What are the recommendations for Varicella (varicella-zoster virus) vaccine administration in adults?

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Last updated: April 15, 2025View editorial policy

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From the Guidelines

All adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine or a second dose if they have received only 1 dose, as recommended by the ACIP statement 1. The chickenpox vaccine is crucial for adults who have never had chickenpox or been vaccinated previously, particularly for those at high risk for exposure or transmission, such as healthcare workers, teachers, childcare employees, international travelers, non-pregnant women of childbearing age, and people living with or caring for immunocompromised individuals. Key points to consider:

  • Adults should receive two doses of the vaccine, given 4 to 8 weeks apart, to achieve optimal protection 1.
  • Evidence of immunity to varicella in adults includes documentation of 2 doses of varicella vaccine, history of varicella or herpes zoster, or laboratory evidence of immunity 1.
  • The vaccine is contraindicated during pregnancy and for severely immunocompromised individuals.
  • Getting vaccinated as an adult is crucial because chickenpox can cause more severe complications in adults than in children, including pneumonia, encephalitis, and bacterial skin infections.
  • The vaccine works by introducing a weakened form of the varicella-zoster virus, allowing your immune system to develop protection without causing the actual disease.
  • Even if you're unsure about your chickenpox history, the vaccine is safe to receive and can prevent potential serious illness. It is essential to note that the most recent and highest quality study, published in 2013 1, provides the most up-to-date recommendations for varicella vaccination in adults.

From the Research

Chickenpox Vaccine for Adults

  • The varicella vaccine is safe and effective in preventing chickenpox, with the best immune responses occurring in healthy children 2.
  • Adult vaccinees have a lower degree of protection (70%) than children, but those who develop breakthrough varicella usually have a modified infection 2.
  • The Advisory Committee on Immunization Practices (ACIP) has recommended the use of live, attenuated varicella virus vaccine for healthy persons ≥ 12 months of age, including adults 3.
  • Varicella-zoster immune globulin (VZIG) can be used for prophylaxis against chickenpox in immunocompromised persons of any age, including adults, but its use is still limited due to supply restrictions 4.
  • The vaccine has been shown to lead to a lower incidence of zoster than after natural chickenpox, particularly in leukemic children 2.
  • A study found that 8-10 years after vaccination, antibodies were detectable in greater than 90% of leukemic children who had not had breakthrough varicella 2.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Varicella vaccine: the American experience.

The Journal of infectious diseases, 1992

Research

Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention.

MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 1996

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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