What are the varicella vaccine recommendations?

Varicella Vaccine Recommendations

All healthy children should receive two doses of varicella vaccine, with the first dose at 12-15 months and the second dose at 4-6 years of age, while persons aged ≥13 years without evidence of immunity should receive two doses 4-8 weeks apart. 1, 2

Age-Specific Vaccination Recommendations

Children 12 Months to 12 Years

• First dose: Administer at 12-15 months of age 1
• Second dose: Routinely given at 4-6 years (before kindergarten or first grade) 1
• The second dose may be administered earlier, provided the interval between doses is ≥3 months 1
• If the second dose is administered ≥28 days after the first dose, it is considered valid and does not need to be repeated 1
• MMRV (measles-mumps-rubella-varicella) combination vaccine may be used when all components are indicated 1

Persons ≥13 Years Without Evidence of Immunity

• Two 0.5-mL doses of single-antigen varicella vaccine administered subcutaneously 1, 2
• Doses should be separated by 4-8 weeks 1, 2
• If >8 weeks elapse after the first dose, the second dose may be administered without restarting the schedule 1
• Only single-antigen varicella vaccine should be used (MMRV is not licensed for use in persons ≥13 years) 1, 2

Catch-Up Vaccination

• All children, adolescents, and adults who previously received only 1 dose of varicella vaccine should receive a second dose 1
• Minimum interval for catch-up second dose:
  • Children <12 years: 3 months 1
  • Persons ≥13 years: 4 weeks 1

Special Populations Requiring Vaccination

School and College Students

• All students should be assessed for varicella immunity 1
• Those without evidence of immunity should receive 2 doses of varicella vaccine 1, 2
• School entry requirements for varicella immunity are recommended at all grade levels 1

Healthcare Personnel

• Should receive special consideration for vaccination if no evidence of immunity 1
• Birth before 1980 is not considered evidence of immunity for healthcare workers 1

Pregnant Women

• Prenatal assessment of women for evidence of varicella immunity is recommended 1
• Birth before 1980 is not considered evidence of immunity for pregnant women 1
• Women without evidence of immunity should receive first dose postpartum before discharge 1
• Second dose should be administered 4-8 weeks later 1
• Women should avoid conception for 1 month after each dose 1

Other High-Risk Adults

Adults who should receive special consideration for vaccination include:

• Household contacts of immunocompromised persons 1
• Teachers and childcare employees 1
• Residents and staff in institutional settings 1
• College students and military personnel 1, 2
• Nonpregnant women of childbearing age 1
• Adults living in households with children 1
• International travelers 1

Evidence of Immunity to Varicella

Evidence of immunity includes:

• Documentation of age-appropriate vaccination (2 doses for children, adolescents, and adults) 2
• Laboratory evidence of immunity or laboratory confirmation of disease 2
• Birth in the U.S. before 1980 (except for healthcare workers and pregnant women) 1, 2
• Healthcare provider diagnosis or verification of varicella or herpes zoster 2

Clinical Considerations

• Vaccine effectiveness after one dose is only about 85%, which has not been sufficient to prevent varicella outbreaks 1, 2
• The two-dose regimen provides significantly higher protection (98.3% efficacy) compared to a single dose (94.4% efficacy) 1
• The risk for breakthrough disease is 3.3-fold lower among children who received 2 doses compared to those who received 1 dose 1
• Breakthrough varicella is contagious, highlighting the importance of the two-dose recommendation 1

Common Pitfalls and Caveats

• MMRV vaccine is only approved for children 12 months through 12 years of age, not for adolescents or adults 1
• Birth before 1980 is not considered evidence of immunity for healthcare workers or pregnant women 1
• When administering catch-up vaccination, using the correct minimum interval based on age is essential (3 months for children <12 years, 4 weeks for persons ≥13 years) 1
• Combination vaccines are preferred when all components are indicated to minimize the number of injections 1