While 3 months is the recommended minimum interval for children under 13 years, if the second dose is given at least 28 days after the first, it is considered valid 1.

4. Missing the second dose: A single dose provides only 80-85% protection against disease of any severity, while two doses provide 98% protection 1, 3.

The two-dose schedule is essential for optimal protection, as studies have shown that breakthrough varicella can occur even in highly vaccinated populations with only one dose 1, 3.