Varicella Vaccination Recommendations for Adults Without History of Chickenpox
A 44-year-old adult without a history of chickenpox should receive two doses of varicella vaccine administered 4-8 weeks apart to prevent potential severe disease and complications. 1
Assessment of Immunity Status
Before proceeding with vaccination:
Determine if there is any evidence of immunity through:
- Documentation of age-appropriate vaccination
- Laboratory evidence of immunity or laboratory confirmation of disease
- Diagnosis or verification of history of varicella by a healthcare provider
- Diagnosis or verification of history of herpes zoster by a healthcare provider
For adults without clear history, serologic testing is generally not necessary before vaccination 2
Vaccination Protocol for Adults Without Chickenpox History
- Vaccine Type: Single-antigen varicella vaccine (not MMRV, which is only approved for children) 1
- Dosage: Two 0.5-mL doses administered subcutaneously 1
- Schedule: Doses should be given 4-8 weeks apart 1
- Administration: Subcutaneous injection 3
Efficacy and Benefits
- Two-dose regimen provides 98.3% protection against varicella compared to 85% with a single dose 2
- Vaccination significantly reduces risk of severe disease, hospitalization, and complications 2
- Adults are at higher risk for severe varicella complications than children, making vaccination particularly important 4, 5
- Even if breakthrough disease occurs after vaccination, it is typically milder with fewer lesions 2
Special Considerations
Contraindications:
- Pregnancy (vaccination should be delayed until after pregnancy) 1, 2
- Severe immunodeficiency 2
- Severe allergic reaction to vaccine components 2
- High-dose systemic steroid therapy 2
Precautions:
- If planning to become pregnant, avoid pregnancy for 1 month after vaccination 2
- If receiving immunosuppressive therapy, vaccination should occur ≥4 weeks before starting therapy 2
Postexposure Prophylaxis
If the individual is exposed to someone with active chickenpox before being vaccinated:
- Varicella vaccine is effective in preventing illness or modifying severity if administered within 3 days, and possibly up to 5 days, after exposure 1
- Vaccination should be given as soon as possible after exposure 1
Priority Considerations
Adults in the following categories should be prioritized for vaccination if susceptible:
- Healthcare workers
- Teachers and childcare employees
- Residents and staff in institutional settings
- College students and military personnel
- Nonpregnant women of childbearing age
- Adults living in households with children
- International travelers 1, 2
Follow-up
- No post-vaccination serologic testing is recommended as commercial assays may not be sensitive enough to detect vaccine-induced immunity 2
- No booster doses beyond the two-dose series are currently recommended 1
Varicella in adults is typically more severe than in children, with higher rates of complications including pneumonia, encephalitis, and death 4, 5. Therefore, vaccination of susceptible adults is an important preventive health measure.