Should a 44-year-old male who has never had varicella (chickenpox) receive the varicella vaccine (Varivax)?

Varicella Vaccination for a 44-Year-Old Male Without Prior Chickenpox

A 44-year-old male who has never had chickenpox should receive the two-dose varicella vaccine series to prevent potentially severe disease and complications. 1

Rationale for Vaccination

Adults without a history of chickenpox are at higher risk for severe disease complications if they contract varicella. Key considerations include:

• Adults typically experience more severe primary varicella disease than children 2
• Complications such as secondary bacterial infection, pneumonitis, and encephalitis occur in approximately 1% of cases 3
• The two-dose vaccine series provides optimal protection with 98.3% efficacy compared to 85% with a single dose 1

Vaccination Protocol

• Dosage and Schedule: Two 0.5-mL doses of single-antigen varicella vaccine administered subcutaneously, 4-8 weeks apart 1
• Administration: Given subcutaneously in the outer aspect of the upper arm
• Efficacy: The two-dose regimen provides 98.3% protection against varicella 1

Special Considerations

Pre-Vaccination Assessment

• Verify absence of contraindications:
  • No history of anaphylactic reaction to vaccine components including gelatin 4
  • Not severely immunocompromised 1
  • Not currently on high-dose systemic steroids 1

Post-Vaccination Guidance

• Breakthrough varicella after vaccination is typically milder with fewer lesions 1
• No booster doses are currently recommended beyond the two-dose series 1

Potential Benefits Beyond Individual Protection

• Contributes to community immunity, helping prevent outbreaks in congregate settings 1
• May potentially reduce the risk of herpes zoster (shingles) later in life 5
• Prevents transmission to vulnerable populations, including immunocompromised individuals and pregnant women 1

Common Pitfalls to Avoid

• Misconception: Assuming adults don't need vaccination against "childhood diseases"

  • Reality: Varicella is often more severe in adults than in children 2

• Misconception: Serologic testing is necessary before vaccination

  • Reality: Serologic testing is generally neither necessary nor recommended before vaccination for those without evidence of immunity 1

• Misconception: Single-dose vaccination is sufficient

  • Reality: Two doses are recommended for adults to achieve optimal protection (98.3% vs. 85% efficacy) 1

The CDC, Advisory Committee on Immunization Practices (ACIP), and American Academy of Pediatrics all support this recommendation for susceptible adults, particularly those in high-risk categories such as healthcare workers, teachers, college students, and adults living in households with children 1.