Can a 22-year-old with low varicella immunity receive the varicella vaccine?

Varicella Vaccination for Adults with Low Immunity Levels

A 22-year-old with low varicella immunity should receive the varicella vaccine as a 2-dose series separated by at least 28 days to establish adequate immunity and prevent potential complications of varicella infection. 1

Vaccination Recommendation Based on Immunity Status

For adults without evidence of varicella immunity (including those with low antibody levels), the vaccination approach should follow these guidelines:

• Adults ≥13 years of age require two 0.5-mL doses of varicella vaccine administered subcutaneously
• The doses must be separated by at least 28 days
• Only the monovalent varicella vaccine (not the combination MMRV vaccine) is licensed for use in adults 1

Evidence of Immunity

According to clinical practice guidelines, evidence of immunity to varicella-zoster virus includes:

• Documentation of age-appropriate vaccination (2 doses for adults)
• Laboratory evidence of immunity or laboratory confirmation of disease
• Birth in the United States before 1980 (except for healthcare workers and pregnant women)
• Diagnosis or verification of a history of varicella or herpes zoster by a healthcare provider 1

Low antibody levels indicate insufficient immunity and warrant vaccination to prevent potential infection.

Immunologic Response to Vaccination

Research shows that one dose of varicella vaccine may elicit detectable but insufficient immune responses for complete protection. Two doses generate significantly higher immune responses that better approximate levels seen after natural disease, providing more robust protection 2.

Vaccination Protocol for Immunocompetent Adults

For the 22-year-old with low immunity:

1. Administer first dose of monovalent varicella vaccine (0.5 mL subcutaneously)
2. Schedule second dose at least 28 days after the first dose
3. Ensure proper documentation of both vaccine doses 1

Special Considerations

• The vaccine contains live attenuated virus and must be administered within 30 minutes of reconstitution
• Post-vaccination serologic testing is not recommended as commercial assays may not be sensitive enough to detect vaccine-induced immunity 1
• Vaccination is particularly important before any planned immunosuppressive therapy, which should be scheduled at least 4 weeks after vaccination if possible 1

Contraindications

Varicella vaccine should not be administered to:

• Pregnant women
• Severely immunocompromised individuals
• Persons with anaphylactic reactions to vaccine components 1

Since the question specifies a 22-year-old with low immunity levels without mentioning immunocompromise, the standard 2-dose vaccination schedule is appropriate to establish protection against varicella infection and its potential complications.