Can a 60-year-old individual with no significant immunocompromising conditions or history of severe allergic reactions receive the varicella (chickenpox) vaccine if required by a school?

Can a 60-Year-Old Receive the Varicella Vaccine for School Requirements?

Yes, a healthy 60-year-old without evidence of immunity to varicella can and should receive the varicella vaccine if required by a school, provided they have no contraindications such as severe immunocompromising conditions or history of anaphylactic reactions to vaccine components. 1

Evidence of Immunity Assessment

Before vaccination, determine if the individual already has evidence of immunity to varicella, which includes any of the following 1:

• Documented receipt of 2 doses of varicella vaccine at least 4 weeks apart
• U.S. birth before 1980 (though this criterion does NOT apply to healthcare personnel or pregnant women) 1
• Verified history of varicella or herpes zoster diagnosed by a healthcare provider 1
• Laboratory evidence of immunity through serologic testing 1

For persons reporting atypical or mild varicella cases, seek either an epidemiologic link to a confirmed case or laboratory confirmation from the time of acute disease 1

Vaccination Protocol for Adults ≥13 Years

If the 60-year-old lacks evidence of immunity, administer the following 1:

• Two 0.5-mL doses of single-antigen varicella vaccine administered subcutaneously
• Minimum interval of 4 weeks between doses (optimal interval is 4-8 weeks) 1
• If more than 8 weeks elapse after the first dose, administer the second dose without restarting the schedule 1

Absolute Contraindications to Screen For

Do not administer varicella vaccine if the individual has 1, 2:

• History of anaphylactic reaction to any vaccine component, including gelatin or neomycin 1, 2
• Severe immunocompromising conditions including malignancies affecting bone marrow or lymphatic systems, AIDS or clinical HIV manifestations, cellular immunodeficiencies, or hypogammaglobulinemia 1, 2
• High-dose immunosuppressive therapy (>2 mg/kg/day prednisone or >20 mg/day total for >2 weeks) 2
• Pregnancy (women should avoid pregnancy for 1 month after each dose) 2

Note that contact dermatitis to neomycin is NOT a contraindication, only anaphylactic reactions 1, 2

Special Considerations for Older Adults

While the vaccine is safe and appropriate for healthy 60-year-olds, be aware that 3:

• Age-related immune decline may affect vaccine response, though this does not contraindicate vaccination in healthy individuals
• Avoid vaccination in elderly patients on significant immunosuppressive medications or with impaired immune function from disease 3
• Use only single-antigen varicella vaccine in adults; MMRV combination vaccine is not licensed for persons >13 years 1

Common Clinical Pitfalls to Avoid

• Do not assume all adults born before 1980 are immune - this presumption does not apply to healthcare workers, teachers, or others in high-risk settings who should be vaccinated regardless of birth year 1
• Do not confuse low-dose corticosteroids with contraindications - inhaled, nasal, topical corticosteroids, and low-dose replacement therapy are NOT contraindications 2
• Do not administer MMRV vaccine to adults - only single-antigen varicella vaccine is appropriate for persons ≥13 years 1, 3
• Ensure adequate provisions for anaphylaxis treatment (epinephrine 1:1000) are immediately available before administering the vaccine 1, 2

Post-Vaccination Considerations

After vaccination 1:

• The individual may return to school immediately after receiving either dose
• Routine serologic testing after vaccination is not recommended, as commercial assays lack sufficient sensitivity to detect vaccine-induced antibodies in all cases 1
• Documented receipt of 2 doses supersedes any subsequent serologic testing results 1