Who should receive the chicken pox (varicella) vaccine?

Who Needs the Chickenpox Vaccine

All children aged 12-15 months should receive their first dose of varicella vaccine, followed by a second dose at age 4-6 years, and all adults without evidence of immunity should receive 2 doses of vaccine. 1

Children and Adolescents

Routine Childhood Vaccination

• All healthy children should receive their first dose at age 12-15 months 1
• The second dose is recommended at age 4-6 years (before entering prekindergarten, kindergarten, or first grade), though it may be given earlier if at least 3 months have elapsed since the first dose 1
• All children entering school should have received 2 doses of varicella vaccine to prevent transmission in school settings 1
• Children aged 12 months to 12 years who previously received only 1 dose should receive a second dose, with a minimum 3-month interval between doses 1

Catch-Up Vaccination

• Adolescents aged 13 years and older without evidence of immunity should receive 2 doses separated by a minimum of 4 weeks 1

Adults Without Evidence of Immunity

All adults without evidence of immunity should receive 2 doses of single-antigen varicella vaccine at least 4 weeks apart. 1

High-Priority Adult Groups Requiring Special Consideration

The following groups warrant special consideration for vaccination due to high risk of exposure or transmission 1:

• Healthcare personnel (HCP) - must have documented evidence of immunity; those without should receive 2 doses 4-8 weeks apart 1
• Teachers and child-care employees 1
• College students and military personnel 1
• Residents and staff of institutional settings (including correctional institutions) 1
• Adolescents and adults living in households with children 1
• Nonpregnant women of childbearing age 1
• International travelers 1
• Family contacts of persons with immunocompromising conditions 1

Pregnant Women

• Pregnant women should be assessed for varicella immunity 1
• Women without evidence of immunity should receive the first dose upon completion or termination of pregnancy and before hospital discharge, with the second dose 4-8 weeks later 1
• Vaccination during pregnancy is contraindicated as this is a live vaccine 1

Special Populations

Household Contacts of Immunocompromised Persons

• All child and adult household contacts without evidence of immunity should be vaccinated to protect immunocompromised family members by preventing introduction of wild-type VZV into the household 1
• The benefits of vaccinating household contacts outweigh the extremely low risk of vaccine virus transmission (no documented cases in >55 million doses distributed) 1

Persons on Low-Dose Steroids

• Persons receiving systemic steroids for conditions like asthma may be vaccinated if receiving <2 mg/kg body weight or <20 mg/day of prednisone equivalent 1
• Those on high-dose steroids (>2 mg/kg prednisone) for >2 weeks may be vaccinated once steroid therapy has been discontinued for >1 month 1

Immunocompromised Patients (Special Circumstances Only)

• Patients with leukemia, lymphoma, or other malignancies in remission whose chemotherapy has been terminated for at least 3 months can receive live-virus vaccines 1
• Vaccination of leukemic children in remission should only be undertaken with expert guidance and availability of antiviral therapy 1
• Only single-antigen varicella vaccine (not MMRV) should be used when immunodeficiency might be present 1

Nursing Mothers

• Postpartum vaccination should not be delayed due to breastfeeding 1
• Women who receive varicella vaccination postpartum may continue to breastfeed 1

Evidence of Immunity (Who Does NOT Need Vaccination)

Adults are considered immune and do not need vaccination if they have any of the following 1:

• Documentation of 2 doses of varicella vaccine at least 4 weeks apart 1
• U.S.-born before 1980 (EXCEPT healthcare personnel and pregnant women, for whom birth before 1980 is NOT considered evidence of immunity) 1
• Healthcare provider-diagnosed or verified history of varicella disease 1
• Healthcare provider-diagnosed or verified history of herpes zoster 1
• Laboratory evidence of immunity or laboratory-confirmed disease 1

Important Caveat for Healthcare Personnel

For HCP specifically, birth before 1980 should not be considered evidence of immunity, and serologic screening before vaccination is likely cost-effective in healthcare settings 1

Postexposure Vaccination

Varicella vaccine should be administered to susceptible persons within 3 days, and possibly up to 5 days, of exposure to varicella to prevent illness or modify disease severity 1

• If exposure does not cause infection, postexposure vaccination provides protection against subsequent exposure 1
• State and local health departments should consider using vaccine for outbreak control in settings like child care facilities and schools 1