Varicella Vaccine Should Be Withheld in This Child
A child with documented, healthcare provider-verified history of chickenpox does not need varicella vaccination, as natural infection provides lifelong immunity that is superior to vaccine-induced immunity. 1
Evidence of Immunity Eliminates Need for Vaccination
The key factor in this case is that the child has confirmed varicella disease verified by a healthcare provider (the pediatrician diagnosed chickenpox and the mother showed typical varicella rash pictures). This constitutes valid evidence of immunity. 1
- A documented history of varicella disease verified by a healthcare provider is explicitly recognized as evidence of immunity and is a valid reason to withhold varicella vaccination. 1
- The ACIP (Advisory Committee on Immunization Practices) has approved criteria for evidence of immunity that include "a diagnosis of varicella by a health-care provider or a health-care provider verification of a history of disease." 2
- Natural varicella infection provides lifelong immunity that is superior to vaccine-induced immunity. 1
Why Other Options Are Incorrect
Postponing until age 2 years (Option B) is unnecessary because:
- The issue is not about timing—the child already has immunity from natural infection. 1
- Even if the child were susceptible, varicella vaccine is routinely recommended starting at 12-15 months of age, not delayed until 2 years. 1
Giving the vaccine now (Option C) is inappropriate because:
- Vaccinating individuals with documented immunity provides no additional benefit and wastes resources. 1
- The child at 18 months has already achieved natural immunity, which is more robust than vaccine-induced immunity. 1
Giving vaccine plus immunoglobulin (Option D) is incorrect because:
- Immunoglobulin is only indicated for post-exposure prophylaxis in susceptible individuals within 96 hours of exposure, not for children who have already recovered from the disease. 1
- This child is no longer susceptible and does not require any intervention. 1
Critical Documentation Point
- Ensure documentation of the verified varicella history is placed in the medical record to prevent future unnecessary vaccination attempts. 1
- Only written documentation of healthcare provider verification should be considered valid evidence—parental reporting alone is insufficient, particularly in young children where the positive predictive value is only 75% in unvaccinated children aged 12 months-4 years. 2
Common Pitfall to Avoid
Do not confuse this scenario with catch-up vaccination schedules for unvaccinated children—a child with documented natural disease is fundamentally different from being unvaccinated but susceptible. 1
Answer: A. Varicella vaccine withheld